What NHS challenges await the new prime minister and health secretary?

Steve Barclay was recently appointed as the new Secretary of State for Health and Social Care after Sajid Javid’s shock resignation.

In his resignation letter, Javid said he had ‘lost confidence’ in the prime minister, Boris Johnson, following a series of scandals, including the lockdown parties held at Downing Street and Johnson’s handling of deputy chief whip Chris Pincher’s conduct.¹

Following further resignations from other members of his cabinet, including Rishi Sunak, Chancellor of the Exchequer, Johnson was left unable to carry on and he too stepped down.

While it is unclear who will become the next prime minister and indeed, how long Mr Barclay will remain in his role, one thing is for sure: these two new leaders have a plethora of challenges on their plate. These include: addressing the backlog of care caused by the Covid-19 pandemic, filling 105,000 vacancies in the NHS workforce, building 40 new hospitals and reforming social care.

So, is the new health secretary up to the job?

Who is the new Secretary of State for Health and Social Care?

Steve Barclay has been an MP for North East Cambridgeshire since 2010 and has previously served as Brexit Secretary, Chief Secretary to the Treasury, and more recently, he was appointed Downing Street Chief of Staff and Chancellor of the Duchy of Lancaster.²

Mr Barclay describes himself as coming from a ‘working class Northern background’, and is the first generation of his family to go to university, reading history at Cambridge and spending a gap year serving in the Army with the Royal Regiment of Fusiliers.

After graduating from university, Mr Barclay became a qualified solicitor. He has since worked as an insurance company lawyer, as a regulator for the Financial Services Authority, and as Director of Regulatory Affairs. He then worked as the Head of Anti-Money Laundering and Sanctions at Barclays Retail Bank before embarking on his political career.

Mr Barclay said it is “an honour” to be appointed as health secretary, adding that he will continue to work with the government to “ensure patients across the country can access the care they need”.

What jobs are in the health secretary’s in-tray?

Fixing the staffing crisis in health and social care

The job most likely to be at the top of the health secretary’s priority list will be to address the backlog of care and ongoing staffing pressures within the NHS.

Staff are working tirelessly to reduce the backlog of diagnostics and elective care, while continuing to provide urgent and emergency care. This is causing high levels of burnout among staff and risks pushing experienced doctors and nurses out of their jobs, further depleting the workforce.

Just last week, a survey by the General Medical Council (GMC) found that nearly a third (32%) of trainee doctors working in emergency care are at high risk of burnout.³

More widely, two-thirds (66%) of trainees said they are ‘always’ or ‘often’ worn out at the end of their working day, while 44% said they were regularly exhausted in the morning at the thought of another day of work.

With a record 6.6 million people waiting for elective care (and forecasts suggesting this could reach 10 million by 2024), the new health secretary will need to prioritise the publication of a long-term workforce strategy.⁴ Without this, health leaders fear the NHS will never fully recover from the pandemic.

Matthew Taylor, chief executive of the NHS Confederation said Mr Javid’s resignation “presents an opportunity for more realism in the immediate challenges facing the NHS”. To achieve this, the Confederation would like to see adequate capital investment in the health service, fair pay for staff and commitment to a fully-funded workforce strategy.⁵

“The new health and social care secretary will be joining as cost of living pressures grow and as coronavirus and associated hospital admissions are on the up once again. After everything the NHS has been through over the last two years, health leaders need political stability from the Government alongside immediate acknowledgement from their new health and social care secretary that the present situation is understood and with no sugar coating, he “added.

Fair pay for NHS staff

Since Mr Barclay began his role as health secretary on 5 July, the government has agreed to all the recommendations made by the independent NHS pay review bodies, awarding more than one million NHS workers an annual pay increase.⁶

The pay increase will affect porters and cleaners as well as nurses, paramedics, midwives, doctors and dentists to varying degrees, and will be backdated to April 2022.

Dentists and doctors will receive a 4.5% pay increase while the basic pay for newly qualified nurses will increase by 5.5%, from £25,655 last year to £27,055 this year. More experienced nurses will see their salary rise from around £35,600 to around £37,000 per annum.

However, while the government views this pay rise as “a fair deal”, the British Medical Association says the increase (at half the rate of inflation) represents “a brutal pay cut that will come as a bitter blow for doctors across England”.⁷

Instead, the BMA would like to see the full restoration of pay back to 2008/9 levels and a fair pay award for junior doctors, who were excluded from the increase.

The Association warns that until this happens, doctors and nurses will be driven away from the NHS and may consider alternative career paths. Indeed, junior doctors in England are already preparing to press ahead with a ballot for industrial action.

“Ministers must act now to avoid the resulting workforce crisis which will see record waiting lists grow longer and patient care suffer,” said BMA junior doctors committee co-chairs Sarah Hallett and Mike Kemp.

The new health secretary together with the Department will now have to carefully weigh up their options and “realise the true cost of keeping the expertise of doctors rather than driving them away from the NHS,” added BMA council chair Philip Banfield.

Addressing health inequalities

The Royal College of Physicians (RCP) is also calling on the new health secretary to address the growing gap in healthy life expectancy between the richest and poorest in England.⁸

The latest data from the Office for National Statistics (ONS) found that female healthy life expectancy at birth in the most deprived areas was 19.3 years less than in the least deprived areas in 2018 to 2020. For males it was 18.6 years less.⁹

In light of this data, the RCP is calling on Mr Barclay to bring forward the Health Disparities White Paper (HDWP) and ensure there is a clear cross-government strategy to reduce health inequalities.

The college says it will assess the HDWP on the extent to which it lays out cross-government action and has an equal focus on the wider determinants of health, behavioural factors, and access and outcomes.

In a written statement, the College said: “It may seem that health inequality is a matter for the DHSC and the NHS, but health and social care services can only try and cure ailments created by the environments people live in. If we are to prevent physical and mental ill health in the first place, we need to act on issues such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution.

“That is why the Inequalities in Health Alliance (IHA), a group of over 200 organisations convened by the RCP, is calling for a cross-government strategy to reduce health inequalities. Tackling these inequalities is a key part of reducing demand on the NHS, and ensuring people live healthier lives.”

Managing the threat of Covid-19

While the number of people hospitalised with Covid-19 is now at a lower level since the peak of the pandemic, the threat from the virus still remains and virologists are warning that new variants will continue to evolve.¹⁰

In an editorial published in the British Medical Journal, editor in chief Alastair McLellan warns that “the link between infections and hospital admissions has clearly not been broken, even if you just consider those being treated ‘primarily’ for the disease.”¹¹

He warns that the latest ONS figures reveal that there have been just under 24,000 fatalities “involving Covid” in the first six months of 2022, and while that figure is substantially smaller than the 66,000 recorded in the first half of 2021, it is more than the 21,000 people who died in the last six months of that year.

Mr McLellan says the heart of the problem is the government’s “failure to recognise that the pandemic is far from over and that a return to some of the measures taken in the past two years is needed.”

The new health secretary will therefore need to keep a careful eye on the data and carefully consider any recommendations made by health watchdogs and other associations. Mr Barclay will also have to manage the rollout of the autumn Covid booster and tackle a possible resurgence of seasonal flu and other winter pressures.

‘Fixing’ social care

Earlier this year, the government introduced a new Health and Social Care Levy and proposed cap on costs to ‘fix’ the social care crisis.

However, Age UK warns that these new plans do nothing to help older people and carers right now.¹² Instead, the charity is calling on the government to provide a comprehensive, immediate funding package for councils to spend on social care so they can deliver:

high-quality care for older people when and where they need it
support for unpaid carers
better terms and conditions for care workers.

The charity says the government must also address the chronic underfunding of the social care sector, the postcode lottery of care which leaves many older people without any support, the 1.6 million people who are currently not having their needs met, and the cuts to local authority care services which are placing increasing pressure on unpaid carers.

Mr Barclay will continue to face calls from charities and care organisations across the country to address these issues and provide a more immediate solution to the social care crisis.

“A tough but not impossible task”

While Mr Barclay says he is “delighted” to be taking up the role of health and social care secretary, it is clear that he has a big job on his hands.

With the NHS in a precarious position and the persistent problems in social care, Mr Barclay together with the new prime minister will need to face the chronic staff shortages, ensure equal access to care and treatment and manage the threat from Covid-19.

Health leaders are hoping that the new health secretary will actively listen to their requests and act accordingly. As Mr Banfield explains: “The Government has an opportunity to demonstrate its support and commitment to doctors and their colleagues. These ministers [the chancellor and health secretary] have a tough but not impossible task ahead of them. Ultimately, it’s a choice between listening to frontline staff and patients, or facing the dire health consequences if they are ignored.”

References

Sajid Javid’s resignation letter and the Prime Minister’s response. GOV.UK. 2022. https://www.gov.uk/government/publications/sajid-javids-resignation-letter-and-the-prime-ministers-response. Published 2022. Accessed July 21, 2022.
The Rt Hon Steve Barclay MP. GOV.UK. https://www.gov.uk/government/people/stephen-barclay. Published 2022. Accessed July 21, 2022.
National training survey. General Medical Council. https://www.gmc-uk.org/education/how-we-quality-assure-medical-education-and-training/evidence-data-and-intelligence/national-training-surveys. Published 2022. Accessed July 21, 2022.
Campbell D. England’s hospital waiting lists may exceed 10 million by 2024, ministers told. The Guardian. https://www.theguardian.com/society/2022/feb/09/englands-hospital-waiting-lists-may-exceed-10-million-by-2024-ministers-told. Published 2022. Accessed July 21, 2022.
Taylor M. NHS Confederation responds to the resignations of the health secretary and the Chancellor. NHS Confederation. https://www.nhsconfed.org/news/nhs-confederation-responds-resignations-health-secretary-and-chancellor. Published 2022. Accessed July 21, 2022.
NHS staff to receive pay rise. Department of Health and Social Care and The Rt Hon Steve Barclay MP. GOV.UK. https://www.gov.uk/government/news/nhs-staff-to-receive-pay-rise. Published 2022. Accessed July 21, 2022.
Media Team B. ‘Brutal pay cut will come as a bitter blow to doctors’, says BMA. BMA media team. https://www.bma.org.uk/bma-media-centre/brutal-pay-cut-will-come-as-a-bitter-blow-to-doctors-says-bma. Published 2022. Accessed July 21, 2022.
The Royal College of Physicians. RCP briefing for health and social care oral questions. RCP London. https://www.rcplondon.ac.uk/guidelines-policy/rcp-briefing-health-and-social-care-oral-questions. Published 2022. Accessed July 21, 2022.
Office for National Statistics. Health state life expectancies by national deprivation deciles, England – Office for National Statistics. Ons.gov.uk. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbyindexofmultipledeprivationimd/2018to2020. Published 2022. Accessed July 21, 2022.
Geddes L. ‘Centaurus’: virologists express concern at new Covid subvariant. The Guardian. https://www.theguardian.com/world/2022/jul/12/centaurus-virologists-express-concern-at-new-covid-subvariant-omicron. Published 2022. Accessed July 21, 2022.
McLellan A, Abbasi K. The NHS is not living with covid, it’s dying from it. BMJ. 2022:o1779. doi:10.1136/bmj.o1779. https://www.bmj.com/content/378/bmj.o1779. Published 2022. Accessed July 21, 2022.
Fix care for good. Age UK. https://www.ageuk.org.uk/our-impact/campaigning/care-in-crisis/. Published 2022. Accessed July 21, 2022.