Trust leaders welcomed the rapid appointment of Sajid Javid as the new health and social care secretary last weekend. This will be a critical year for the NHS, and with a challenging in-tray, Javid will need to hit the ground running.
Javid has rightly recognised that his first priority will be navigating the next phase of the covid-19 pandemic and ensuring the health service has what it needs to clear the backlog of care. The latest NHS data shows that there are now more than five million people on a waiting list for planned surgery, and demand has significantly increased for mental health services, within community settings, and for ambulance services and other emergency care. Staff are working extremely hard to tackle the backlog, going faster than official targets, despite sustained infection prevention control measures which restrict capacity. Javid will have to ensure this rapid progress continues with the right funding and support.
The secretary of state has already set out his commitment to supporting the service to “live with covid-19.” Although vaccines are currently breaking the link between infections, hospital admissions, and deaths from the virus, there is still a risk from new and existing variants, evident in the transmissibility of the delta variant. Plans will need to be put in place to ensure we can live with covid-19 longer term, including potentially rolling out a booster campaign in the autumn. Our survey published last week found that 88% of trust leaders said that another surge of covid-19 cases would place additional pressures on their services, and 89% were worried these pressures would come during the challenging winter months. The new secretary of state will need to ensure that the government and national bodies work with NHS leaders to get the planning on track for winter pressures to manage the risks ahead.
Trust leaders are also extremely concerned about their workforce. While they have put in place a range of measures to protect the health and wellbeing of their staff, including innovative new ways of working, half of trust leaders say they have seen evidence of staff leaving their organisation due to early retirement, burnout, or the impact of working in the pandemic. The BMJ’s investigation last week echoed similar concerns. The secretary of state will need to address these pressures with appropriate recognition and reward, to protect morale and prepare the workforce for the challenges ahead. An urgent review of the pay deal being offered to frontline staff will be an important start. In the medium and longer term, he must work with government to deliver a fully funded people plan setting out the desired future shape and size of the NHS workforce, with investment in training, recruitment, and retention.
But the secretary of state cannot confine his early decisions to operational pressures. The sector is keen to hear his decision on the timing of the forthcoming Health and Social Care Bill which is due to bring about the biggest reforms to the health service in over a decade. It will be important to ensure that the bill is robust, clear, and enabling, to allow different systems to meet local needs. Our view is that key parts of the legislation should not be delayed. However, we are also very open to the prospect of time to debate elements of the bill, such as the need to maintain the clinical and operational independence of the NHS appropriately within the legislation, and to ensure a robust process to progress local service reconfigurations. In any event, trust leaders are keen that decisions on the future of the bill are made in consultation with the sector.
Sajid Javid will also, no doubt, have the upcoming comprehensive spending review front of mind. This process will be essential in confirming funding for a number of priorities. These include a multi-year people plan; much needed capital investment to ensure safe, high-quality care and to invest in digital transformation. We also need a funding settlement to meet rising demand, tackle the backlog of care, confirm long-term funding for “discharge to assess” so patients can leave hospital when they are fit to do so for care at home and in the community; as well as putting in place plans to “live with covid-19.” It is also crucial that any long term investment in the NHS goes hand in hand with a long-term funded plan for the future of social care. Garnering cross party and public support for the required investment and reform of social care—alongside an appropriate multi-year revenue and capital package for the NHS—will be key for the new secretary of state.
Finally, but equally critically, we need to focus on addressing health inequalities, which have been brought into sharp focus over the past year with disproportionately higher infection rates and poorer outcomes among marginalised groups. The indirect effects of the pandemic include lower access to usual healthcare services and impact on the wider determinants of health such as employment, housing, education, and social connection. Trusts have a lot to offer as “anchor institutions” for their local communities within local systems to reduce inequalities and ensure services are accessible and person-centred.
There is widespread agreement that the task list for the new secretary of state is long and challenging. But trust leaders remain ambitious for patients, communities, and their staff.
Saffron Cordery, deputy chief executive, NHS Providers.
Competing interests: none declared.