By: Peter Saunders
08 Jul 2024 8 min read
There are 1.7 million staff working for the NHS and this workforce faces longstanding issues such as industrial action, low retention rates, and reliance on international workers. There are also huge staff shortages in the care sector.
Labour has promised to develop local partnerships working between the NHS and social care on hospital discharge, an additional 8,500 mental health workers, and a commitment to the Long-Term Workforce Plan.
However, high levels of dissatisfaction, continued strike actions and high numbers of doctors, nurses and other clinicians leaving the NHS early in their careers, all contribute to publicly-funded health and social care services being understaffed and under strain.
The Labour government must support the staff already within the health service, working with unions to develop a compromised way forward and focus on making health and social care an attractive career option. Immediate action should focus on the industrial action and review and implementation of the Long-Term Workforce Plan with increased training and career pathways. This should be focused on building a workforce for the future with the potential expansion to include social care staffing.
While there are several key issues for a new government to focus on, given the timing of the election preparing for the winter pressures will need urgent focus. The NHS frontline is always under pressure over the winter period as demand tends to increase with the onset of cold weather and flu.
The Government will need to urgently address these pressures by leading the effective planning for winter. A focus on staffing, capacity, whole-system working, preventative measures such as vaccinations and efficient discharge will be required.
It is also clear that the NHS estate is in a state of disrepair after years of neglect with over £11.6bn backlog maintenance identified. Labour is committed to delivering the New Hospitals Programme but has stated that it needs to assess all NHS capital projects to make sure money is allocated efficiently, waste is eliminated, and that we prioritise projects that will get patients the care they deserve faster.
Given the high profile of the condition of the estate, a new Government could be tempted to make immediate funding announcements to deliver the new infrastructure. However, research shows that this does not always lead to the most effective way of allocating funding. A lack of certainty and flexibility about funding over multiple years and excessive layers of sign-off required from spending departments and the Treasury have undermined the private sector’s ability to quickly and efficiently meet public sector capital needs. This has hampered the effective delivery of capital programmes.
By leveraging digital and AI technologies, the NHS can potentially enhance patient care, improve healthcare delivery, and contribute to more efficient and effective healthcare systems. These technologies have the potential to: transform the speed and accuracy of diagnostic services, contribute to operational efficiency by optimizing resource allocation, and streamline admin tasks. This could play a significant role in tackling current NHS pressures caused by escalating demand and workforce shortages.
It will be important for the Labour Government to get the basic infrastructure right, including digital infrastructure, skilled staff and an enabling environment. An over-arching strategy on the use of AI, and co-ordination, is needed to ensure the full benefits of AI can be realised at scale across the NHS, preventing the exacerbation of health inequalities.
Labour will digitise the Red Book record of children’s health, improving support for new families. It will also enable vaccinations for babies and children as part of health visits.
The Labour manifesto identifies the importance of preventative care and embedding long-term planning across government departments, in particular health and social care to address health inequalities.
The UK has stark health inequalities. It cannot be right that life expectancy varies so widely across and within communities. As part of its health mission, Labour will look to tackle the social determinants of health, halving the gap in healthy life expectancy between the richest and poorest regions in England. We must change the NHS so that it becomes not just a sickness service, but able to prevent ill health in the first place, a model where more services are delivered in local communities. The government needs to adopt a prevention-led approach and adopt evidence-based policies to prevent the early onset of ill health across all ages of the population. The new Secretary of State for Health has committed to investing in primary and community care to focus on prevention and managing patients in innovative ways out of hospital.
The public health grant is paid to local authorities from the Department of Health and Social Care (DHSC) budget to provide preventative services that help to support health. This includes smoking cessation, drug and alcohol services, children's and sexual health services, and broader public health support across local authorities and the NHS. However, the public health grant has been cut by 28% on a real-terms per-person basis since 2015/16, the allocation for 2024/25 is £3.6bn. Investment in prevention can represent value for money by maintaining and improving population health. A failure to invest in a preventative service will lead to widening health inequalities and population health worsening further. This is particularly pertinent to deal with future demand from an ageing population.
Labour promises to increase capacity across mental health services - increasing therapies, peer support workers, access in schools, use of the third sector, increased youth provision, and tackling loneliness. The aim is to give people access to treatment before they reach crisis point. This is a longer-term strategy which will have the added benefit of freeing up GP appointments and reducing A&E pressure.
They have also mentioned providing open-access mental health services for children and young people in communities through the new Young Futures hub, along with mental health support in every school. ONS estimates a third of 16 to 34-year-olds are out of work, affected by mental health, with 1.2m people waiting for mental health treatment. Mental ill health is the most common cause of work-limiting conditions among those aged 44 or younger. Therefore, it is imperative that the new Government takes a proactive approach to addressing mental illness among the workforce.
Labour have a headline commitment to create a national care service and refer to a 10-year plan for reform with a principle of ‘home first’ care linking into the prevention-led approach referred to above. With the growing demand for social care, demand for better pay and conditions for care workers to address recruitment and retention challenges, and a need to raise standards across the industry, this will be a long-term challenge for the new government to address.
Productivity in the NHS determines how much care is delivered using the funding available and it has declined post-pandemic. Rather than increasing the pressure on the existing workforce, the focus should be on the whole health and social care system working more efficiently together. While pressure on public finances is likely to limit increased spending, improvements in productivity will be critical for the NHS to meet the continued needs of an ageing population. From 2017 productivity growth in the NHS has stalled and since the COVID-19 pandemic, the disruption has had a knock-on effect on productivity, from which it is yet to recover.
Therefore to sustain productivity improvements the new government needs to focus on:
addressing staffing issues
investment in preventative care
tackling the backlog maintenance of estates
leveraging AI and digital technologies
management of operational flows
maximizing value for money through reducing duplication and making use of collective purchasing power.
Tackling the backlog is high on the new Government's agenda, with Labour pledging an additional 40k appointments per week as part of an ambitious five-year goal to prevent patients waiting longer than 18 weeks for treatments. Productivity, releasing private sector capacity, the use of digital tools such as virtual outpatients, review of follow-up appointments and maximising deployment of the workforce, for example, increased roles in primary care such as paramedics as part of the Additional Roles Reimbursement Scheme (ARRS) scheme, will be key to supporting the additional appointments.
Resolving the industrial action: this is not easy given the financial position and the asks from junior doctors. The term “junior doctor” covers straight out of training to those on the cusp of consultant. Working with this group to agree the way forward will be top of the list.
Elective recovery: an additional 40k appointments per week was the commitment. Resolving industrial action will help, but focus needs to be on: discussions with the private sector, understanding how the entire workforce can support, drivers of productivity in theatres and outpatients including how can day case rates be increased, use of digital, advice and guidance models – reducing variation across across the country - and sharing best practice.
New hospital programme: commit to reviewing the New Hospital programme and agreeing by a set date the commitments and timescales.
By addressing these priorities, the new government can show early progress at pace against the NHS reform agenda.
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