Comment / Winter is coming

It is unfair to expect major new ideas or solutions to current NHS challenges to be announced in the first days of a new government. It is perhaps enough at this stage to acknowledge that new prime minister Liz Truss has at least set the NHS as one of her top three priorities.

No-one could argue with the to-do list set by new health and social care secretary Therese Coffey  – her slightly trite ABCD of ambulances, backlogs, care and doctors and dentists.

But the new government leadership team needs to quickly move beyond the simplistic and obvious if it is going to support an NHS that, according to the NHS Confederation, is in the ‘most challenging state it has been in for decades’.

It may be early days for the new regime, but the Conservative government in general and its new leaders have in reality had plenty of thinking time to prepare a response.

The government – and the country – face a huge cost in paying for the much-trailed action on rising energy bills.

But the NHS will also need further funding both in the short and medium term. When has the NHS ever not needed more money?

The service faces immediate pressures that cannot be ignored. Some of these are in the form of its own direct energy costs. Some is the energy-cost induced inflation of goods and services. And some of it relates to other costs – the pay settlement that was not fully funded, for example.

The NHS Confederation estimates the service faces a real-terms cut in funding of between £4bn and £9.4bn, depending on which measure of inflation is used. This would be hard enough if the service was simply attempting to deliver the status quo. But, coming out of the Covid-19 pandemic, the service in fact faces major challenges, with some 6.8 million people now waiting for planned treatment.

Funding is also desperately needed for social care. Health and social care are inextricably linked, with insufficient social care capacity having a direct impact on the NHS in the form of delayed discharges and unnecessarily occupied beds.

The changes needed in social care are huge, including raising pay levels to make vital social care roles more attractive to existing and potential new care staff.

But the big decisions are not all about money and the expected emergency Budget in September. Workforce remains the stand-out issue across the whole health service.

Beyond the remaining threat of industrial action in response to this year’s below-inflation pay deal, workforce will remain on the agenda for years, with solutions needing to be actioned now.

The NHS is currently carrying over 130,000 vacancies – although it is not clear that it could afford to fill all these positions. However, the consequence of those vacancies is under-staffing – heaping more pressure on already overworked staff – and overuse of expensive temporary staff solutions.

Given the time it takes to train doctors and nurses, the NHS needs to be planning now for its future requirements. And it needs to be doubling down on efforts to upskill existing staff and develop new roles to make best use of those staff. A long-term plan for workforce remains conspicuous by its absence.

Refreshing the whole estate – and the new hospital building programme – are also essential to delivering the right quantity and quality of care in the decades to come.

All of these are huge challenges. They will need considered, rather than knee-jerk, responses. But decisions also need to be taken quickly. Winter is coming. And although the service has already been experiencing winter-like demand, a flu season on top of any surge in Covid infections could place even more stress on services.

Restructurings are not the solution. The new system-based arrangement has to be given time to bed in. But perhaps most important will be a sense of realism.

There needs to be recognition of the resources the NHS needs to make progress and pragmatism about what can be achieved this year and next.