In a letter to the service in May, NHS chief executive Amanda Pritchard said integrated care systems and their partners must focus efforts on recovery and the quality of patient care. ICSs should concentrate on delivering timely urgent and emergency care and discharge; providing more routine elective and cancer tests and treatments; and improving patient experience. She downgraded the Covid pandemic response from a level 4 (national) to a level 3 (regional) incident. A sustained decline in community and inpatient cases meant it was time to reclassify the response, she said, though she also insisted the service must remain vigilant. The full establishment of ICSs on 1 July signalled the next step of reform, Ms Pritchard added.
The Welsh NHS Confederation said the local NHS needs financially sustainable services if it is to address the effects of Covid and reduce the backlog of planned care. Responding to the Welsh government’s plan to reduce elective backlogs, accompanied by an additional £60m over four years to boost recovery and transformation, the confederation said the local NHS needed investment in estates, technology and workforce. This would allow it to try to create a sustainable service in the long term.
Covid and funding are not the only barriers to addressing waiting times. The NHS also needs more staff. In May’s Queen’s Speech (pictured), the government promised to fund the NHS to reduce Covid backlogs – a promise the Royal College of Nursing dubbed ‘hollow’ without a plan to recruit more nursing staff. Without a credible recruitment strategy, patients would continue to suffer, it argued.
However, the Nursing and Midwifery Council (NMC) revealed that the number of registered nurses, midwives and nursing associates rose to more than 758,000 in 2021/22, an increase of 26,400 over the year. The number leaving the register is also increasing, with more than 27,000 people leaving – a rise of almost 3,200 (13%). In recent years the number of leavers has been falling. Reasons for leaving in 2021/22 included pressure at work and poor workplace culture. A third of respondents said Covid-19 had influenced their decision – some worried about their health, while others struggled to cope with the increased workloads and lack of staff, the NMC said.
NHS England and NHS Improvement also set out high-impact enablers, including ideas to expand workforce capacity, to support elective recovery. A letter on reducing the elective backlog said it was important to ensure staff are protected from burnout, and are able to take holiday and breaks. It acknowledged challenges in addressing elective waiting times, including the high level of Covid infections. However, it insisted that staff must be given the opportunity to choose to do additional hours. Systems should examine ways of doing this, such as removing the cap on consultant job plans, helping staff to increase their contracted hours, and maximising the use of staff banks. Recently retired staff and those considering retirement could be encouraged to consider supporting training or working in outpatients. The focus on accelerating substantive staff recruitment should remain, it added.
As Healthcare Finance went to press, this year’s NHS pay rises had not been announced, but with inflation going through the roof, there will be pressure on the government to breach the 2%-3% ceiling it set itself just three months ago. Health unions are pressing for above-inflation pay rises, while junior doctors have said they will campaign for higher pay. In May, doctors in training said their salaries had fallen by more than 22% in real terms over the past decade – they agreed a multi-year pay deal in 2019 that will give them a 2% uplift this year.
The 2022/23 budget for Health Education England (HEE) will rise by £502m compared with 2021/22, the training body confirmed. HEE’s overall funding of £5.5bn includes £160m from NHS England and NHS Improvement earmarked for training to support elective recovery and the delivery of the NHS long-term plan. The budget includes £2m for the HEE’s administration costs, supporting the education body’s merger with the new NHS England and increased pension costs. HEE highlighted risks to delivery of NHS training in the coming year, including the focus on service recovery, which could mean that clinical work is given priority over training.
Local government and Northern Ireland Assembly elections took place in May. The latter prompted the Northern Ireland Confederation of Health and Social Care (Nicon) to call for more funding and a three-year budget that must be accompanied by priority investment in the workforce. In its election briefing, Nicon, part of the NHS Confederation, acknowledged issues would not be resolved overnight. But local health leaders committed to using resources to best effect, tackling waiting lists and investing in reform. As Healthcare Finance went to press, a new local executive had not been formed, leaving uncertainty over public services funding.
The Scottish government has provided a further £3.6m to expand hospital-at-home services, which offer care to elderly patients in their home rather than in hospital. Patients on the scheme are more likely to avoid stays in hospital or care homes for up to six months after a period of acute illness, the government said. Patient satisfaction is higher, and the scheme takes pressure off NHS beds, it added.
NHS Providers chief executive Chris Hopson has been appointed chief strategy officer at NHS England and NHS Improvement. Mr Hopson, who has led the providers’ body for 10 years, will leave on 10 June. His deputy Saffron Cordery will become interim chief executive.
‘The legal creation of integrated care boards and partnerships on 1 July is the next step of our reform agenda; it is vital every system partner has – and takes – the opportunity to contribute to making the strategic ambitions of ICSs a reality.’
NHS chief executive Amanda Pritchard (pictured) urges health service bodies to get behind the new partnerships
‘With tens of thousands of vacancies in health and care, nursing staff are facing a losing battle in trying to provide safe and effective care without the staff to do it.’
RCN general secretary Pat Cullen is not impressed with the lack of a workforce plan to bolster NHS recovery efforts
‘We know that frail patients tend to occupy hospital beds for a longer period of time and that is why we are expanding the scheme. In reducing the number of prolonged hospital stays, we will free up more hospital beds.’
The hospital-at-home scheme provides real benefits for patients and the NHS, says Scottish health secretary Humza Yousaf
‘The Health and Care Act is the most significant change to the healthcare system in a decade and will put it in the strongest possible position to rebuild from the pandemic, backed by our record funding.’
Health secretary Sajid Javid (pictured) says the new legislation will deliver high-quality, joined-up care
From the HFMA
More data is needed on the benefits of video consultations, according to Andrew Bone (pictured), HFMA Scotland Branch vice-chair. In a blog on the association website, he discusses Scottish NHS video conferencing service Near Me, which was launched in 2016 and saw a 50-fold increase in uptake in the first four months of the pandemic. Work by the HFMA policy and technical team, commissioned by the Scotland Branch, concluded there was not enough information at clinic- or patient-level to assess whether Near Me generates financial savings, he says.
In a separate blog, Milton Keynes University Hospital NHS FT finance director Terry Whittle says finance staff can create the right environment for innovation by highlighting constraints and challenging thinking. But he believes this could be supplemented by national changes, such as the business case framework, and by allowing the finance regime to develop taxpayer value from innovative partnerships.
Further refinements are needed to the NHS capital regime, locally and nationally, so the NHS has the infrastructure for elective recovery, according to Suzi Joberns (pictured), Wye Valley NHS Trust deputy chief financial officer, and Lee Outhwaite, Chesterfield Royal Hospital NHS FT chief finance officer.
Also on the site, Nuffield Trust senior fellow Billy Palmer looks at how the government is doing in meeting its goal of 50,000 extra nurses by March 2024, and the return on overseas recruitment.
HFMA members, associates and friends come together again for the biggest and most prestigious HFMA event of the NHS finance calendar.
HFMA Northern would like to invite you to attend the 2024 branch annual conference.