Under pressure

The country may be talking about the return to normality, with venues and restaurants now in full swing. But in the NHS we face a new normality, with Covid-19 treatment now part of business-as-usual.

Daily cases continue to be high – similar levels to those in late January. And daily admissions to our hospitals appear to be around 800 to 900 nationally, with over 6,000 beds given over to Covid-19 patients.

Despite a hugely successful vaccination programme, the pandemic is clearly not over – even if international events have temporarily grabbed the top of the news agenda. We are all too aware of this in the health service. However, our continued response to the virus is just one of the major pressures we face.

There is a huge focus on recovery and no-one should underestimate the scale of this task. There has been some great progress on the numbers waiting over a year to start treatment and on cancer check-ups. But the backlog of patients waiting to start treatment now stands at 5.5 million.

We face this while experiencing major pressure in our urgent care pathways. Across England, we averaged 70,000 A&E attendances a day in July, the highest level since winter 2019.

Beyond these immediate pressures we also face a further restructuring, with the move to integrated care boards from next April. Greater system working is clearly part of the solution. That is how we can optimise pathways that may cut off some urgent care demand by moving interventions and support further upstream. That’s also how we can tackle some of the wider determinants of health and start to address health inequalities – a further challenge underlined during the pandemic.

Changes such as these require time and headspace to implement, and transformation is difficult to take forward when clinical and support staff are understandably focused on the here and now – as well as exhausted from a difficult 18 months. Planning for these challenges is essential, but that is difficult when we don’t yet have certainty on our funding levels for the second half of the year.

We understand the extreme financial challenges facing government, with competing demands from numerous departments, all with a good case for their claims. But we urgently need clarity on funding, so we can map out the rest of the financial year.

Beyond this, we must hope the spending review provides a realistic multi-year settlement for health and social care. The move to system working offers exciting opportunities to integrate care for patients, but it will be entirely dependent on having a realistic level of funding in both sectors. Without the promised fix for social care, system working will be starting on weak foundations. And funding has to be targeted at the long-term recruitment and development of NHS staff.

With the right settlement, we must also ensure we have an appropriate mechanism for moving funds around the system. The accelerated switch away from the national tariff should help systems to move funds behind revised pathways. And there are proposals for a default payment system based on a core fixed price for agreed activity, with variable elements to support elective recovery.

However this is taken forward, we need to keep it simple, giving systems the maximum flexibility to meet their challenges and ensuring time is spent on recovery and transformation, not on negotiation and contracting.