Labour faces stark choices over funding 5 July 2024 Labour’s plans for the NHS imply seismic changes in workforce performance and culture. They claim they can do it without major injections of money. The party has set itself the challenge of clearing waiting times for elective treatment of over 18 weeks within five years. That means clearing the current backlog of 3.2 million cases and new ones joining the list. Its commitment to additional spending is £1.8 billion, although the baseline is unclear. The party is also committed to delivering an extra 40 000 appointments a week across the system. None of this will be possible until Wes Streeting, incoming Secretary of State for Health and Social Care, resolves the junior doctors’ pay dispute. His comments demonstrate he will not repeat the mistakes of the bungled negotiations over doctors’ pay under Tony Blair’s government, when big rises were delivered without extracting commensurate changes in working practices or performance. He has talked about a “journey to fair pay,” indicating that higher salaries and better conditions will be traded for more effective ways of working. The aim will be a step change in productivity. Department of Health and Social Care spending increased from £158bn in 2019-20 to £182bn in 2022-23, staff numbers increased substantially, but performance barely flickered. Labour claims that existing funding and staffing coupled with technical efficiencies can eat away at the elective care backlog. Read the full article at BMJ __________________________________________________ Election promises are built on quicksand 7 June 2024 The early promises on health in the election campaign head in different directions. The Conservatives are focusing on community services, Labour aims to slash the elective care backlog, and the Liberal Democrats want to strengthen prevention. All the plans are built on financial quicksand. The Conservative offer revolves around moving care “closer to home” by building 100 general practice surgeries, modernising 150 more, shifting some primary care work to pharmacies to free up general practice appointments and building more community diagnostic centres. Just as the party’s increase in defence spending is, implausibly, to be funded by cutting civil servants, the £1.2 billion annual cost would be funded by cutting 5,500 NHS managers and halving government consultancy spending. The pledge to build surgeries would have more credibility if tangible progress had been made on the 2019 manifesto pledge to build 40 new hospitals, now mired in design and funding problems. Promising to move care closer to home contrasts with the Tories’ record. Nuffield Trust analysis reveals that NHS community services in England were cut in real terms in three out of the six years between 2016/17 and 2022/23, while GPs’ share of total funding was unchanged. Read the full article at BMJ __________________________________________________ Does NHS have a productivity problem? 25 January 2024 Health service productivity matters for the whole economy. Healthcare spending, both governmental and non- governmental, consumed 11.3% of gross domestic product in 2022, compared with 6.8% in 1997. NHS effectiveness has a big impact on the overall productivity of public services, perceptions of value for money for taxpayers, and the ability of the NHS to help people to be fit for work. In evidence to the health select committee in November, NHS England chief executive Amanda Prichard dismissed current productivity measures as “a fairly blunt tool” and said there was a “misunderstanding” about NHS productivity, because the figures do not fully reflect activity such as critical care, diagnostics, community services, and virtual wards, or quality improvements such as the recent £165m investment in maternity staffing. Healthcare data scientist Steve Black describes the idea that there is not a significant problem as “absolutely ludicrous, given the past three or four years of NHS history.” He highlights analysis by the Institute for Fiscal Studies showing that over the past four years the numbers of consultants, junior doctors, nurses, health visitors, and support staff grew between 15.8% and 24.6%, while treatment volumes in emergency and non- emergency admissions went down, and outpatient appointments and the waiting list barely moved. “We’ve got vast amounts more staff and more money but output is unmoved,” Black says. “The leadership is in denial that there is a serious problem.” Total Department of Health and Social Care spending increased from £158bn in 2019-20 to £182bn in 2022-23. Global health expert Mark Britnell says many health systems have productivity problems. “Healthcare is considerably less productive than other sectors of the economy. Bearing in mind that growth in health spending has outstripped economic growth in many countries over the past 60 years, it’s easy to see why some question the long term sustainability of healthcare,” he says. “Health leaders need to engage seriously with the productivity debate to protect existing gains and secure future progress.” Read the full article at BMJ __________________________________________________ Workforce plan will challenge status quo 4 July 2023 Delivering the NHS workforce plan depends on implementing major reforms which will challenge professional and organisational power. The NHS Long Term Workforce Plan for England1 makes bold assumptions about productivity improvements, moving care out of hospital, getting better at prevention and early intervention, and breaking down clinical hierarchies and boundaries. The plan estimates that the number of people aged over 85 will grow 55% by 2037 as part of a continuing trend of significant population growth. It is inconceivable that the healthcare needs of this cohort could be met by continuing the NHS’s hospital- centric, sickness-based operating model. Moving care from hospitals to homes, exploiting artificial intelligence (AI) and robotic process automation (using software robots to emulate human actions such as putting together a patient discharge summary) and removing barriers that prevent clinicians innovating or working differently are just three of the changes on which the success of the workforce plan depends. The shape of the workforce is projected to change markedly, with the total nursing staff working outside acute settings increasing from 30% to 37%, and the total community workforce nearly doubling. The demand for mental health and learning disability staff is growing at 4.4%, more than double the growth in acute demand. Alongside this are ambitious plans to increase the number of nursing associates—who sit between healthcare support workers and registered nurses—from 4 600 to 64 000. This will give them a greatly increased role in care delivery, while registered nurses will focus more on care planning and assessment. If successful this will provide a career development pipeline from support worker to nurse. Read the full article at BMJ __________________________________________________ Starmer’s promises set Labour up to fail 26 May 2023 Keir Starmer is making big, conflicting, and unrealistic promises on health, without a clear plan for delivering them, which is setting Labour up to fail. In a speech at a Braintree ambulance station on Monday 22 May 2023, Starmer, leader of the Labour party, committed a Labour government to meeting a raft of targets that haven’t been hit for years, saying, “Ambulances – seven minutes for cardiac arrest. A&E – back to the four hour target. GPs – the highest satisfaction levels on record. Waiting lists – down. Planned treatment within 18 weeks. No backsliding, no excuses – we will meet these standards again.” As if that isn’t enough to keep a new government busy, he also committed Labour to improving healthy life expectancy and halving the inequality gap between English regions. He claimed this would be achieved by diagnosing 75% of all cancers at stage 1 or 2 – which would require a huge performance leap – and cutting heart attacks and strokes by a quarter within a decade. He also committed to cutting the number of deaths by suicide. All this will be achieved while Labour shifts services from hospitals to communities with a big expansion of local health services. Read the full article at BMJ __________________________________________________ Labour’s health plan has a serious flaw 25 April 2023 Labour may have got the basic idea right in prioritising primary care over hospitals if they come to power, but they risk deluding themselves about the scale of the task. In a major speech at the King’s Fund last week fleshing out the opposition’s plans for the NHS, shadow health secretary Wes Streeting touted New Labour’s achievements in slashing waiting lists and waiting times as proof that his party could turn around the fortunes of the health service. He said the plans would be delivered by a mixture of investment and reform, but “the state of the public finances means reform will have to do more of the heavy lifting.” Keir Starmer’s team have been keen to learn lessons from New Labour’s time in power, and it shows. There is more than a hint of former health secretary Alan Milburn in Streeting’s approach—positioning himself on the side of patients to challenge the system rather than being a cheerleader for the health service. But the scale of change Labour is proposing is massive, going far beyond recruiting more primary care staff. They are promising a fundamental shift of care from hospitals to communities and homes. “Healthcare on your doorstep” is now one of Labour’s three principles for healthcare, alongside “there when you need it” and “patients in control.” Read the full article at BMJ __________________________________________________