The general election on 8 June is an important opportunity to restate what is needed to keep the NHS afloat. Its continued success needs investment in services and the capacity to reshape them to meet 21st century needs. Without this, patients, service users and frontline staff will feel the impact, and trusts will struggle to deliver improvements.
This is set against the backdrop of one of the longest and deepest financial squeezes in NHS history, with demand for services going through the roof and every type of trust running at capacity levels (pdf) way beyond the recommended levels.
NHS Providers has set out seven priorities for the next government to help decision makers and opinion formers understand where they should focus their attention. One of the most important priorities is the workforce.
An organisation is only as good as the staff it employs and keeps. The personalised, caring and highly specialised nature of healthcare means this is particularly the case for the NHS. The huge gap (pdf) growing between the supply of trained staff and the increasing demand for services has set the health service on a collision course in terms of the timeliness, quality and safety of care patients receive.
It is particularly concerning that NHS trust leaders report that tackling this issue is one of their top priorities alongside and sometimes ahead of health service finances.
So where did these challenges come from and what is the impact on the frontline? There are a number of reasons. First, we need more staff to deal with the growing demand and the increasing complexity of patients’ needs, but the staff are not there.
This is compounded by the fact that we are still in a period of substantial pay restraint. Trust leaders tell us that seven years on, this is preventing them from recruiting and retaining the staff they need to provide safe, high quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.
Pay restraint must end and politicians must therefore be clear about when during the next parliament it will happen and how. The NHS obviously has to stick to the budget the government sets and we will therefore need difficult discussions about how this fits alongside its other priorities.
It’s not just that salaries are less competitive. Recent reports on the pressure on A&E departments over winter have shown the working conditions are becoming ever more stressful (pdf).
If we then layer Brexit on top of this, the staff shortages worsen further: EU staff already working in this country have not been reassured about their current or future status, and the flow of staff being recruited from the EU is slowing.
On the frontline this makes it harder to ensure patient safety. All providers – hospitals, mental health trusts, community and ambulance services – are seeing rota gaps that cannot be filled, and on occasions services closing unnecessarily. Understaffing has a direct impact on quality and a longer term impact as staff who are happy and motivated provide better care.
We need resolution on the status of EU nationals and a focused conversation on when and how we end pay restraint. However, we also need a strategic solution. So, whichever party is in government must work with NHS national bodies to agree and fund a long-term approach to workforce planning, which is currently lacking.
The other priorities for the next government, which will help it invest in the success of the NHS, should be:
• Funding that allows trusts to deliver the standards expected by patients and enshrined in law in the NHS Constitution
• Investing in social care: ensuring the extra money in the budget is used to ease pressure on the NHS, alongside a sustainable long term funding solution
• Action to ensure words promising parity for mental health are matched by deeds. That means higher levels of investment and making sure investment reaches the frontline
• Supporting new ways of working and closer collaboration between health and social care so more people can be treated and supported closer to home. The priority must be quality of care rather than saving money, and the timetable must be realistic
• Establishing the long-term funding needs of the NHS to ensure it can meet the increasing demands of an ageing population
• Recognising the economic value of the NHS as an organisation that protects health, provides employment and promotes research
Delivering on these will support the NHS’s quest to serve the rapidly growing healthcare needs of today and tomorrow.
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