The hole in Sajid Javid’s NHS masterplan
It all comes down to the workforce — why don't health secretaries ever see that?
Given the crisis facing the NHS, Britain’s most beloved institution, it was surprising to see a near empty Commons chamber as Sajid Javid outlined his latest plans to tackle the Covid backlog. Perhaps those absent felt as though they had heard it all before.
In his speech, Javid began by emphasising the need for more doctors and nurses while conveniently ignoring the impact of his recent proposal to force mandatory vaccination on NHS staff. The policy has since been paused (“in consultation”), but it was ironic to see the Health Secretary once championing a policy that could have led to an estimated 70,000 lost jobs.
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The Health Secretary went on to claim that there are more doctors and nurses than ever working in the NHS. There’s always tendency to massage NHS statistics (for example, by counting students as doctors), but even if one accepts this dubious assertion, it still doesn’t negate the fact that England has one of the lowest numbers of doctors per capita in the EU. Indeed, the BMA estimates that there is currently a shortfall of 50,000 doctors, or 31% of the total doctor workforce. For nurses the picture is little better, with over 38,000 reported vacancies.
And it’s not just the lack of staff either. The NHS has a dismal record on employment rights, discrimination, and abuse of its staff. Burnout is rife, and care must be taken to improve the health service’s culture and retain existing clinicians.
The Health Secretary was also eager to stress the role of the independent sector in increasing capacity, describing it as an “important part of our contingency plans for Covid 19”. Unfortunately, the evidence from the pandemic is unconvincing: billions were ploughed into the private sector for very little benefit. Javid would do well to be more sceptical about a policy that was, for all intents and purposes, a wasteful mess.
Javid then unveiled his latest bright idea — an expansion of “one stop shop” “community diagnostic centres”. Currently England has 69 such centres, which the Health Secretary plans to increase to over 100. This may seem like an attractive idea, but there’s a problem. GPs are needed to assess and refer patients for diagnostic tests, but because there is a growing deficit of staff in general practice, any plan aiming for more diagnostic capacity while failing to address this shortfall is inadequate. At a time when hospitals are struggling to fill their rotas, questions must be asked about where the staff for these centres will come from.
The Health Secretary’s next idea was an online portal for patients so that they could be ready for surgery. Lack of patient preparation, he claimed, represents a significant cause of cancelled operations. But this is dwarfed by the number of operations that are cancelled for hospital-related reasons; in fact, a survey by the Royal College of Surgeons gave a lack of available hospital beds as the main reason for cancelling operations. In light of Javid’s recent mandate policy, this oversight is particularly galling: care homes lost tens of thousands of carers, which lengthened the backlog on hospital discharges, resulting in significantly hampered bed availability.
Finally, for all the time given to cancer and elective surgery, very little attention was paid to mental health, despite the “catastrophic” backlog. If listeners had been hoping for mental health to finally have parity with physical health, they must have felt very short-changed.
Javid is correct that the Covid-19 pandemic may represent a possible paradigm shift in health policy. Unfortunately, he has failed to grasp the most significant issue facing the NHS currently — the workforce crisis. There has been no national NHS workforce strategy since 2003, with gaps addressed by woefully inadequate measures. Let’s hope that Javid does not turn out to be yet another in a long line of a health secretaries with a fundamental lack of understanding of how the NHS functions.
I am probably going to be leaving this comment, or a variation thereof, on articles and chats for the next few years, but here goes:
The problem with refunding the health service is that there are now fewer resources available to pay for health care. This is the case because we shut down the economy for a year and a half. (“If you don’t make stuff, you don’t have stuff.”) Attempts at pump-priming a supply-side recession will only result in rising prices – something we have been seeing.
So if you attempt to raise taxes to pay for more healthcare, you will be taxing people who are already seeing their cost of living rising. They will be made poorer.
It was stupid to shut down the economy for a year and a half. It will have consequences for some time to come. And by ‘consequences’ I mean deaths. Actual, quantifiable, deaths:
Costs and Benefits of Lockdown (2): Translating GDP into human lives – Graham Stull
Let’s remember this the next time we are told to shut down our economy because of some halfwit’s epidemiological model.
Thank you for a good article. Quite some time ago I worked as a management consultant for a private hospital chain operating in the UK. The management challenged us to reduce costs for operations without reducing the high quality of care they delivered. To their surprise we actually managed to increase their cost-effectiveness whilst not increasing risk. During our consignment we dealt with managers and clinicians who all shared a can-do attitude and a willingness to embrace new ways of working. I wonder, would this be the case in the NHS? Somehow I doubt it and therein lies a big problem.
It is sad to see a Conservative government’s main strategy for the NHS is to throw more money in (or away).
For a very long time, I have felt that a symptom of severe problems in this country is that we find it necessary to find doctors and nurses from other countries. Quite apart from the doubtful morality of doing so, it is surely better that English is the first language. Don’t other countries manage this basic thing? When did we stop doing so?
So; policy #1; train many more clinical staff – no loans, but include a period of mandatory service. If we employ enough, that in itself will surely make the job less stressful, and easier to cope with part-time doctors. (In addition, I suspect the change in the training of nurses has added to our problems.)
Policy #2; have plenty of beds. Build extra wards, including convalescent wards. I believe that false economy triumphs over and over.
Policy #3; stop and reverse if feasible the reorganisation caused by lumping together different establishments and then closing departments in some of them. During one course of treatment, we had to visit, at various times, 5 of our 6 connected local hospitals. It was clearly for the convenience of the consultant, since it was anything but, for us, and would have been very difficult by public transport. I have to conclude that the consultant habitually worked in all locations, but presumably claimed travelling expenses, and was perhaps paid his travelling time.
Policy #4. Remove levels of management and return power wholly to clinicians, supported of course by professional staff such as accountants, secretarial, IT and maintenance engineers.
We should have a commission to examine how a number of other countries which appear to achieve better health care than us for comparable cost, and simply copy it, but I don’t think the existing political parties will ever have the courage.
Britain is so fortunate to have other countries with an abundance of trained nurses available for Javid.
The main causes for ill-health are: poor housing, poor education, poor food (=modern farming food which equals poor nutrition and therefore poor immune systems and chronic illness) and other pollutions. If real efforts were to be made in these areas, there will less pressure on the NHS.
At the same time change medicine from being an XL sheet occupation, organised to nourish an industry of health, to a system that is interested in making people healthy.
The current medicine model is completely unaffordable: no money will ever be able to pay for it however many people you train or money you throw at it.
And in an article written by Javid in The telegraph, he mentions “social justice” in relation to “levelling up” the access to treatment of certain demographics based on identity markers such as age, ethnicity and deprivation.
Now “levelling up” when seen in the light of “social justice” could be a euphemism for ‘equity’, of the sort that is an enforced redistribution of resources. So with the workforce resource bottleneck, how would such a redistribution come about?
Could Amy Jones by any chance be an NHS doctor? Why does every paragraph here appear to require an extra sentence:’And therefore the government should stop interfering in the NHS and just send in more and more and more money (and we doctors can decide best how to share it out’?
Disappointing from ‘UnHerd’, as these self serving views are endlessly heard, online, in newspapers, and particularly in their letters columns. Let us rather hear from someone who can throw light on the awful management of resources within the NHS and how real change could be made to happen.
.. NHS absenteeism seems rife. And many of those who did turn up can’t have been as busy as constantly portrayed by their PR agency (aka the BBC) given the reduction in hospital treatments during the pandemic. And fancy an organisation with over one million employees needing help from a few thousand soldiers. Shameful.
Yes, and amazingly nobody appears to see this obvious logic. Knowing lots of NHS nurses and doctors who sat around during the pandemic whilst the NHS was closed for business. Recognising that not all trusts were as pathetic. And any can-do attitude had to be imported in via the military who were trained to ‘adapt and overcome’. Yes, shameful.
Why don’t you provide evidence of where all this money is wasted then? We have spent much less in terms of GDP than most other first world nations for a very long time now, and it’s finally coming back to bite us
Is the NHS really Britain’s most beloved institution? If so, why?
It is often said that the UK is not a country (or 4 countries, 3.5 countries) but a failed NHS masquerading as a country. Is it really beloved?
More tosh from Anonymous Amy. NO reason she couldn’t put her name on this. Stop hiding, Amy. Time to put on your big girl pants and stop hiding. And for consistency, I also object to UnHerd permitting anonymity to the business guy in the article on Peloton. Without a really compelling reason, anonymous sources/writers should not be routinely allowed.
Why shouldn’t anonymity be allowed? How else are you supposed to get an inside perspective of these organisations if you don’t allow the writer to keep their identity secret for fear of reprisals?
Or is it simply the fact she has different ideas on the problems and solutions to the problems in the health service, so you want to shut her down (cancel her if you will)?
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