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.