GPSJ Autumn 2024 ONLINE - Flipbook - Page 31
NHS & HEALTHCARE
If Rishi Sunak had gone
to the polls when political
correspondents predicted that he
would, the UK would have been
voting at the start of November.
However, he called an election in
May, the country voted on 4 July,
and Sir Keir Starmer had been
in his job for four months by the
time bon昀椀re night rolled around.
The NHS emerged as an
election issue during the
campaign, which posed a
challenge for Labour. The party
knew it was going to inherit
an economy with low levels
of growth and high levels of
debt. It also knew the NHS was
struggling and ‘unprotected’
public services were facing
cutbacks on an undeliverable
scale.
Yet shadow chancellor Rachel
Reeves ruled out the most
obvious ways to raise taxes.
So, Labour made the electorate
a ‘retail o昀昀er’ of an additional
40,000 appointments per week
to tackle waiting lists, paid for by
a crack-down on ‘non-doms’,
while insisting there would be no
further money without “reform.”
Buying time
When he arrived at the
Department of Health and Social
Care, new secretary of state
Wes Streeting announced that
“the policy of this department
is that the NHS is broken.” He
also announced an independent
review by Lord Ara Darzi, a
surgeon and health minister in
Gordon Brown’s government.
In September, Lord Darzi made
headlines by declaring that the
NHS “is in serious trouble.” But
health tech entrepreneur Ravi
Kumar said: “there is nothing in
there that will surprise people
who have been in and around the
NHS.”
“There were no surprises in
there,” agreed David Hancock,
an interoperability expert who
has worked for both shared care
record and electronic patient
record suppliers, “so why do it?
The only reason was to buy time.”
Cindy Feddell, a former NHS
CIO who now works in Canada
agreed, although she felt more
urgency was needed. “I thought
they would have used the review
to launch a plan, but they didn’t,”
she said. “It’s very disappointing,
because it is a plan we need, not
more strategic reviews.”
Diagnosing NHS Failure
Lord Darzi did make a diagnosis
of the NHS’ problems that could
feed into the 10 Year Health Plan
due next January. He argued the
root of its challenges lie in the
austerity politics of the Cameron/
Osborne era, that starved public
services of money while driving
demand.
He argued these issues were
exacerbated by the “calamity
without international precedent”
of health secretary Andrew
Lansley’s reforms in 2012,
which fractured NHS structures
in a last-ditch attempt to drive
competition across the system.
But he also noted that the
governments that came before
and after these changes have
talked about ‘left shift’ reforms
without making them stick.
Lord Darzi argued one reason
is that they failed to align funding
昀氀ows with these changes. Plus,
he noted, it has become routine
to transfer capital funding to
the ‘frontline’ – leaving the NHS
with crumbling facilities and
“stuck in the foothills of digital
transformation.”
Reform talk and reality on
the ground
When Streeting talks about
“reform” these days, he talks
about three shifts: from hospital
to community, from treatment to
prevention, and from analogue to
digital.
However, Nicola HaywoodCleverly, a former chief
information o昀케cer and trust
non-executive director, noted
there is a big gap between where
the NHS is now, and where these
three shifts would take it.
At the moment, she said, NHS
England is focused on waiting
lists and 昀椀nancial discipline,
even if this means cuts in sta昀昀
or services that pull in a di昀昀erent
direction. “I want to know what is
going to be di昀昀erent,” she said.
“At the moment, my main
concern is there might be a gap
between what the Operational
Priorities and Planning Guidance
[which sets out NHS England’s
‘must dos’ for the service] and
the 10 Year Health Plan might
say.”
Budget smoke and mirrors
This gap was not closed by
the much-anticipated Budget
delivered by chancellor Rachel
Reeves in October. To 昀椀ll the
“£20 billion black hole” in this
year’s public 昀椀nances, invest in
infrastructure, and stabilise public
services, Reeves raised taxes by
£40 billion and borrowing by £70
billion.
Around half the headline tax
increase will go to the NHS,
which was promised £22.6 billion
over two years. However, this
year’s £10.4 billion includes a £1
billion transfer from the capital
budget and £1.8 billion for waiting
list initiatives announced in the
summer.
What’s left will have to cover
昀椀nancial pressures of around £4.8
billion, drug and pay pressures,
including changes to employer
National Insurance contributions.
“What came out of the Budget
was smoke and mirrors, again,”
said James Norman, who worked
in NHS 昀椀nance and as a trust
CIO and who now works on the
supplier side. “It is just covering
the pressure that is there; there
is nothing new coming down the
line.”
In fact, he argued, it’s worse
GPSJ
than that, because NHS
employers will be covered for the
NI changes, but the GPs, third
sector, and social care providers
who will have to deliver any shift
from hospital to community
and prevention, won’t. Another
example of how talk about reform
and reality on the ground are
pulling in di昀昀erent directions.
Capital funding mirrors and
smoke
The Budget also made a big
deal out of promising more
capital spending. An additional
£3.1 billion was added to next
year’s capital budget, taking
it to £13.6 billion. Of this, £1.5
billion has been allocated to
capacity increases, including
additional beds, surgical hubs,
and scanners, and £2 billion to
“technology and digital.”
However, the advisory board
noted that while Streeting talks
about a shift from analogue to
digital it is virtually impossible
to invest in the current climate.
“Digital leaders are saying they
cannot do anything without going
through two or three layers of
governance outside their own
organisations,” said Nicola
Haywood-Cleverly.
“That makes it very hard for
suppliers to build a pipeline.”
Many trusts are having to freeze
vacant non-clinical posts to
manage system de昀椀cits, reducing
their capacity to digest innovation
and transformation.
Meantime, it is unclear
whether Reeves’ tech spending
is new money or, in e昀昀ect, a
re-announcement of the £3.4
billion that her predecessor,
Jeremy Hunt, announced for NHS
digitisation in March. Certainly,
the Treasury ‘red book’ makes no
mention of the latter.
Left shift, acute capture
For the advisory board, though,
the big question is how the
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