NHS leaders are calling for a reassessment of what the health service can deliver.
This comes as the NHS prepares to grapple with a ‘triple whammy’ of rising COVID-19 infections, a major backlog of treatment and reduced capacity due to infection control measures.
Informed by a new survey of more than 250 of the senior leaders in the English NHS, the NHS Confederation is warning the government of the need for extra investment and support for front-line services if the NHS is to emerge from the pandemic on a stronger footing.
With COVID-19 infections on the rise and a second surge of the virus expected, the NHS Confederation report is calling for a raft of positive changes that have been introduced in recent months to be ‘locked-in’ for the benefit of patients, local communities and NHS staff.
They include ‘stripping back red tape and bureaucracy’, handing more control to local NHS leaders, accelerating steps to integrate health and social care, and sustained and funded action to tackle the health inequalities that have been exacerbated by coronavirus.
Above all, the report calls for political leaders to be honest and realistic with the public about waiting times and other areas of treatment as the NHS continues to resume services while managing the ongoing threat of coronavirus.
Moment of truth
Danny Mortimer, chief executive of the NHS Confederation, said the survey reveals widespread concerns as it heads into the traditionally busy winter months, alongside a positive vision for how services can be ‘re-imagined’.
‘This is a moment of truth for the government and its stewardship of the NHS.
‘Either it embraces what we have learned in recent months and provides the support and investment the NHS and social care need to get back on track and reform for the long term.
‘Or they continue with short-term fixes, bail-outs and ever-increasing targets and regulation that continue to stifle NHS staff from ‘locking-in’ the changes that are essential if the health service is to manage the threat of the pandemic and emerge in a stronger position.
‘In return, taxpayers and the government will rightly expect the NHS to embrace new technology, eliminate waste and deliver services in new and improved ways for patients.’
The survey found that more than eight in ten leaders (84%) say they believe the NHS must deliver a step-change in how it cares for diverse and marginalised communities.
While nine out of ten leaders (88%) say a lack of funding will be a significant barrier to delivering waiting time standards for patients.
Three out of four leaders (74%) say they are not confident their services will be able to meet the national targets to bring back routine operations to ‘near-normal’ levels by the end of October.
And fewer than one in ten NHS leaders (8%) say their current funding allows them to deliver safe and effective services. Fewer than one in ten (8%) were confident they would achieve the goals of the NHS Long Term Plan within their existing funding settlement for day-to-day ‘revenue’ spending.
While, following a gruelling six months, nine out of ten leaders (90%) said they are concerned about the long-term impact that the pandemic will have on doctors, nurses and other frontline staff.
And the overwhelming view is that while the NHS in England benefitted from the £20 billion, five-year funding settlement made in 2018, the ongoing impact of coronavirus means this must be reassessed in the Government’s Comprehensive Spending Review in November.
Leaders also said that additional revenue and capital funding will be needed to cover the extra costs of meeting rising demand, especially in mental health, and in enabling the NHS to play catch up with the backlog of treatment.
A radical and conscious shift
Lord Victor Adebowale, chair of the NHS Confederation, said: ‘COVID-19 has been the biggest disruptor in the NHS’s history. Out of necessity, it has transformed patient services in ways previously unimagined and changes that would usually take years have been delivered in weeks.
‘This is the moment for government to grasp the nettle, be bold and invest in a health and care system not just for this winter but for the long term. It must be reimagined in a way that lets local leaders deliver services that work for everyone in their communities.
‘Above all, we need to see a radical and conscious shift in every part of the country towards tackling health inequalities. If there is one lesson from the pandemic, it is that our universal health service does not care for everyone equally.’
Responding to the report, UNISON head of health Sara Gorton said ‘the stakes are too high’ and the pressures too great to delay NHS pay rise
‘This report highlights the immense pressures the NHS is under. But it stops short of calling for an early and significant pay rise for all NHS staff. This would quite simply make the world of difference.
‘Years of falling employee numbers, increasing workloads and under-investment have left health workers on the brink, and that was before the pandemic struck.
‘A wage rise this year, of at least £2,000 to all staff, will help keep skilled workers in their jobs and attract many much-needed new recruits.
‘There’s no time for dither or delay. The stakes are too high and the challenges too great for anything less than decisive government action now.’
A Department of Health and Social Care spokesperson said health and care staff were invited to share their insights and experiences of ‘overly burdensome bureaucracy’ in the health and social care system as part of its call for evidence.
‘We are committed to supporting the NHS to respond to the pandemic and safely restore services.
‘In July, the chancellor announced an extra £31.9bn for health services, plus an additional £16.4bn last week to tackle coronavirus and will continue to provide the NHS with the funding it needs. This is on top of a record cash funding boost of £33.9bn extra a year for the NHS by 2023/24.
‘We’ve asked health and care staff for their views on changes seen during the pandemic which should be continued, and where unnecessary bureaucracy can be cut, so they can focus on providing safe, high-quality care.’
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