Perhaps one lesson to be taken from the past two years is that the country needs contingency plans to run mass-vaccination programmes, whether against Omicron (if new vaccines should be needed), some other new variant of Covid-19 or indeed, whatever the next pandemic should be. While the ability of the NHS, local government and other services to respond at scale in a crisis is astounding, the cost to routine services and to the patients and users that rely on them is all too clear and any future plan will need to think carefully about where staff and resources for vaccination programmes (or indeed, other emergency measures) are to come from.
And beyond Covid-19? If we stay optimistic and assume that either the latest boosters will be the final word or that new vaccines will appear that finally tame the virus, what else does 2022 hold?
We will again need to return the plans for the recovery of health and social care. A plan for elective recovery was on the launch pad just as Omicron first appeared but there can be no avoiding the fact that winter 2021/22 will make that challenge harder, as it will do across all services. Switching-off routine (but essential) services to re-allocate staff into the vaccine programme and to free up hospital space for Covid-19 patients sadly can only make the backlogs – whether in the acute sector, mental health, general practice or elsewhere – worse. In addition, Covid-19 shone a bright light on the already-high health inequalities that existed before the pandemic and the agenda becomes even more challenging when we accept that reducing these inequalities should be core to recovery. The key to this in 2021 was pragmatism: what could already exhausted staff realistically do to, and by when. This will be even more true for 2022 and beyond.
Meanwhile major reforms are making their way through Parliament, reforms that combine a major shake-up of the NHS and its relationships with its key partners in local government and the voluntary sector. However, the timescales for the implementation of reforms are looking ever-more challenging as leaders everywhere turn back to the operational imperatives of Covid-19. This again may argue for some pragmatism: the reforms, largely, point in the right direction but the speed with which they are implemented needs to recognise the enormous pressures already on the system and its leaders. The first step appears to be about to be taken with an expected delay to the start date of the reforms.
I ended last year’s blog with a rather tentative hope the government would grasp the nettle of social care funding reform. Well, it did. I don’t think there are many that would argue the reforms are perfect, but they still amount to easily the most significant attempt to ‘fix’ social care for a generation (at least in terms of the model for funding). They would be made fairer if the members of the House of Lords overturn the regressive changes to the cap on care costs that will reduce financial protection for people with low to moderate assets. The tricky task of planning implementation (something of a theme here) can then begin. Like the NHS changes, these reforms are complex and not immediately straightforward to either explain or to deliver (on the former our Health and Care Explained virtual conference will have a go). Further reform is likely to come from the promised integration White Paper. I will resist trying to guess its contents, but ‘watch this space’.
I don’t forget the changes underway with the public health system following the demise of Public Health England. These could hold out the hope of better integration between public health – particularly in the form of the directors of public health – and the wider system. But again, lots will lie in how these new relationships evolve over the year.
Looking across this landscape, the government has taken some radical steps – raising taxes to increase NHS funding and pay for the social care funding reforms already mentioned, are two examples. Yet it’s also impossible to ignore the great blot that risks unravelling all the plans and aspirations for recovery and reform. That blot is the lack of a clear, funded workforce plan, for it is workforce shortages across all almost all aspects of health care, public health and social care that are the rate-limiting factor now. Any plan needs to marry both short-term actions that may help reduce pressure now, with longer-term measures needed to get us out of this crisis and stay out in a sustainable way.
Yet the government continues to resist even the most modest of legislative proposals in the Bill (which would commit them to at least setting out the balance of supply and demand) let alone committing to a workforce plan itself. For a government that has shown itself ready to take action and is not averse to making workforce commitments (remember the Manifesto pledges on more doctors, nurses and other health professionals?), this failure becomes ever more puzzling (and damaging) as the months and years go by. Damaging to patients and users, to staff and to the government itself come the next general election.
I agree with Mr Nicholls, and perhaps could make two other points:
First, on the issue of data, the proposals for a new mandate for the Secretary of State over data – how it is collected, shared, used – raises a number of questions in relation to
• private sector engagement in commissioning via ICS membership
• the powers and duties of local authorities in relation to client data
• the powers and duties of the Information Commissioner and Caldecott Guardian.
Is the Bill creating the groundwork for, a prelude to, the sale of NHS (anonymised) data to e.g. private insurance companies in order to facilitate the transfer of commissioning to the private sector? Private health insurance is one of the most profitable industries in the USA and is a funding model popular among conservative politicians and thinktanks.
The implications of the proposals go far beyond an innocuous sounding standardisation and linkage of systems.
Second, far as social care in particular is concerned, and setting aside small amount and delayed timing of the proposed resource, I’m not convinced that ‘the model is sound.’ It’s antiquated, focusing as it does on ‘choice’ rather than real engagement by people in the planning and implementation of their care, aka ‘Co-Production,’ a concept at whose heart is rectifying inequalities in health. And it’s noteworthy that the Social Care Bill once again replaces ‘inequalities’ with ‘variations’. Some of us can remember the time when the then Conservative government’s response to the Black Report on Inequalities in Health (1980) was not only to decline to implement its recommendations, but to publish only 260 copies and direct public services to cease using the word ‘inequalities’ at all and use ‘variations’ instead. Plus ça change?
While fully agreeing that tackling the staffing crisis across Health and Social Care is the most urgent task facing NHS leaders and the Government, I fear longer term damage to the sector may well lie in the Bill currently passing through Parliament with very little opposition.
I would challenge Mr Murray’s claim that that the reforms set out “largely point in the right direction”. Not only is the timing bizarre given the formidable current and future problems you have outlined, but the lack of cohesion and detail in the funding and governance arrangements for meeting the desirable objective of greater place based service integration appear unfit for purpose.
More sinister are the proposals for greater powers for the Secretary of State, including for major contracting and resource allocation decisions and in the use of NHS data. These with the growing evidence of the purchase of group practices and primary care networks by American companies, the establishment of yet another enquiry into NHS management, the establishment of more bureaucracy on the the way GPs operate, and the lack of challenge to the growing criticisms of the NHS in the media, raise serious concerns about the Government's future intention to maintain a largely nationally funded and equitable health and care service,"