Just when you thought things couldn’t get any stranger, 2022 happened. So, here’s our annual look at what the health policy year had in store.
The NHS started 2022 in the grip of the Omicron variant of Covid-19. Rising Covid-19 cases and shortages of lateral flow tests dominated the news and the NHS planned to open mini-Nightingale hospitals to cope with the pressure.
The furore over mandating Covid-19 vaccinations for NHS staff also continued (several months after care home workers were already working under a vaccine mandate). One hospital chief executive said he could lose 10 per cent of his staff because of the mandatory vaccination proposals – which would ultimately be paused on the last day of January.
This month also saw new national data published on the links between climate change and hospital activity and the head of NHS England asking for a ministerial direction (basically asking ministers to put contentious proposals in writing) – to buy more capacity from the private sector despite its concerns over value for money. The rarity of health care ministerial directions shows just how serious these concerns were (Figure 1).
NHS England published its plan to tackle growing hospital waiting lists this month, as pressure from the Omicron wave started to gradually ease. The plan included new offers of patient choice, proposals to expand surgical capacity, and challenging new targets to reduce waits (Figure 2).
This month also saw the publication of the Cavendish Review of adult social care, which acknowledged the financial pressures on the sector but highlighted opportunities to commission services differently and empower staff. And the Department of Health and Social Care published its White Paper on integration, which proposed changes to how health and care services would be organised and laid the ground for the Health and Social Care Act that would follow in July.
The end of the financial year was a busy time in health policy.
It wouldn’t be a health policy year without a set-piece speech from the Secretary of State for Health and Care. March saw the first – but not last – of these, when Sajid Javid set out his four priorities of prevention, personalisation, performance and people.
March also saw the impact of the Russian invasion of Ukraine on health policy, as NHS England was asked to end its use of Russian energy suppliers. March would also see the first serious knells of the cost-of-living crisis that would ring throughout the rest of the year and dominate the domestic policy agenda. Health and care services would not be immune, and the Spring Statement announced the latest ‘crackdown’ to drive efficiency, which included a doubling of the NHS’s annual efficiency target.
The annual NHS staff survey results published this month painted a sobering picture with one-third of staff saying they were burnt out and half reporting periods of being unwell because of work-related stress. This came in the same month that free car parking for NHS staff ended in most organisations and the Royal College of Nursing raised concerns about the mileage costs of nurses who travel long distances to care for their patients.
The high-profile Cleveland Clinic opened its new hospital in London in the same month that it was listed as the second-best hospital in the world by Newsweek magazine (the next highest UK entry came in at number 41). And this month’s annual report from the Institute for Public Policy Research on the state of the health and care system raised concerns of a two-tier system, where access to better health care would depend on a patient’s ability to pay for private care.
And towards the very end of the month the Ockenden review into the terrible care failings in Shrewsbury and Telford hospital NHS Trust maternity services was published, and the latest British Social Attitudes survey showed that while the public maintained its strong support for the founding principles of the NHS, satisfaction with current services plunged precipitously to its lowest level since 1997 (see Figure 3).
The Goldacre Better, broader, safer review of using health data for research and analyses was published this month. The report included some 185 recommendations over 112 pages (the Health and Care Secretary noted in his forward that this ‘certainly met our level of ambition’) to use the public’s data safely and effectively to improve health care. Some of these recommendations would be included in the government’s own Data Saves Lives policy paper in June.
The Health and Care Act 2022 received Royal Assent in April to provide a legislative footing for more collaboration and partnership-working in health care – principally through new integrated care systems. The most significant health care legislation in a decade caused noticeably less heated debate than the Lansley reforms of 2012.
Other news this month included the government acknowledging it was falling well short of its target to increase the number of GPs (see Figure 4) and widely-reported shortages of hormone-replacement therapy products due to supply issues.
And in the first month after a dedicated national fund to support hospital discharge was wound-up, a Department of Health and Social Care minister’s comments about hospital discharge policy during the early days of the pandemic – ‘this is written like the NHS is divine and care homes are slaves’ – hit the headlines.
This month, Sir Robert Francis, the chair of Healthwatch England – the independent champion for people who use health and care services – stepped down earlier than planned and used his resignation letter to raise his concerns about ‘the alarming decline in the resources’ available to the organisation. It was the month for warnings as the nursing director for an ambulance service said his organisation was facing a ‘Titanic moment’ by August, where local service ambulance services would not have the resources to respond to calls.
May also saw the publication of the Fuller Stocktake on how primary care services were integrating services. The review noted services had made some progress but had further to go before providers of general practice, community pharmacy, dentistry and optometry could say they were working more closely to deliver better care for patients.
And in the same month that the government delayed new restrictions on multi-buy deals and advertising junk food, an annual report on obesity by the World Health Organization highlighted the UK’s unenviable position in the league table of European nations (see Figure 5).
General Sir Gordon Messenger’s review of leadership in health and social care was published on the 8 June – though it mostly focused on leadership in NHS secondary care. The review had some punchy things to say about the constant demands and behaviours that emanate from the top of the NHS – including politicians – and recommended new development offers for mid-career professionals and equality, diversity and inclusion being a personal responsibility of leaders. But a large share of the oxygen in the room around the time of publication was consumed by Sajid Javid’s comment that England had ‘a Blockbuster health care system in an age of Netflix.’
In other news this month, the polio virus was detected in London’s sewage samples, nearly 20 years after the UK was declared polio-free; Freedom of Information data showed violent incidents at health centres and GP surgeries nearly doubled over the past 5 years; and the Khan Review of smoking was published, which recommended more funding, raising the legal age of sale for tobacco products, and a greater focus on prevention to lead to a smokefree generation in the UK. Despite the clear link between smoking and poorer health (see Figure 6) it is hard to see what tangible action the government has taken in response to the Khan review – apart from depositing a copy of the review in the libraries of the Houses of Parliament.
Hover over each segment to explore NHS hospital admissions attributable to smoking in more detail.
Sajid Javid had said that 2022 would be a year of reform for health and care services. This probably wasn’t what he had in mind: he resigned from the cabinet and was replaced by Steve Barclay.
July was also a survey-heavy month. The GP patient survey found the majority of patients still had a good overall experience of their GP practice but there were sharp falls in their experience compared to last year. The Association of Directors of Adult Social Services Budget survey found ‘adult social care is far from fixed’; and the General Medical Council training survey found the risk of burnout in trainee doctors had reached its highest level since it was first tracked in 2018.
This month the Covid-19 inquiry was officially launched and operational pressures in the NHS continued to hit the headlines (see Figure 7) as all 10 ambulance services in England reached ‘black alert’ status – leaving them unable to deliver comprehensive care – and the President of the Royal College of Emergency Medicine said the NHS was at risk of breaking its fundamental promise to the public to deliver timely care in an emergency.
The Prime Ministerial contest grabbed most of the headlines this month. The losing candidate Rishi Sunak promised to reform the NHS and tackle hospital waiting lists, in part by potentially introducing charges for patients who failed to attend GP appointments.
This month the number of vacant posts in the NHS remained stubbornly high (see Figure 8) and reached 130,000 for the first time since comparable records began, and Health and Care Secretary Steve Barclay was confronted by a member of the public who had ‘brief but punchy remarks’ about the government’s record.
This month an NHS Providers survey showed the growing impact of the cost-of-living crisis on patients and staff, with rising mental health issues reported due to stress, debt and poverty and more than one-quarter of surveyed trusts offering food banks for staff. And NHS England ordered an immediate review of safety in providers of mental health and learning disability services, after BBC Panorama exposed a ‘toxic culture of humiliation, verbal abuse and bullying’ of patients in Edenfield Centre.
And, of course, September brought a new Prime Minister in Liz Truss and a new health and care secretary in Therese Coffey (see Figure 9). Ms Coffey would go one better than the Jackson Five in setting out her priorities as A (ambulances), B (backlogs), C (care) and D (doctors and dentists). And her Plan for Patients included a commitment for patients to receive a GP appointment within two weeks and a £500 million fund to support social care services and speed up hospital discharges. This month rumours also circulated that she had scrapped the government’s planned White Paper on health inequalities.
But ultimately, the government’s disastrous mini-budget – The Growth Plan – would mean that these plans for health and care and the economy as a whole – would not last much longer.
Another month, another new Prime Minister in Rishi Sunak and a new-but-old-but-new health and care secretary in Steve Barclay. October would also see the return of Jeremy Hunt to the cabinet as Chancellor, after his previous posts as Chair of the Health and Social Care Committee and Health and Social Care Secretary.
This month the chief finance officer of NHS England warned the NHS could have a hole of up to £7 billion in its budget next year if staff pay and other inflationary costs were far higher than originally planned. And a report from the General Medical Council found there had been a dramatic increase in international medical graduates practising in the UK (see Figure 10) – noting that while these graduates were welcome and essential, the reliance on this group puts the UK in a ‘precarious position.’
And not for the first time, the NHS was rocked by the findings from another independent report into care failings into maternity services. The Kirkup review of care at East Kent recommended that more must be done to identify poorly performing units, provide care with compassion, support teamworking and respond to challenges with honesty.
November was dominated by the government’s major fiscal event – the Autumn Statement. This provided an unexpected funding boost to the NHS and adult social care, an unexcepted new review of how integrated care systems (ICS) were operating, a long-awaited commitment to publish projections of how many staff the NHS would need in future years, and the Chancellor’s stated ambition to deliver ‘Scandinavian quality alongside Singaporean efficiency’ (it is worth noting that health spending in Denmark, Norway and Sweden is generally higher than the UK – see Figure 11). Unfortunately, it was perhaps all-too-expected that fundamental reform to social care funding and charging was delayed once again.
Many suggested that this health and care funding boost at a time of fiscal restraint was due to the chancellor’s previous experience of the health and care sector. But if Jeremy Hunt was hoping this would set the NHS on an even keel the rest of the month brought more worrying news. The Royal College of Nursing announced strikes in some NHS organisations would take place later this year unless nursing pay was improved; leaked minutes from a Scottish government meeting raised concerns that the NHS was heading for a more formalised two-tier system based on ability to pay; and a highly-rated ICS sounded a warning note about its financial health – noting ‘there is a fundamental dichotomy between operational reality and financial assumptions.’
December brought the two days of strikes by nurses and ambulance staff over their pay and conditions, after seeing pay levels fall further behind inflation. According to NHS England, 2,450 elective procedures planned on the first strike day had to be rescheduled, with separate data highlighting the challenges the NHS has faced in rebooking cancelled procedures since the Covid-19 pandemic (Figure 12).
The Migration Advisory Committee used some strikingly strong language in its annual report published this month – saying it was ‘bewildered by the lack of urgency’ from the Department of Health and Social Care in tackling the crisis in adult social care staffing in England, compared with the action taken to tackle low pay by the Scottish and Welsh governments.
And in the same month that The King’s Fund published a report on how waiting lists had been successfully tackled in the past, an Office for National Statistics survey found long waits for NHS treatment were affecting people’s health, employment and relationships, with around 1 in 8 adults reporting they had paid for private medical care because they felt the wait for NHS treatment was too long.
So, that was the year. Looking backwards it was dominated by yet more political change at the top of government, a cost-of-living crisis, a looming winter of strike action, growing fears of a two-tier health system based on ability to pay, and the continued second-class citizenship of an adult social care system that saw its charging reforms delayed once again.
Nobody knows what 2023 will hold. But in many ways, I hope it’s not more of the same.