It goes without saying that this is an exceptionally difficult time for many that work in, or rely on, health and care services in England. Does 2023 hold out hope of something better?
'Everywhere patients look there are simply too few services with too little capacity to treat and support them in a timely manner.'
For the next few months there are probably few in the health and care sector that will be able to do anything other than simply get through the day. Everywhere patients look there are simply too few services with too little capacity to treat and support them in a timely manner. This is despite the increases in staff numbers that we have seen in some quarters – acute hospital nurses for example – as difficulties in discharging patients back into the community alongside a raft of other pressures eats up capacity. Those other pressures still include Covid-19, as the latest wave begins to increase hospital admissions and bed usage even if not (yet) on the scale of the 2020 and 2021 waves. To complete an already bleak picture, industrial action has reached the NHS as it has so many avenues of life in England.
This means that coping with operational challenges are going to dominate the early part of the year for the health and care sector. If some combination of extra money (the Chancellor was relatively generous to social care in the Autumn Statement) and the arrival of warmer weather doesn’t ease some of the pressures then they risk dominating the whole year. This includes the Department of Health and Social Care, as the new(ish) Secretary of State seems keen to get involved in performance management and may bring the senior leadership of NHS England into his Victoria Street offices to make this all the easier. However, though there are real shortages of some of the building blocks of healthcare (staff, medicines), there is no shortage of performance management and adding in any more is unlikely to make any positive difference.
Integrated care boards (ICBs) and integrated care partnerships (ICPs) were established in July this year and have been born into the most difficult of times. For many, their ways of working and cultures are still new and 2023 will continue to map out how they will work (recognising that there is a lot of variation across the country – something we must remember the NHS asked for). This is important business and there are challenges. On one side the deep performance challenges in the system may draw them into being simply another layer of performance management. With so many visible challenges in the acute sector they may also end up side-lined as the day-to-day business goes on between the centre and trusts. However, neither of these outcomes is inevitable and ICBs can still bring together the broad range of health and care stakeholders and try to carve out some space amid all the noise to focus on integration, population health and inequalities – those longer-term agendas that may help the service get off the treadmill it is currently on.
One of the early signs of how this structure will develop will come from the Hewitt Review. Led by former Labour Secretary of State Patricia Hewitt (now an ICB Chair), the review will look to ensure ICBs have the space to deliver on their original intention and hopefully, hold back some of the (excessive) national asks that can so limit their room for manoeuvre.
'[The Workforce Plan] is a critical first step and its absence has held back the co-ordinated, system-wide action that the workforce crisis has long cried out for'
If the Hewitt Review does hold out some hope of a better balance between the centre and local areas, so too does the long (long, long) awaited Workforce Plan from NHS England and Health Education England also hold out hope that finally the national workforce crisis will be grasped, if admittedly only for health as it excludes social care. Of course a plan is just the first step and implementation will take time. But it is a critical first step and its absence has held back the co-ordinated, system-wide action that the workforce crisis has long cried out for.
Given all the pressures in the system, 2022 also saw a louder chorus of voices beginning to question the future of the NHS. This included comparisons to social insurance systems as run in some European countries or raising the possibility of charging for seeing a GP. Given the pressures are unlikely to evaporate anytime soon and equally, given that we are moving towards a general election, 2023 is likely to see more of this probing of the fundamentals of the NHS. Until any of these more radical ideas can show how they would actually help overcome the problems faced by health and care it is unlikely that they will amount to anything more concrete. Probably more important, we can also expect to see the political parties beginning to hone down their strategies for health and care as they develop their manifestos for the next general election. Pessimists will fear the risk that the electioneering may get unpleasant if politicians are tempted to try a little manager-bashing. Optimists may hope that the need to attract the electorate will push the parties to genuinely confront the deep and long-term challenges we face.