The NHS is a People Organisation

Goodness me it’s the 1^st of May already. One year ago, I started as Chair of Stockport NHS Foundation Trust (SFT). I have enjoyed every moment of the past year and look forward to many more. It’s my blog, so I want to use it to say a big THANK YOU to all my SFT colleagues who have worked, (and continue to work) so hard to make a difference every day to so many people. You are truly wonderful.

Sadly, there are others who are not remotely wonderful. It is day 67 of the war in Ukraine. The stories of cruelty, despair, death and destruction continue to fill our media. The pain and torment etched onto the faces of so many folk caught up in the war is almost unbearable to see. Closer to home, Partygate rumbles on, and we have yet another MP caught up in a sleaze row. I’m certain that many people will find it hard to accept that Neil Harris opened the porn website by accident. Particularly as he apparently managed to do so on two separate occasions. However, it certainly wasn’t by accident that Boris Becker has ended up in prison. He was found guilty of hiding huge sums of money whilst declaring himself bankrupt. Again, this is not the action of a honourable and trustworthy person. And I’m not sure how one loses a £38 million pound fortune.

Mind you I have never had anything like that sort of money. Sadly, I didn’t win the Euro lottery on Friday, although I did spend some time thinking about how I might have spent the £133 million jackpot if I had won it. After giving some to my family and perhaps buying some land and a new house, I quickly ran out of ideas as to how to spend the money. 

Such a situation would never occur if you happened to be funding the NHS. In fact, the £133 million would only keep the NHS going for 8 hours. That is right, 8 hours. The NHS costs nearly £373 million each day to run. That is a staggering £136 billion each year. The true cost when you include public health (including grants to local authorities), the training and education of NHS staff regulating the quality of care and the cost of dealing with the Covid-19 pandemic is actually just over £190 billion a year. Now that is a lot of money.

It also represents an awful lot of activity. Those great folk over in the Kings fund have a fascinating website that breaks down the cost of different aspect of health care – have a look here. For example, the cost of someone visiting their local A&E department varies between £77 - £359 depending on the A&E department and the emergency care provided. If you are taken to A&E by ambulance, it will cost the NHS £292 to get you there. Whereas a 9 minute consultation with your GP costs a bargain £39. Just under 50% of NHS funding goes to pay the costs of most people working in the NHS. It’s a people rich organisation, more of which later.

One of the final new Acts of Parliament squeezed through last week was the Health and Care Bill. On Thursday the Bill received Royal Assent, becoming the Health and Care Act 2022. The Bill has been hotly debated since it was first published last July. Rightly so in my opinion, as this is the biggest change to the underpinning legislation for the NHS in over a decade. The Act removes all of the legal impediments that have prevented the much needed development of a more integrated approach to the provision of health and care. The ambition to foster more partnership working, collective decision-making and greater collaboration is to be realised through the creation of Integrated Care Systems, managed by Integrated Care Boards (ICB).

Each ICB is charged with working towards better health for all, and when they need it, better care for all. There is an explicit requirement to ensure the efficient and effective use of all NHS resources (an evidence-based approach). Lastly to ensure that everything that gets done works towards reducing health inequalities. It’s a tough ask, but long overdue. We have to stop or at the very least, reduce the impact of the social determinants that have a negative impact on people’s health and wellbeing.

Thankfully the proposed additional powers sought for the Secretary of State for Health and Social Care to ‘interfere’ in the workings of local Foundation Trusts was defeated. This is an important outcome in terms of preserving the right of Foundation Trusts to be accountable to their local Council of Governors (elected representatives of the communities the Trust serves) for the quality and safety of the services provided. This accountability, however, will need further exploration in the context of Integrated Care Systems, and the move towards greater system decision-making.

As regular readers of this blog will know, I do try and stay clear of politics. However, there is one aspect of the new act that I am very disappointed in. It was the amendment to the Bill that would require the Secretary of State for Health and Social Care to report every two years (to Parliament) on how the government was planning to ensure we had an effective workforce in health and social care. Despite being fiercely defended as a positive requirement by members of the House of Lords, the amendment was defeated. We currently have some 110,000 vacancies across the NHS, and the Act does nothing to ensure a long term workforce plan is in place. Given that the NHS is one of the world’s largest employers, with some 1.2 million folk working in it, this just seems totally unacceptable and wrong.

The NHS is a people organisation. The incredible people working in it look after others at times when, for whatever reason, they can’t look after themselves. The NHS is made up of our people and we owe it to them to look after them now and in the future.