People, resilience, hope and the need for change

Well, here we are in September. 2022 is three quarters done. Realising this, reminded me that we are around for just one time and the importance of living each day to the full. Each day we have will be different. There will be different things to see, hear, do or say. Today is day 193 of the war in Ukraine. Every day I keep all those impacted by this dreadful war in my thoughts and prayers. Friday saw an escalation of events once again. 

However, I was reminded of the need to see each day as a gift by a picture in yesterday’s Financial Times showing a group of children in Odessa painting wrecked Russian military vehicles in bright colours and patterns. 

The photograph was one that spoke to me of resilience and innocence and the importance of being a child.

September also brings with it the outcome of what has felt like a never ending process to see who might be our next Prime Minister. For different reasons, whatever the outcome and whoever becomes the next PM, the future feels just as bleak as that facing the children in Odessa. Alongside the war in Ukraine, the cost of living crisis has rightly dominated the headlines over these past few weeks. What has attracted less attention, both from the media and our politicians, has been the struggle to keep our NHS best able to deliver care safely and effectively. As September beckons the end of summer, I think many of my colleagues will tell you that the summer of 2022 has been worse than many of the winters they will have experienced.

I don’t need to tell colleagues working in health and social care what the issues are, but fundamentally the long waiting lists, pressure on emergency and urgent care services and growing numbers of people in acute hospital beds who have no medical reason to be there, are caused by two issues: workforce shortages and the absence of a comprehensive social care system.  

Vacancies in the NHS are now running at an all time high, with 1 in 10 posts currently unfilled. Without the right number of people, services cannot be provided. The same is true in social care, where providers struggle to recruit enough carers.

I was amused and irritated in equal measure last week when our latest Secretary of State for Health and Social Care, Steve Barclay, noted that there were some 53 thousand people employed in organisations across the NHS ‘of whom the majority are not providing direct patient care’. He was talking about, NHS England, Health Education England, NHS Digital and even the Department of Health and Social Care itself. I was amused by the old chestnut that we have too many managers and administrators and not enough folk in white coats, but irritated that he suggested that the 53 thousand needed to ‘streamline the administrative burden of those on the front line and not risk adding to it’.  

Why my irritation? Well, it goes like this. Politicians make policy decisions such as how much to spend on the NHS, or how many health care professional training places to commission through our universities. When they get it wrong and there is an unexpected consequence that impacts on what society expects, they look for a scapegoat to move the scrutiny away from themselves. For example, in 2015, the then Chancellor, George Osborne announced that student nurses would cease to get a bursary in 2016. It caused much outcry across the nursing profession, universities and in fact, almost everyone except perhaps the Daily Mail and Daily Express. The consequence was a 40% drop in number of applications to nursing programmes over the following few years.

We are living with the legacy of that decision now. In June of this year there were some 40,000 nurse vacancies in England. Without the right number of people, we can’t provide safe and quality services.

So, what I found really irritating about Steve Barclay’s notion of reducing the administrative burden is that politicians, (including himself and his predecessors) in looking for scapegoats, actually increase the administrative burden by asking NHS England Regional Offices to provide data and explanations as to why, for example, the waiting lists aren’t reducing. It’s a request which then gets passed down to individual NHS Trusts to come up with the figures. All of which is a huge distraction. Every day, many hours will be spent producing this information which then gets passed up the line to eventually reach the politicians. This information then appears to provide Ministers of State, the Daily Mail, Express and other right wing media with ammunition to castigate NHS provider organisations for not doing enough to get things sorted. After all, the NHS budget has been increased, so there should be more than enough money to get things sorted.

Even with additional money, though always welcome, without the right number of people, it’s difficult to see how waiting list numbers can be reduced and safe and quality services continue to be provided. The same is true in terms of both health and social care services.

Now dear reader, I don’t want you to think that my polemic here is a result of despair. Not at all. I’m proud to work in a health care system that has given more than a 100% over the past few years, and continues to do so now. I’m proud to work with folk that raise their eyes and ambitions and think about how we might transform our NHS. I’m proud to stand alongside colleagues who day after day go that extra mile in making a difference to the lives of others. That said, the challenge to bring about real change is here right now and needs addressing. Whoever becomes our next PM on Monday will need to be thinking not just about where the NHS is currently, and the winter to come, but the very future of the NHS itself.