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All Change- Again?

Indranil Chakravorty MBE

In a tweet the Royal Family announced that the George Cross was awarded to all members of the UK National Health Service at an investiture attended by Amanda Pritchard and representatives of the NHS. This is a momentous day for all the 1.3 million employees of this jewel in the crown of British institutions and an ‘envy of the world’. We are proud to be in the deserving NHS millions.

While this is indeed a day of pride and honour, the NHS is facing a summer of challenges and discontent. The NHS waiting lists tracker estimates that over 6.5 million patients are waiting more than 12 weeks for their procedures a whopping 2 million more than July 2019, before the pandemic. In addition, there are around 300,000 patients waiting more than 52 weeks. Emergency care attendances in England have remained around 2.2 million per month, yet the waiting times in emergency departments in excess of 12 hours, rose from under 3000 in Jan’22 to nearly 25,000 in Apr’22. The story in primary care remains challenging with many patients experiencing delays in making appointments. Data from NHS Digital shows that there were 27.5 million appointments in General Practice in May’22 with nearly 44% seen on the same day and nearly 50% by GPs. The NHS Workforce data shows that there were over 35,000 full time equivalent GPs and over 16,000 nurses in primary care in May’22. The Health Foundation estimates a shortage of around 4,200 full-time, qualified, permanently employed GPs in England, in 20-21, rising to a predicted shortfall of over 10,700 in 2030-31. The shortfall in nursing numbers has risen sharply from 10-12% in June 2020 and the UK government’s target of recruiting 50,000 nurses from abroad will not go far enough.

NHS People

Hence, workforce recruitment and retention remains paramount as an essential tool in steering the country from further deterioration of its population health. There is ample research from social scientists that suggest that autonomy, being valued and inclusion are more important than remuneration in determining job satisfaction. Since 2009, the NHS Staff Surveys have provided a barometer for job satisfaction and are aligned to the People’s promise. In 2021, the staff survey showed a 6-7% decline in many parameters. Only 59% of staff would recommend their organisation as a place of work. Although over 87% felt that they were making a difference to people, only 68% felt happy with the standard of care they were able to provide.

The prevalence of racism and discrimination from patients and managers in the NHS was rising. Almost 8-10% of all staff and 17-19% of staff from minority ethnic backgrounds reported racism and discrimination. Only 42% felt valued and less than a third of staff were satisfied with their pay and remuneration.

The net change in pay for NHS staff has remained well below inflation in the last decade. The BMA has calculated that the estimated take-home pay for the average junior doctor in England has declined by 22.4% in real terms (RPI) between 2008/09 and 2020/21, taking into account estimated tax and pension contribution changes. The average consultant in England has seen their real terms take-home pay cut by nearly 35%.

All Change - again?

Add to this backdrop, two further significant events - the legal status of the Integrated Care Systems (1 July 2022) and the fall of the Johnson government amidst a bevy of scandals, cronyism, nepotism, a total disregard for the people (partygate) and the cost of living crisis. The Conservative party retains its huge majority in the House of Commons and a new leader is expected by early September. What are the attributes that the country needs in its new (Tory) leader? What should be the priorities for the country and for the health service? How should a new Secretary for Health and Social Care tackle the challenges facing the NHS?

While 2020 brought on a shift towards working from home for many people, others had no choice but to continue working on the front lines. Some have hailed frontline workers as ‘heroes,’ but it’s also worth considering what that label means moving forward in 2021. Merely calling healthcare workers ‘heroes’ is harmful. While their actions may be heroic, calling them ‘heroes’ without also listening to what they have to say closes off any possibility for improvement. Public recognition is important, but bottom-up communication within an organisation is essential for making sure frontline voices continue to be heard.

Aspirations from the new PM

As of now there are eight contenders for the Tory leadership - Jeremy Hunt, Rishi Sunak, Suella Braverman, Nadim Zahawi, Liz Truss, Penny Mordaunt, Tom Tugendhat and Kemi Badenoch. The most recent Secretary for Health and Social Care, Rt Hon Sajid Javid bowed out before the first round of voting began. While Rt Hon Jeremy Hunt has a chequered legacy with the healthcare sector since 2012, particularly during the junior doctor strikes, he is also the one who has remained outside the fatalistic Johnson government and had reached the top in the previous leadership contest- a darling of his parliamentary colleagues.

What is common amongst all contenders now is their commitment to Brexit, to tax cuts and to reduce the government/ public footprint. Rishi however, has his heart set on fiscal discipline, tax rises to fund investments and economic growth. Most healthcare professionals are far removed from the complexities of fiscal policy and many have little interest in party policies or politics. It is unwise to ignore the leadership race, as the values and beliefs of the new leader will indeed drive future policies and have a lasting impact on the health service, healthcare workforce and the health of the nation.

The priorities for the new leader for the healthcare sector should include -

  • supporting the ICSs to deliver on their aspiration for levelling up and tackling health inequalities working jointly with local government,
  • providing autonomy to primary care, public health and the secondary/ specialist care sector to determine their local priorities,
  • To work collaboratively with patients and the voluntary sector, in providing the tools to reach sections of society that are far removed from the NHS provision,
  • to reform the healthcare workforce by recognising the contribution of international graduates, funding adequate pay, improving working culture and environment,
  • To support NHS to become an anti-racist organisation, and a model employer -an exemplar in equality, social justice, embracing the power of diversity and inclusion.

Over the next few weeks, we will be seeking opinions and ideas from our readers to submit our proposals to the new leader, so feel free to contact us.


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