Healthcare has dominated the headlines of the world’s media for the past 18 months, with the global battle against the Covid-19 virus still raging. The period has also seen a transformation in the way healthcare systems operate, which much innovation.
Recent months have also witnessed a transformation in terms of the leadership of the UK healthcare system; Sajid Javid replacing Matt Hancock as Health Secretary and Amanda Pritchard taking over the mantle of CEO of NHS England from Sir Simon Stevens.
In this update, we look at four themes that have been in my view, particularly noteworthy here in the UK healthcare market over recent months as the UK vaccine rollout has permitted restrictions to be lifted from July this year.
Together they present challenges and opportunities to those within the UK healthcare recruitment and workforce management sector, a sector estimated to be worth £4.32billion according to the LaingBuisson Healthcare Workforce and Recruitment UK Market Report which was published in June 2021 and which I was privileged enough to author.
PEOPLE
Healthcare is quintessentially a “people” centric sector. So, quite rightly, there has been a focus on those working in the NHS and social care system and, in particular, their wellbeing given the extraordinary demands made upon them in the fight against the pandemic.
In June 2021, the House of Commons Health and Social Care Select Committee issued its Report entitled Workforce burnout and resilience in the NHS and social care; the Committee was chaired by former Health Secretary Jeremy Hunt. The Committee’s inquiry into this issue was launched in July 2020, the same month that the We are the NHS: People Plan for 2020/21 was published.
It pulled no punches in its conclusions about the dangers facing the UK healthcare system, stating that it faced an “emergency” regarding the risk of burnout for NHS and social care staff.
“Burnout is a widespread reality in today’s NHS and has negative consequences for the mental health of individual staff, impacting on their colleagues and the patients.”
It cited evidence from across the health and social care spectrum with witnesses expressing concern about the “exhaustion of large groups of staff”. For example, many workers the Committee heard were experiencing “heartbreak” at the level of excess deaths seen in that sector in social care.
But the Committee added that this precarious situation was not new or something arising from the fight against the pandemic. There had indeed been recognition of employee dissatisfaction prior to the first lockdown here in the UK, which was instigated in March 2020.
The British Medical Journal, to take one example, in January 2020 had reported a survey stating that one-third of doctors responding to the survey describing themselves as burned out. Furthermore, The NHS Staff Survey in 2019 found that 40.3% of respondents reported feeling unwell as a result of work-related stress in the last 12 months, up from 36.8% in 2016.
The HSC Select Committee did applaud the efforts of the NHS during the pandemic in terms of both resources it had devoted to supporting workforce wellbeing and the fact that the work of the healthcare workforce had gained wider public recognition during the pandemic.
Nevertheless, the Committee pointed out that (in addition to other factors related to conditions of employment and general workplace culture including issues of discrimination and bullying) the leading cause of the “emergency” situation was caused by chronic workload stresses resulting from poor workforce planning.
The Committee pointed to staff shortages as “the most important factor in determining chronic excessive workload”; it referred to evidence confirming deficits with the likes of the Royal College of Nursing estimating approximately 50,000 nursing vacancies across the UK prior to the pandemic and Skills for Care estimating some 122,000 vacancies across social care in 2018/19.
The Committee proposed additional support and resource to support workforce wellbeing but insisted that without proper funding for both social care and NHS (as well as a People Plan for the social care sector) the threat of burnout would not be solved. In its conclusions, it used direct language:
“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning.”
PERFORMANCE
The Health and Social Care Select Committee’s warnings about the wellbeing of the healthcare workforce (published in June 2021) resonate deeply, given the mounting current pressures affecting the healthcare system and the projected needs it has for even more staff in the future.
In September 2021, NHS England, for example, issued its performance summary for the July-August 2021 period and this made for grim reading.
This includes the fact that over 96,000 patients spent more than four hours waiting for a trolley from a decision to admit to admission in August 2021, the highest number for any August since records began.
Even more starkly is the confirmation that the number of people awaiting elective treatment increased to over a 5.6million in July 2021, the highest level since records began. In addition, many commentators (and indeed the Government itself), such as the Health Foundation, estimate that this record number could increase dramatically. During the pandemic, millions of patients who had been expected to be referred for treatment were not, and estimates put this “missing patients” number at 8 million.
This is in addition to the 5.6million awaiting treatment referred so the actual numbers are potentially awaiting hospital treatment could exceed 13million.
Furthermore, as the UK population ages and expectations of healthcare service delivery rise too, the pre-pandemic staff shortages across healthcare referred to above may widen in the coming decade to meet this anticipated demand for services.
For example, the Health Foundation estimated the workforce gap in the NHS workforce at 115,000 in 2020/21 and states that this is projected to double over the next 5 years and may exceed 475,000 staff by 2033/34. And this excludes the potential impacts of the covid-19 pandemic!
Within social care, the Health Foundation and Institute of Fiscal Studies project that a further 458,000 social care staff will be needed in England by 2033/34.
These twin challenges (the current emergency in healthcare workforce wellbeing and the current backlog of people awaiting hospital treatment) would tax the will and resources of any Government but Boris Johnson’s administration has also taken this moment to pursue profound change in the very process of how the NHS operates.
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PROCESS
The Health and Social Care Bill (published in July 2021) is making its way through the legislative process and is arguably the most significant NHS reform since Andrew Lansley’s 2012 reforms.
In addition to giving the Health Secretary potentially profound increases in power to intervene in local health decisions (which has courted much controversy in media coverage), the Bill seeks to transform the way the NHS is organised.
At the heart of the Bill are proposals to promote the “integration” of health and social care. The aim being to allow a more joined-up service model across local authority and NHS service models with prevention of unnecessary hospital admissions (and more seamless discharge from them) being a key policy goal; fundamentally, it is about joining up different elements of health and care provision around individual patients and/or specific geographies.
Integration within healthcare policy has been much like Homer’s Odyssey, a journey with many meanderings over almost two decades since the Wanless Review (2002).
The Health and Social Care Bill will seek to put Integrated Care Systems (ICS) on a statutory footing. This will divide the service into 42 ICS’s to drive integration and collaboration in health and social care.
This new structure will also involve workforce planning at a systems/ICS level and will represent a potential opportunity for those in the recruitment and workforce management sector to partner with the NHS in innovative and creative ways.
However, it should be noted that there have been calls for the idea to place ICS’s on a statutory footing on hold on the basis of there being inadequate evidence to support the idea that this will lead to better results in terms of healthcare delivery.
The Centre for Policy Studies published a report this month (September 2021) entitled “Is Manchester Greater?” in which it examined the existing “pilot schemes” around integration. This included looking at the evidence over recent years from Greater Manchester (where integration is most advanced) and West Yorkshire (where integration is under direct NHS supervision) as well as 13 pilot areas.
It found results to have been generally poor and refers to the example of Greater Manchester which despite a cash injection of £450million to support integrated services, there has been a 65% increase in delayed transfers of care (i.e. from hospital to community settings) which the CPS Report describes as “the benchmark for whether health and social care systems are working properly together”.
The Report goes on to compare the results across the 13 pilot integration areas on a range of metrics. However, the most alarming finding was that delayed transfers of care increased by an average of 24% between 2016 and 2020, weighted for population, whereas the figure was just 9% in the rest of the NHS.
Karl Williams, report author and Senior Researcher at the CPS, said:
‘Ministers need to take a step back and let the pilot schemes run their course so we can properly evaluate their success. Now is not the time to push through costly and disruptive reforms that are not supported by the data, especially given the current pressures on the NHS and its staff.’
Whether this call for a pause will be heeded or not, the pressures to which the author refers are clearly evident from what we have discussed.
And (in part) to address these pressures on the NHS, the Boris Johnson Government announced significant plans earlier this month in early September 2021.
POLITICS
The Government has published a policy paper, Build Back Better: Our Plan for Health and Social Care, which outlines its plans to secure a total £36 billion increase in funding for health and social care services. This includes the introduction of a new 1.25% Health and Social Care Levy based on national insurance.
The Government also announced that it would also introduce a lifetime cap on personal contributions to the cost of care of £86,000, with those with between £20,000 and £100,000 of assets to be eligible for means-tested support. The Government announced that this would “end catastrophic costs for people across the country and include extra investment in the care sector to improve training and support.”
The Government described these measures as “responsible, fair and necessary action” and claimed they amounted to the “biggest catch-up programme in the history of the NHS and reformed the adult social care system”.
Of the £36billion intended to be raised by the Health and Social Care Levy, some £5.4billion has been earmarked to support social care over three years.
The bulk of the £36billion is, therefore, to be deployed to support the NHS and specifically to address the huge numbers of people awaiting hospital treatment which we discussed above.
The new CEO of the NHS, Amanda Pritchard, did, however seek to manage public expectations in respect to the waiting lists:
The waiting list for routine operations and treatments such as hip replacements and eye cataract surgery could potentially increase to as high as 13 million. While today’s extra funding will go some way to help reduce this number, waiting lists will rise before they improve as more people who didn’t seek care over the pandemic come forward.
There are two immediate policy-related issues that have occupied commentator’s minds arising from the Government’s plans to introduce the levy.
The first relates to whether the sums earmarked for the NHS will be sufficient to tackle its pressures and the huge elective backlog. Richard Murray, CEO at the King’s Fund, welcomed the three-year funding settlement for the NHS but warned that
“putting this funding to best use will critically depend on developing a plan to address chronic workforce shortages. Public expectations will rise with their taxes and the government must be honest about how long it will take to recruit and train enough staff to provide the tangible improvements to NHS care the public will expect.’
In terms of social care, his comments are more strident:
Social care will see only £5.4 billion over three years, with no guarantees of sustainable funding beyond this., there is a real risk this will leave inadequate financing to bring about meaningful change in areas such as workforce, access and quality.
Meanwhile, Natasha Curry, the Deputy Director of Policy at the Nuffield Trust, commented:
“While the decision to raise taxes for social care is bold and welcome action, the reality is the money left for social care (£5.4bn over three years) will only go some of the ways to stabilise a dire situation and leaves little for meaningful change.”
It is also perhaps instructive to note that the Health and Social Care Select Committee in its Report Social Care: Funding and Workforce”, published in October 2020 called for a 10-year plan for social care and stated a “starting point” for social care funding would be an additional £7billion per year by 2023/24.
What is clear from the above four themes is that healthcare is set to remain centre stage of political, economic and social imperatives in the immediate future and indeed beyond.
