A new plan to rescue struggling NHS emergency services, pledging 800 ambulances, 5000 more hospital beds and bolstering community care has been launched by Rishi Sunak. Although the plan is to be supported by a £1bn fund, it has since been confirmed that this is not new funding, which has led to renewed calls for wider action on the staffing crisis and long term investment.
Follow-up analysis of one of the key parts of the plan – to raise NHS hospital bed capacity from its current level of 102,000 has clarified that it will only introduce 1000 new beds as the remaining 4000 represent existing beds which will be moved from other areas, such as top-up bays and corridors.
In fact hospital bed numbers have been falling for a decade, down by 12% since 2011, contributing to the recurrent blockages and delays in accident and emergency. Even if the new plan were to open 5000 new beds it would still only return the NHS to the number of available beds in 2010/11 (107,448).
Any new ambition to raise capacity has to first deal with how services will be staffed. and as Patricia Marquis, the Royal College of Nursing’s director for England points out “extra beds are only safe when there are enough nurses for the patients in them. And because of the workforce crisis, existing services are unsafe.”
Without the workforce strategy – promised at least two Tory leaders ago, this plan lacks the power to raise capacity and make meaningful change. Professor Alison Leary, nurse and professor of healthcare and workforce modelling at London South Bank University told the Nursing Times ”It is hard to see how any meaningful recovery plan can be designed or implemented without the largest safety critical workforce in healthcare.”
Important promises to introduce new resources, like the fleet of 800 ambulances which “are expected to be available during 2023/24”, sound hollow without a convincing plan as to how they will be staffed within the time frame.
Sunak’s attempt at headline grabbing proposals only partially recognises how stresses are passed between sectors. Ambulance workers are amongst those calling for capacity planning across all areas of the NHS as much of their workload results from the excessive pressure on GPs, mental health services and in social care.
The emergency care plan does make a significant promise to expand intermediate care – a care stopover between hospital and home, but this would rely heavily on substantial investment and a strategy setting out who would build and run these new services. Would they be in residential care, private facilities or in new facilities run by the NHS? This is an important medium to long-term ambition but so far there is little detail behind it.
GPs only receive a cursory mention – with the plan promising alignment with a forthcoming GP access recovery plan, but social care features strongly with commitments to improve collaboration between agencies and discharge procedures. The report reminds us of the £7.5bn allocated to social care over the next two years, but the major supply side questions remain unanswered. How is the workforce crisis in social care being addressed? Where will much needed extra capacity come from? Age UK point to 2.6 million people aged 50+ who still aren’t receiving the care and support they need.
As an unresolved issue social care will be influential in the next election campaign. Labour have so far not given any further detail on their major policy idea of a national care service since Wes Streeting told the Guardian in the summer “I would love to see a national care service delivered exactly on the same terms as the NHS, publicly owned, publicly funded, free at the point of use, but we’ve got to be honest about the scale of the challenge. So our starting point is to make sure we deliver national standards for care users and better pay and conditions for staff who work in social care,”
Overall the Emergency Care Plan attempts short term responses but is cornered by the neglectful decisions of previous governments stretching back over a decade. Unsurprisingly there is no mention of the ongoing pay dispute, which is a short term lever the government can pull. Much of the plan focuses on the medium and long term, but too frequently without the detail and funding commitments to persuade NHS staff of a meaningful shift in policy towards building NHS capacity.
The plan unwittingly reminds us that raising capacity across the NHS has been ignored for too long. In the ambulance service the number of calls has increased by 77% between 2011 and 2021 whereas the number of ambulance workers has risen by just 7% – according to a GMB analysis. Ambulance services have “historically been under-funded, with financial settlements not keeping up with ever-increasing demand faced by the sector. This has an inevitable negative impact on patient experience and clinical outcomes, as well as the mental health and wellbeing of ambulance service staff.” according to NHS providers. Today 80% of ambulance staff say that there are enough staff in their organisation for them to do their job, and despite attempts to recruit and retrain staff many are now leaving the NHS.
Unison head of health Sara Gorton said: “The government has at last acknowledged that there are deep problems in emergency care. But if the prime minister wants to take credit for fixing emergency care next winter, he must first resolve the workforce crisis happening now.”
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