Therese Coffey’s much vaunted new plan for the NHS, ridiculously titled Our Plan For Patients is neither new nor a plan. It lacks both of the elements that are needed to make its limited promises a reality: extra funding and a plan to secure sufficient workforce.
The main selling point to grab headlines was declaring an “expectation” that a patient who needs an appointment with a GP within two weeks should be able to get one. But this is a feeble and belated echo of the guarantee made in 2000 by New Labour’s NHS Plan that all patients would be able to see a GP within 48 hours by 2004, and indicates how far the NHS has declined since George Osborne slammed the brakes on spending back in 2010.
In fact, Coffey is proposing that 3 million people seeking to see a GP (about 1 percent of the total demand for appointments) should instead be offered appointments with pharmacists, physiotherapists and other health professionals, who may or may not be seen as able to answer the problems that are raised.
The vague and evasive wording circles round the fact that Coffey cannot compel GPs to cap waiting times at two weeks: that would require renegotiation of the GP contract the Department of Health and Social Care agrees every year with the British Medical Association. It would mean talking to people: this government does not do that.
Indeed Coffey’s announcement was drawn up in a few days without bothering to consult GPs or the wider NHS, and crudely cobbles together odds and ends from previous NHS England policy guidance.
It claims to “sit alongside the NHS Long Term Plan, the forthcoming workforce plan, and our plans to reform adult social care.” But the Long Term Plan has already been effectively derailed by the lack of funding, capital to invest in new projects, and staff: the ‘workforce plan’ has been repeatedly promised, but stalled since at least 2014 by the refusal of the Treasury to commit to the resources needed to recruit and train additional staff.
And the hollow claim by the Johnson government to have ‘fixed’ social care is almost comically exposed by the chronic problems hospitals face in discharging patients for lack of social care support.
Labour’s plans from 2000 that made it possible to bring down waiting times in A&E and a maximum 18 week wait for elective care as well as improved access to GPs were backed by a decade of significant investment in the NHS and expansion of its staff. By contrast today’s threadbare promises made by Coffey follow 12 brutal years of real terms cuts in spending and years of broken promises to increase numbers of GPs. There are now 1850 fewer GPs in post than there were in 2015.
To make matters worse the right wing newspapers and news media that eagerly backed the Truss takeover of the Tory Party have also been conducting relentless campaigns of vilification against GPs, disregarding the astonishing effort GPs have made to increase numbers of appointments in spite of their growing caseload and the additional tasks dumped upon them by NHS bosses.
Indeed 85% of appointments already take place within two weeks, and 44% on the same day as the request. Contrary to the assertions of the right wing press, two thirds of these appointments are face to face: 30% are telephone consultations, often more convenient and efficient for both doctors and patients. To insist that all have to be face to face would inevitably reduce the number of appointments available.
Coffey’s plan claims to “focus relentlessly on ABCD – ambulances, backlogs, care, doctors and dentists.” But this leaves out so many pressing issues (e.g. A for anaesthetists and other staff shortages; B for beds and actual front line capacity; C for collapsing hospitals and the £9bn-plus of backlog maintenance; D for dementia and the dreadful gaps in mental health services which never feature at the top of any priority list). It also lacks any commitment of new funding or resources.
Even the £500 million now allocated for a short-term a ‘Adult Social Care Discharge Fund’ is not new money. And the announcement that this Fund is to be cobbled together from reallocating cash from the DHSC budget is followed in the Plan by an ominous commitment to
“further action from next year to rebalance funding across health and care, to establish a strong and sustainable social care sector with greater accountability for use of taxpayers’ money.”
Given PM Liz Truss’s few statements on the NHS and social care, this seems to threaten that any increased funding for social care will be snatched from an already inadequate NHS budget.
With no more cash on the table the whole statement is reduced to the trivial and token gestures. The response to ambulance delays is to recruit more call handlers to answer the phones quicker, and once more to repeat the tired old nonsense of trying to redirect patients away from A&E.
- “dedicated 24/7 helplines for patients experiencing a mental health crisis”
- supporting the NHS to better redirect patients to … urgent care centres, walk-in centres or minor injuries units
- expanding the use of remote monitoring of patients at home …
- expanding “falls prevention and falls response services, to avoid unnecessary ambulance call-outs and emergency admissions”
Ms Coffey is apparently oblivious to the fact that these alternatives have been tried and failed in the past. They need more staff and resources and much better community and primary care provision to make them possible … and are simply irrelevant for the most serious Type 1 and Type 2 patients who need ambulance services and are most likely to need a hospital bed, but face the longest delays.
Coffey’s plan to expand hospital capacity is to “open up the equivalent of 7,000 beds” – an idea plagiarised from the vague and unconvincing plans from NHS England for “virtual wards” which we have discussed at length in The Lowdown:
Moving on to B for backlogs, Coffey’s plan is similarly recycled verbiage from the NHS England Delivery plan for tackling the COVID-19 backlog of elective care – which we know is heavily dependent on utilising private sector beds and facilities, and impeded by the dire staffing shortage.
Coffey also repeats stale old pledges to recruit 50,000 more nurses by 2024 ignoring the official figures showing 132,000 vacant clinical posts in England and other statistics showing the increasing numbers of staff leaving the NHS through burn-out, or for less stressful, better-paying jobs elsewhere.
And her only substantial reference to mental health focuses not on the proven and widening gaps in care, but waffles vaguely about “access to NHS talking therapies, children and young people’s mental health services and enhanced community support for adults living with severe mental illnesses and expanded support in schools.” With no new resources on offer and mental health staff shortages generally the highest in most areas, none of the bland words will lead to any real change.
On C for Care, Coffey has nothing of substance to say apart from promising a £15m effort to recruit staff from overseas which we know already will struggle to attract anyone given the appallingly low pay and poor conditions of work in social care, and the huge obstacles to overseas recruitment erected by previous Home Secretary Priti Patel’s vicious immigration laws.
And on D for Doctors and Dentists the main focus is NOT how to recruit, train and retain the necessary qualified staff, but on piling more pressure on GPs alongside vague promises of new incentives to dentists.
But with insufficient staff, no new money, soaring inflation and energy costs and local NHS Integrated Care Boards facing demands to cut spending this year to balance the books, Coffey tacitly admits the system can only work if she can persuade more people to fill in the gaps by working for nothing as ‘volunteers’:
“To succeed, we need a national endeavour. That could involve clinicians who have retired to return to work or opening up opportunities for the million people who volunteered to help during the pandemic, like becoming community first responders or Good Neighbour Scheme leaders.”
While thousands were indeed willing to volunteer to assist the NHS in the fight to tackle the pandemic, it’s far from clear that the same reservoir of good will and dedication would apply to apparently indefinite unpaid voluntary work to bail out an NHS that has been deliberately and systematically under-funded by a government seeking to line private pockets rather than protect and develop our most popular public service.
If ministers took the future of the NHS seriously they would be applying a ‘laser like focus’ on recruiting, training and paying a new army of recruits to deliver services safely and effectively rather than trying to cobble together a Dad’s Army of retired staff and well-meaning but unqualified volunteers to plug the gaps they have created in 12 disastrous years.
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