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How to reform the NHS to cope with winter pressures

January 13, 2018

Every winter we see the same headlines about patients waiting long hours to be seen, sometimes kept on trolleys in corridors or in ambulances backed up outside A&E.  All governments, Labour, Coalition and Conservative respond by saying that they have already allocated more money and planning for winter pressures is better than before.  But this year it does seem to be a lot worse.

My own local hospital in Bristol, Southmead, is reported today (http://www.bristolpost.co.uk/news/bristol-news/southmead-hospital-bristol-worst-country-1048383 ) to have the most patients in England waiting more than 12 hours to be seen in A&E.  The hospital managers say they are running at 104% of capacity, management speak for bursting at the seams. The Bristol Post reports that some patients in the hospital have gone without hot meals.  A nurse claims that staffing levels in her department are a third below their required level.  We thus have a terrible combination of patient excess demand and clinician under supply.  Action is clearly required immediately to inject the resources needed to bring services back into balance.  But to avoid a repeat in 12 months’ time a big shift in political thinking by the government is required.

The first big initiative should be a fair way of finding extra money. The NHS will celebrate its 70th birthday this July.  When it was founded not many people lived beyond their seventh decade.  Yet even without the current pressure of an ageing population it was recognised at the outset that there would never be enough money and rationing was part of the system.  Aneurin Bevan thought that the best way to secure maximum resources for his NHS was to take the funding from general Treasury resources.  He did not want the NHS or treatment entitlements to be linked to national insurance in the same way as the other pillars of the welfare state, social security benefits and pensions.  I have thought for many years that this principle needs to be set aside.  We need a full understanding of what 21st century healthcare expectations will cost and then a clear and fair way to find the resources.

I believe that we need a new tax, specifically dedicated to raising the money for the NHS. It should also fund social care services, the cost of which is currently borne by local councils. The clearest and fairest way to do this is to reform national insurance and dedicate all the proceeds to a combined NHS and Care system.  This would give the system the resources it needs and each year the Chancellor would adjust the tax to keep revenues at the right level to support service needs.  This would enable politicians to be clear with the public about how much the system costs and how much we all need to pay. It would also relieve local government of its biggest spending commitment and reduce the level of the unfair council tax. I’ve written more on how the new tax could work here – https://stephenwilliamsmp.wordpress.com/2016/09/29/a-new-tax-to-fund-the-nhs-and-care/

Money raised for the NHS is spent mostly on its staff.  Extra money from a new tax should enable recruitment of a larger workforce.  But this will not be easy.  Training doctors, nurses and paramedics takes time. The NHS is the country’s biggest single employer and its workforce is made up of people from all over the world.  Britain’s exit from the EU next year will make it harder to recruit key staff as freedom of movement comes to an end.  Indeed the inflow of key workers from other EU countries is already drying up and many of those who are already here are choosing to leave for better opportunities (and a more welcoming environment) in France, Germany and our other neighbours.  So the second major and urgent shift in thinking is about the impact of Brexit on our NHS and care services.  The government needs to make an emphatic statement guaranteeing the rights of existing EU origin workers.  If we are to go ahead with the madness of Brexit then something that replicates freedom of movement needs to be in place for essential public services.  My 10 years’ experience as an MP in a cosmopolitan city with two major hospitals and two major universities showed me that the Home Office is a useless dysfunctional outfit that cannot manage effectively the existing visa regime.  Imagine the utter chaos that will ensue in March 2019 if we apply a work visa system to everyone from the EU. There is no sign that Theresa May grasps that her obsession with reducing immigration is going to inflict massive damage on the NHS.

The third shift in thinking has been slowly gathering pace for several years.  The boundary between the NHS and social services care causes problems for both sides.  The systems have different political masters and different funding streams so it is hardly a surprise that there is a failure to deliver a seamless service to the patient.  The Coalition began in 2014 to bring the systems together by pooling some local NHS and council budgets into the Better Care Fund. Mrs May’s shambolic reshuffle of her government this week renamed the Department of Health to add Care to the title of Secretary of State Jeremy Hunt.  It is unclear at the moment whether this means that Hunt and the new DoHC will be taking over care funding from my old ministerial department of DCLG, which also got a name change.  The Liberal Democrats have called for some time for the NHS and Care to be merged.  But without new funding Mrs May’s adoption of our approach will remain cosmetic.  At a local level elected Mayors and councillors need to focus on what they can do to align their social services departments with local NHS hospitals so that patients are admitted only when they need to be and are discharged promptly.

More money, extra staff and closer integration of services are all needed to avoid not just seasonal pressures but to make the NHS and Care fit for purpose all year round.

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One Comment leave one →
  1. Kevin Yorke permalink
    January 15, 2018 9:26 am

    Good Morning Stephen,

    Yet again another articulate and well thought out blog explaining your views on how to tackle the problems within the Health Service. However I will pick you up on one point which you failed to raise and that is recruitment and retainment of overseas workers within the NHS.

    You are right to say that due to Brexit then EU Nationals currently working within the NHS are leaving and that recruitment is drying up. Can I draw your attention to the Office of National Statistics who state (November 2017) since the EU Referendum in June 2016 that 10,317 foreign nationals left the NHS. This is in line with current trends where from the periods of 2012-2013 (9,451 left the NHS). 2014-2015, 1,1878 Foreign Nationals left the NHS.
    However in the same corresponding years, data from recruitment as specified that from 2012-2013 11,101 Foreign Nationals entered the NHS (+1650). 2014-2015 (-619) and since the Brexit vote in June 2016, 10,317 Foreign Nationals left the NHS whereas 13,467 Foreign Nationals entered the NHS (+3150).

    As you can see Stephen, the Brexit vote has had no detrimental effect whatsoever on NHS Recruitment since the Brexit Vote. Could you please update and amend your blog to reflect these figures?

    Can I leave you with a statement from the UK Independent Fact Checking Charity……

    Across the UK, EU immigrants make up 10% of registered doctors and 4% of registered nurses. Immigrants from outside the EU make up larger proportions. Restrictions on non-EU immigrants have affected NHS recruitment, suggesting that the same could happen if there were limits on EU immigration. However, these restrictions did not trigger a process of existing healthcare workers fleeing the UK.

    Thanks mate and keep the blogs going and hopefully you will get back into Parliament to implement your well thought out views. Even though we disagree on Brexit then I have always said that you were one of the most hard working MP’s in the country.

    Kind Regards…….

    Kevin Yorke.

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