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The Parliament Brief: The triple threat facing the NHS as winter approaches

MPs hear about the pressures facing the health service, from waiting lists to strike action.

By Samir Jeraj

Welcome to the Parliament Brief, where Spotlight, the New Statesman’s policy section, digests the latest and most important committee sessions taking place across the House of Commons and House of Lords. Previous editions can be found here.

Who? The Health and Social Care Committee took evidence from Amanda Pritchard, chief executive of NHS England and Professor Stephen Powis, the national medical director at NHS England.

When? Tuesday 14 November 2023 at 10am.

What was discussed? Waiting lists, the involvement of independent (private) healthcare providers in NHS services, the workforce, dentistry, professional standards and whistle-blowing.

Why did this come up? The session was for general scrutiny of the work of NHS England, but against the background of record waiting lists, staff strikes and the oncoming winter, the session felt more urgent.

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So what did they say? Pritchard said that she had already met the new Secretary of State for Health and Social Care, Victoria Atkins, assuring MPs that they had had a “wide-ranging discussion” but that the immediate focus for both was the coming winter. She added that waiting times would have started to fall by the end of the year had it not been for industrial action, but pointed to successes in reducing the longest waiting times (which had been in excess of two years).

The committee chair, Steve Brine, quizzed Pritchard on the shifting of £800m in NHS budgets to tackle the crisis in acute and emergency care, and what is going to suffer as a result. Last week, the NHS announced it would be transferring the sum across NHS trusts to cover funding gaps. Pritchard said £300m had come from government and the other £500m from “things that have not yet been spent on tech and on capital”.

On industrial action, Powis said that the relatively short notice given for strikes and gaps in between strike action were very disruptive – though this is surely the point of it. “Consultants have been providing six weeks’ notice, but even that is not sufficient for planning,” he said. NHS England is particularly concerned, Powis added, about patients who are outside the urgent category of “needing immediate treatment”, but who need it within a month. He gave the example of cancer and cardiac patients. Powis said NHS England had raised this with the British Medical Association (BMA).

The NHS workforce plan also came under scrutiny. It assumes the workforce will become “more productive” by around 1.5 per cent to 2 per cent – but is that achievable, asked Brine? Pritchard said these gains would require continued investment in technology and the NHS estate, but warned that the way productivity is currently measured in the NHS is quite “blunt” and does not take into account things like diagnostics. 

Rishi Sunak’s promised ban on smoking was welcomed when Powis talked about the role of prevention and public health. “The chief medical officer and I, for the last 18 months, have been banging on that this is everybody’s business,” he said.

Any conclusions? Pritchard and Powis regularly highlighted the impact of strikes on the performance of the NHS. Clearly NHS England is concerned about the impact of future industrial action by the BMA.

One of the ways NHS England is tackling its lengthening waiting lists is allowing service users to choose to go for appointments or treatments further away, though only 3.5 per cent are taking this up in pilots of the scheme. This is also linked to the increasing use of private healthcare for those able to pay to speed up their treatment. Pritchard highlighted the role of innovation, using new technologies like AI to provide better services, but will the NHS be able to innovate itself out of its crisis without a measure of stability first? NHS digital transformation and the productivity gains envisioned in the workforce plan seem a long way off.

While prevention and public health are generally agreed to be the best way to promote health, public health budgets have been cut heavily since being devolved to councils. And the focus of politicians will always be on waiting lists for operations rather than “stop smoking” programmes, or decent housing.

What next? As this is not part of an inquiry, the session will not necessarily produce a report with recommendations. However, expect the performance of the NHS over the winter to be under scrutiny as traditional “winter pressures” lead to a rise in hospital admissions. With a new secretary of state starting in the health department, there is also the possibility that priorities change – although it would be difficult to see how. When David Cameron was running for prime minister he said he could sum up his priorities in three letters “N, H, S”. Now he has returned to government, he might actually be held accountable for its state.

[See also: Can Victoria Atkins, the new Health Secretary, save the NHS?]

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