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Can Keir Starmer transform the sickness service?

To fix the NHS, Labour must prioritise prevention, retention and capacity issues, say healthcare policy experts.

By Spotlight

As one of his five missions Keir Starmer has committed to building an NHS fit for the future, including through a renewed focus on prevention over sickness, creating more care in the community, and investing in the workforce and new technology. Spotlight asked healthcare policy experts what they thought of the Labour leader’s plans, and how the opposition could act on its promises.

We need a national retention scheme

by Professor Kamila Hawthorne, chair of the Royal College of GPs

General practice is in crisis, and we need a bold plan to improve care for patients. This September, general practice delivered more than 32 million appointments, five million more than in September 2019, despite a fall in qualified GPs.

The statement that primary care will be at the heart of Labour’s NHS plan is a promising start. We have called for a shift in focus from hospitals to the community, but extra responsibilities have not come with the requisite funding. If you want to improve access to GP services, resources need to follow.

Labour’s plans to expand training places for GPs is another positive. This is essential, but only one part of the puzzle. It takes at least ten years to train new GPs, and GPs are leaving the profession at a greater rate than they’re joining.

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It also leaves the question of where these extra GPs are going to train and work. Eighty-four per cent of practice staff tell us they do not have room for more trainees, and so far no party has committed to the capital investment required to make more spaces. Visa rules also need to change to ensure GPs from overseas who train in the UK can stay to work in the NHS once qualified.

Other proposals include more direct referrals to specialist services and incentives to support patients to see their doctor of choice, which we are keen to explore. We agree with Labour’s focus on prevention, and want measures to reflect this.

There is more we would like to see. Our manifesto sets out seven solutions, including a national retention scheme, cutting bureaucracy so GPs can spend more time with patients, and giving primary care the premises and tools it needs to keep patients healthier for longer.

Practices in the poorest communities – including those in rural and coastal localities – have more patients and fewer GPs. To truly tackle health inequalities, funding streams should change so greater spending goes to the areas of greatest need.

Overall, Labour has positive ambitions. We hope its manifesto will back these up with the pledges that would be required to turn them into reality.

[See also: Dropping the Mental Health Bill is yet another broken Tory promise]

Detailed policy will turn vision into reality

by Sally Warren, director of policy at the King’s Fund

Labour’s health and care plans centre on three big “shifts”: shifting care outside of hospitals by boosting primary, community and social care; moving from a sickness service to one based around preventing poor health; and embracing the full potential of digital technology.

Alongside these, the party has made ambitious commitments to expand the workforce, and quickly improve waiting lists to levels not seen since 2015.

Does the vision stack up? It is what a lot of people in the sector say is needed. But the sting in the tail is that the vision is what has been promised for more than two decades. National policy has been to shift care outside of hospitals for years, but the exact opposite has happened – a greater proportion of NHS staff and budget are now spent on hospitals. And we’ve lived through many a false start of an NHS technology revolution: robots and AI are exciting, but feel a long way off for the nurse taking 30 minutes to log in to their computer.

So, a vision isn’t enough. Labour will have to develop and share the detailed plans, policies and actions that turn that vision into reality.

Second, to achieve its vision, Labour needs to be clear about its plans for investment in the NHS. Whether that’s about pay for staff, structural reform, or improving buildings and kit, the level of funding will be a key constraint on how fast waiting lists can be improved.

Third, the pace of change relies on staff. Yes, training more staff is necessary, but so is action on working conditions, culture, leadership and flexibility to make a career in the NHS more attractive. On this we need more detail, or Labour’s vision will fail through a lack of staff to make it reality.

Finally, it’s encouraging to see recognition that the NHS doesn’t operate in a silo – from commitments to improve children’s health through breakfast clubs and mental health hubs in schools, to taking action to bolster social care. This is critical for a sustainable NHS, but more importantly for a healthy, happy and productive society.

[See also: People blame the economy and work for ill-health – not just the NHS]

It is much easier to make plans than deliver them

by Professor Jane Dacre, emeritus professor at University College London (UCL) medical school

As a former president of the Royal College of Physicians, current president of the Medical Protection Society, and a longstanding clinical academic and doctor, it saddens me to see that our NHS is struggling to cope, with reducing patient satisfaction and long waiting lists. This is worsened by the ageing population and chronic illness. Workforce shortages, staff burnout, patchy IT and poor buildings haven’t helped, and these issues have been exacerbated by the pandemic and staff strikes.

Labour’s Mission for Health pledges to “build an NHS fit for the future: that is there when people need it”. This commitment is welcome, and has the potential to make a significant difference, but the implementation of health pledges is complex; it is much easier to make plans than deliver them.

Shifting the focus of care into the community is an excellent aspiration, but so far, following the expansion of community pharmacy and other roles in support of primary care, the number of GPs is still falling, due to poor retention and early retirement. Addressing the mental health crisis is vital, but previous government pledges, such as to increase the mental health workforce, have not actually resulted in more mental health doctors and nurses.

The shift away from treating sickness to prevention is potentially transformational, so the aim to create longer-term funded plans is essential. This has been recommended by many medical royal colleges, and tried before.

The pledge to move to cutting-edge technology should improve care, but this is hampered by patchy implementation of electronic health systems, and low levels of digital literacy among some staff, patients and service users.

A National Care Service would be a big opportunity to improve struggling social care services, but data is lacking because the sector is not joined up, making it difficult to measure outcomes.

These commitments are great, but successful implementation will be very important and, ultimately, very difficult.

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

It is time to resuscitate emergency care

By Dr Adrian Boyle, president at the Royal College of Emergency Medicine

The NHS is in trouble and the public knows it. With winter on our doorstep, we don’t have the staff, beds or resources we need to give patients the care they need or deserve.

Many of our patients in emergency care, especially older and vulnerable people and those experiencing a mental health crisis, face extremely long waits. This can be life-threatening, and is devastating for the patients, their families and for staff. Despite the herculean efforts of stretched and burnt-out staff, the continued challenges mean patients are not getting the care they deserve.

Although it is an extremely challenging time for the NHS and social care, the issues emergency care and the wider health and social care system face are fixable. There is a huge opportunity to improve the lives and health of many people by tackling some of the existential threats to the NHS.

Looking at Labour’s plans for the NHS, there is a welcome focus on prevention, but even perfect prevention will only reduce some of the demand for acute services. Our population is getting older, and therefore needs more care, and at the moment there is just not enough of it. Improving the capacity of social care, not only to help people leave hospital but to avoid hospital in the first place, is vital.

The reality is the NHS is under-bedded, under-doctored and under-nursed. We have fewer beds per capita than almost any comparable country, and distribution of beds and access to care is unequal and frankly completely unfair.

What is desperately needed, more so than ambitions with AI, technology or increasing hospital machinery, is fixing the basics, and fixing them well. Whoever forms the next government needs urgently to increase the number of beds in hospitals, implement tangible measures to retain existing staff, and recruit more doctors, nurses and healthcare professionals.

And lastly, but possibly most significantly, get a grip of social care, so our older and vulnerable patients can receive the care they need and deserve with dignity in hospital, and return to the comfort of their own home or community in a timely way.

It is time to resuscitate emergency care and we urge all parties to adopt our priorities.

This piece was first published on 24 November 2023 in a Spotlight special print edition about Labour policy. Read it here.

[See also: Donna Ockenden: “Mothers were blamed for their own deaths”]

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