Health professionals respond to plans by England’s Health Secretary to give NHS patients more choice by asking, ‘where are the solutions to staffing shortages?’

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Sajid Javid fleshed out plans for putting the NHS on the ‘road to recovery’ in a speech Tuesday afternoon that sparked controversy for having ignored solutions to solving the chronic workforce shortage.

In a speech on healthcare reform delivered at the Royal College of Physicians (RCP) in London, England’s Health Secretary delivered a well-trailed commitment that some NHS patients who found themselves stuck in long waiting lists for secondary care will be helped to choose alternative providers for their treatment.

The measure is part of reforms aimed at giving patients more choice, expanding personalised care, and improving health prevention, that also include an ambition to remould the NHS app into a ‘front door’ for health services.

‘Unsustainable’ NHS finances

Mr Javid told his audience that the health service must adapt to the long-term challenges of ‘changing demographics and disease, changing technology and expectations, and unsustainable finances.’

He said: ‘Taken together, it’s clear that we were always going to come to a crossroads: a point where we must choose between endlessly putting in more and more money, or reforming how we do healthcare.’

The case for reform had been strengthened by the COVID-19 pandemic, the Health Secretary added. ‘The risks of doing nothing have dramatically increased. It’s not that we would simply stand still, we’d actually go backwards: taxes and waiting lists would rise. That’s not going to help anyone. That’s not going to help people get their operations in good time. That’s not going to help staff recover from the collective trauma of COVID. That’s not going to help managers hold onto talented and dedicated colleagues.’

Health secretary championed ‘patient choice’

Setting out a proposal to expand the Government’s current target for 200,000 people to have a personal health budget by 2024, he said that, by 2030, he intended ‘personalisation to become the norm, and personal health budgets to be an increasing part of that’  in what would be ‘one of the biggest transfers of power and funding in decades: from the state, to the individual and their family.’

In the shorter term, patients who faced long waits for secondary care treatment would be contacted and given the ‘right to choose’ their provider.

‘I know it won’t be easy, and that we must begin by making this offer to the very longest waiters. So, by the end of December, people who are at risk of waiting 78 weeks will be contacted first’, Mr Javid promised, adding: ‘For the trusts with the highest number of long waiters, and those who have been waiting more than 2 years, they will be contacted by the end of this month.’

Although he did not specifically refer to it in his speech, The Times reported at the weekend that patient choice for those waiting the longest could extend to private health providers.

The British Medical Association (BMA) has predicted that the measure would ‘ultimately fail’ because the Health Secretary had ‘omitted the most fundamental element of any recovery strategy, which is tackling the chronic workforce shortages in the NHS.’

Dr Chaand Nagpaul, BMA Council Chair, said: ‘Choice can only be provided if there are enough staff to deliver it, and currently there is no clear plan to achieve this.’

Health tests ‘should be as easy as ordering a burger’

Ahead of the Government’s digital health and care plan, expected this spring, Mr Javid said that the NHS app, downloaded by millions since the pandemic, would become a gateway to NHS services. ‘You could say: the NHS app is for life, not just for COVID,’ he quipped, with the health system embracing technological changes that would make it ‘as easy for doctors and patients to order a blood test as it is to order a burger—or a salad—on your phone.’

Among other points made by the Health Secretary:

  • a target for electronic health records will be rolled out to 90% of trusts by December 2023, and 80% of social care providers by March 2024

  • the planned Health Disparities White Paper will be launched later this year and focus on preventing disease and addressing health inequalities

  • primary care, including GPs, pharmacists, and dentists will be ‘at the heart’ of prevention

  • community Diagnostics Centres (CDCs) will deliver at least 1.5 million extra tests in their second full year of operation

  • lessons learned from the COVID-19 vaccination programme will be built on to create a routine vaccination service ‘that doesn’t displace other health and care services’

  • the entire health and care system will be pushed ‘harder on the prevention of cardiovascular disease’

  • a commitment will be made to provide a long-term workforce plan. 

Where are the policies for solving NHS staffing shortages?

Commenting on the proposals, Andrew Goddard, President of the RCP, said: ‘The Secretary of State’s acknowledgement that there will be no additional funding to support this brings clarity, but this will undoubtedly make the challenge all the greater.’

He called for the Government to ‘accept the amendment made by the House of Lords last week, which would see regular independent assessments of how many doctors and other health care staff we need to meet demand now and in the future.’

The BMA said that Mr Javid should concentrate on proper funding for the NHS, which it said was more efficient and reliable than private providers. Dr Nagpaul warned: ‘We should also be wary of private providers bidding for contracts which cherry-pick low risk patients while being unable to provide comprehensive care for those with more serious and complex needs.’

Pat Cullen, General Secretary of the Royal College of Nursing said: ‘The nursing workforce crisis is adding to waiting lists and treatment delays. Without addressing this fundamental issue, other ambitions risk never being realised.’

On the increased role for CDCs, Dr Jeanette Dickson, President of the Royal College of Radiologists, said: ‘These will only be successful if we have enough radiologists to review the scans’, adding: ‘There is already a shortage in the workforce before these centres are fully rolled out, and the increased demand they create will stretch it even further.’

For an in-depth analysis of staff shortages in primary care, see Dr David Jenner’s article, Urgent action is needed to address workforce issues in primary care. 

This article was originally published on Medscape, part of the Medscape Professional Network.

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