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Public must debate true scale of NHS challenges

Most trust leaders say they don’t have enough of the right staff and investment to deliver high-quality health care

Louise Prime

Tuesday, 08 October 2019

Failure to present the public with the true scale of the challenges facing the NHS risks putting public faith in the health service “on the line”, NHS Providers warned this morning. Their latest survey revealed that most trust leaders believe there has been inadequate debate about the NHS’ challenges, opportunities and long-term future.

NHS Providers’ latest report looked in detail at the growing pressures and difficulties faced by trusts, despite welcome funding pledges from government and a new long-term plan for the NHS. It found that trusts need realism about the scale of the challenges facing the NHS; a funded, credible NHS people plan; clarity around the quality standards the public can expect from the NHS; whole system investment; and support for integrated care and system working.

In The state of the NHS provider sector, NHS Providers called for honesty, realism and transparency with patients and taxpayers about how much the NHS can deliver, and how quickly – “given how far current NHS performance has dropped, 100,000 staff vacancies, an underlying £4bn provider sector financial deficit, a £6bn maintenance backlog and no firm decisions on social care, public health, capital and training budgets”.

Its survey, which had responses from leaders at more than half (54%) of hospital, mental health, community and ambulance trusts, showed that the overwhelming majority (91%) do not feel there has been enough public debate about the challenges and opportunities facing the NHS and its long-term future. The survey also revealed that:

  • only 29% are confident that their trust currently has the right numbers, quality and mix of staff in place to deliver high-quality healthcare to patients and service users
  • 90% of trust leaders are worried about a lack of investment in social care in their local area
  • 77% of trust leaders are worried that there is not enough investment in public health and prevention services in their local area
  • 72% are concerned about whether their trust can make the capital investment needed to maintain and modernise the NHS estate and equipment. This is against a backdrop of £6bn of built-up backlog maintenance across the NHS, including £3bn that is safety critical.

Trust leaders said they were worried about their ability to deliver the “positive and ambitious aspirations set out in the NHS long term plan” – only 29% felt confident that progress towards system working in their area will move fast enough within the next 12 months to help them deliver the plan.

Furthermore, more than half (54%) of trust leaders said they did not believe that the necessary support is in place to properly join up working between GPs and hospital and community care; and 90% were worried about a lack of investment in their local social care.

NHS Providers call in their report for:

  • a funded, credible final NHS workforce plan that addresses recruitment, training, culture and inclusion
  • greater clarity on the quality standards the public should expect along with the resources to deliver them
  • a proper, full, multi-year capital settlement and appropriate sustainable funding for social care and public health
  • greater realism about the scale of the challenges facing trusts and the wider health and care sector and the current level of operational instability, which place significant constraints on how quickly the new NHS long-term plan can be delivered.

NHS Providers chief executive Chris Hopson commented: “It is very striking that over 90% of trust leaders are worried that there hasn’t been the full, frank and open national conversation about the severe pressures facing the NHS and how much these constrain what it can deliver.

“It’s an uncomfortable debate to have. The government wants to be seen as an effective steward of the NHS. NHS England and NHS Improvement want to be seen to lead the service effectively. And frontline leaders want to provide outstanding care to every patient. But we need greater realism about how much the NHS can deliver, and how quickly, given where we currently are and the challenges we face.

“It’s great that the new government has made the NHS its top domestic priority. Trusts have welcomed increases in funding compared with other public services and the ambitious plan for the next decade.

“But the NHS faces a triple whammy of rapidly rising demand, severe workforce challenges and the need to recover from the longest and deepest funding squeeze in NHS history. Current performance levels are the worst in a decade and trying to work NHS staff harder and harder is simply not sustainable.

“Unless we level with the public about how long it will take to recover from where we are and how quickly we can deliver the NHS long-term plan, public commitment to the NHS is on the line. NHS leaders are sending a clear signal that we need an honest, realistic and transparent view of the difficult choices and challenges – as well as the exciting opportunities – that lie ahead.”

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