In his first week in the post, the new Secretary of State for Health Sajid Javid has already noted that his first priority is to navigate the next phase of the pandemic. With Covid-19 on the rise, the continuing threat of new variants and an expected spike in flu and other respiratory illnesses, alongside the ever-growing waiting list across the services, the NHS is facing the perfect storm.
All this is happening against a background of huge change in the NHS: Simon Stevens is due to step down as CEO of NHS England at the end of this month and so the appointment of his replacement will be near the top of the list, as Javid has the right to veto the board’s decision. The new CEO has some big shoes to fill, largely delivering Steven’s vision over the next five to ten years. One could argue that the job has probably never been more difficult. Whoever is the chosen one needs to be able to, manage the politics; understand the funding and how to work with Treasury to get the best deal; be creative in strategy; strong and focused in operational delivery; and a strong leader of people who can unite an exhausted workforce. Are the remaining three strong in all those areas? The NHS needs strong leadership from its new SoS and from its new CEO over the next few years.
Big structural changes in the NHS are about to happen: these are captured in upcoming legislative proposals that will see the abolition of CCGs and the creation of Integrated Care Systems and Partnerships. The legislative proposals are the biggest since Andrew Lansley’s controversial 2012 Health and Social Care Act reforms, which Javid voted in favour of and the White Paper is largely unpicking. With the Parliament timetable set, the Bill needs to go to its second reading before the summer recess if ICSs are to receive statutory footing by April 22. We’re all keen to hear Javid’s thoughts on this and some quick decisions made.
Javid has stated his ambition to tackle social care, staffing and safety, while these are laudable ambitions, there is also much more coming down the line. These are the items we feel should be on Javid’s list:
1: Empowering NHS bodies locally so we can live with Covid-19
Javid will need to work quickly to put plans in place to ensure we can live with Covid-19 longer term. The Prime Minister has been talking recently about a planned Covid-19 booster campaign, possibly combining this with the flu vaccination programme. Moving from a one-off emergency response to ensuring the NHS can vaccinate everyone who needs a Covid-19 jab year in year out means empowering local NHS bodies to make Covid-19 vaccination part of their everyday work. Integrated care systems will have a crucial role here; given their ability to bring together GPs and Primary Care Networks, trusts, local government, and the voluntary sector. Javid will need to ensure that the Government and national bodies work with NHS leaders to get the planning on track for winter pressures to manage the risks ahead.
Staffing is quite rightly a key area the new Secretary of State has said he’ll be focusing on and although health and social care staff have done extremely well to get us to this point, there is no doubt they are on the verge of burnout. System leaders have reported they have seen evidence of staff leaving their organisation due to early retirement, burnout, or the impact of working in the pandemic. With his experience of the Treasury, there is a lot of expectation for him to deliver a fully funded people plan to set out the future shape and size of the NHS workforce, with investment in training, recruitment, and retention.
3: Long-term strategic investment in social care
Javid will also have the upcoming Comprehensive Spending Review front of mind. The budget and last year’s spending review didn’t offer much optimism. The one-year funding settlement for social care was barely enough to meet the demand for this vastly overstretched sector and was silent on social care.
Javid must garner cross-party and public support for the required investment and reform of social care. Social care desperately needs a longer-term funding settlement and radical reform. Against a backdrop of competing priorities, it is often left with a familiarly vague Government commitment to bring forward proposals ‘later this year’. It is crucial that any long-term investment in the NHS goes hand in hand with a long-term funded plan for the future of social care.
4: Patient safety
The relentless pursuit of patient safety is every healthcare leader’s primary moral obligation. Over the years there has been a vast array of safety improvement interventions. Not least the most recent update to the patient safety strategy published by NHS England, which looks to better address inequalities. There is no doubt that improvements have been made, because of this strategy bought about by Javid’s earlier predecessor Jeremy Hunt, but we know it is not being consistently applied as we continue to see patient safety issues being buried away in hospital reports. Last year it was reported that over 11,000 deaths resulted from patient safety incidents. Javid needs to change this by putting effective learning and meaningful change in place.
The list of priorities for the new secretary of state is indeed long but he must grasp that nettle and get a plan in place, one that health and social care leaders can be confident to deliver, protects and retains staff and one that supports the ever-increasing demands of the health and care of the population.