With the healthcare system on its knees, 'The Saj' talks about making plans

Andy Cowper reviews the last month of health and social care news
Health secretary Sajid Javid and PM Boris Johnson visit the construction site of the new children's hospital at Leeds General Infirmary. Photo: Christopher Furlong/Pool via REUTERS/Alamy Stock Photo

By Andy Cowper

19 Nov 2021

Last month, we looked over the political party conference season as it affects health and social care. A lot has moved on since then.

Firstly, and most importantly, it looks as if the lobbying scandal around Conservative MP Owen Paterson’s work for serial Covid-19 contract winners Randox Laboratories, and the government’s attempt to subvert the Parliamentary Standards Commission’s ruling against him, may have started to shift the dial on the government’s popularity.

In a remarkable turn of events, Times Radio’s Tom Newton Dunn reported that Conservative backbench MPs are telling him that government whips are placing the blame for that “disastrous motion” on Paterson’s case at the feet of Boris Johnson, saying the chief whip did not instigate the motion but “was following direct orders from the PM”. 

Once the whips are briefing against No.10, as Newton Dunn notes, things have gotten very interesting.
We’ve also had a Budget and Comprehensive Spending Review, of course. So, how was that for you?

Income optimism

Having promised in the media run-up that this budget would “usher in a new age of optimism”, Mr Sunak’s Budget speech described how “the health capital budget will be the largest since 2010… 40 new hospitals; 70 hospital upgrades; more operating theatres to tackle the backlog; and 100 community diagnostic centres, all staffed by a bigger, better-trained workforce, with 50,000 more nurses and 50 million more primary care appointments”. There are, of course, no 40 new hospitals, as Full Fact has confirmed. 

Mr Sunak went on, “we have taken some corrective action to fund the NHS and get our debt under control, but as we look towards the future I want to say this simple thing to the House and the British people: my goal is to reduce taxes”. Well, it’s a point of view. 

Yet it’s clear from analysis by the Office for Budget Responsibility, the Institute for Fiscal Studies and the Resolution Foundation that the national direction of travel is towards higher taxes. IFS director Paul Johnson observed: “Health spending was topped up again, partly because of a higher inflation forecast, and partly because the OBR expects the health and care levy is to raise a couple of billion more than the Treasury thought last month. The latter is a nonsense. We can be sure of two things. The amount the NHS needs is entirely unrelated to how much the levy will raise. And NHS funding would not have been cut if revenues had moved in the other direction.”

The Johnson you can trust concluded that “Mr Sunak has bowed to the demands created by public services which have suffered a decade of cuts, and to the inevitability of increased spending on the NHS.” Quite. 

No workforce plan

Mr Sunak’s failure to fund a workforce plan as part of the Comprehensive Spending Review was noted by the King’s Fund and Health Foundation, with the Nuffield Trust reviewing progress to date towards workforce targets. 

In the middle of Mr Sunak’s fiscal drag act of a Budget, smart observers such as HSJ noted that the key determinant of NHS progress – workforce staffing and training budgets – remained pointedly unaddressed. Hey-ho.

Former health secretary, and current chair of the health and social care select committee, Jeremy Hunt has also moved an amendment to the health bill currently before parliament, which would introduce a legal duty on the government to publish regular workforce demand and planning projections.

Analysis of NHS Digital workforce data by the Liberal Democrats shared with the Guardian suggests that general practice is facing a workforce meltdown. The data on retirement trends “suggest that with 6,421 GPs aged 55 or over, on average almost every surgery in England could soon lose one of its doctors”, the piece suggests.

No pressure drop

On the eve of this month’s national waiting time announcement, the NHS Confederation released a worrying if unsurprising survey of its members, also to the Guardian. It emphasised that patient safety is at “unacceptably high” risk. It seems that Sajid “The Saj” Javid’s assertion that “we don’t believe that the pressures currently faced by the NHS are unsustainable” may not age well. 

The latest NHS England waiting list data, perhaps predictably, showed a new high of over 5.8 million, with two-year waiters up by 3,000 in a month. Emergency care waiting times have also deteriorated. NHS Providers issued a report of similar warnings about pressure and performance issues just before their annual conference. 

Meanwhile, the Independent had a worrying leak from the Association of Ambulance chief executives. The body reports that tens of thousands of sick patients are being harmed as a result of ambulance delays outside hospitals. Their report features examples of severely ill patients not being treated properly, being forced to go to the toilet in ambulances, and being denied food and drink, as well as antibiotics and fluids. East of England ambulance trust’s entire comms infrastructure with its crews went down for what seems like most of a day, HSJ reported. 

No plan

We are in the extraordinary position – in the middle of a real NHS crisis and as waiting lists head inexorably up towards six million – of having no workforce plan and no backlog plan.

The Saj is merely talking about making such plans. His contribution to improving current NHS performance is having a series of regular “bollockings” meetings with NHS England boss Amanda Pritchard. Perhaps they make him feel powerful: who knows? 

Is The Saj actually, you know, doing anything else? Oh yes: he’s also re-announcing the appointment of Sir Michael Barber to help on the backlog and performance issues. Barber, former head of the No.10 Delivery Unit under PM Tony Blair, has been advising the government since earlier this year, as news reports from April confirm. 

The Force – not actually a real thing, Saj

I’m starting to wonder if noted Star Wars fan The Saj actually believes that public sector reform is driven by the Force. Or,        
being as he is as an Ayn Rand fanatic, by the force of an individual’s will.
If “The Saj” believes in either of those fictions as likely solutions to the workforce and backlog issues, he will be very disappointed. 

Andy Cowper is the editor of Health Policy Insight

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