by GK Strategy 4th October, 2016

A “self-sufficient” NHS

Delegates, journalists, and laypeople alike eagerly tuned in to ‘domestic policy day’ at the Conservative Party Conference, keen to hear the May ministry’s priorities for – among others – the Home Office, Justice, and Education. May’s career up until this point has had very little to do with health policy, thus Health Secretary Jeremy Hunt’s announcement provided valuable clues as to the Prime Minister’s vision for the country. In addition, Conference is an opportunity to set the direction for the health service following the Government’s high court win over the junior doctors regarding the imposition of the new seven day contract. And, of course, the spectre of Brexit looms over it all.

It is clear that the NHS workforce is in a state of crisis, and was plunged into further uncertainty by the decision to leave the EU given over a quarter of the workforce was born overseas. So Hunt’s commitment to reform the workforce by adding 1,500 extra training places a year for British-born medical applicants – expanding the current number of places by 25 percent – is a clear sign that ‘Brexit means Brexit’ applies to NHS too. While he reiterated that EU staff do a “fantastic job” and emphasised that they were still welcome in the UK, his proposal expands the pipeline specifically to “home grown” doctors. Not only does he hope to expand the pipeline, but secure it too; those trained through taxpayer-funded training places would be committed to the NHS for four years after qualification. This, he announced, was to ensure the NHS was “self-sufficient” by 2020. Some uncertainty remains though – does the Government ultimately intend to replace all its EU staff?

Dr Mark Porter, Chair of the BMA, has already voiced his concerns on forcing doctors to remain in the NHS. Rather than locking them into service, we should be creating the conditions whereby they want to stay, although this is rather easier said than done. There remain questions over the critical nursing shortage, and the GP shortfall – both exacerbated by an ageing workforce, with a third of nurses set to retire in the next ten years. For conditions to improve and the NHS to remain an attractive prospect, the Department of Health must deploy measures to address these key factors. This would help to improve the low return to work numbers for workers tempted either by sunnier climes or the flexible hours and premium pay of agency shifts.

Some of the £100m for expanding training places will be funded by increasing costs for foreign students, though it’s unlikely any extra money will be supplied to deliver this commitment. However, the Government would argue that funding would come from savings from reducing hospitals’ agency worker spend. After the headline announcement of Hunt’s speech today, the finer details will slowly emerge in the coming weeks.

Nevertheless the policy gaps outlined above remain, and there are plenty of questions still for the future of the health service – no word on the obesity strategy, for example, or the much-vaunted Accelerated Access Review. It may be that health is to keep a relatively low profile on May’s watch, or a sign that her Government will focus the bulk of its energies elsewhere. Yet with patient demand rising, it is important to find new ways of addressing the workforce shortages. Government strategy must be more than one-off measures, and instead strive for holistic and whole-system approaches to truly deliver 21st century integrated health and social care.

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