The first major policy announcement from the re-elected Prime Minister on Monday was, perhaps rather surprisingly, about the NHS. This may be because the whole topic of the future of the health service was kicked around a lot at the General Election and there are, no doubt, fears still lingering in the wider electorate that there will be further reorganisation and ‘privatisation’ of the service under the returning administration. Allaying those fears was doubtless a serious political priority for the new government.
And the proposals from 10 Downing street (alongside the priorities being spelt out by the NHS Executive’s ‘Forward View’) were commendable – at least in principle. The emphasis was on prevention, primary care (with ‘whole person care’ as one of its core values), mental healthcare, joined up health and social care systems and a move towards a fully seven day a week NHS in England. Few working in the NHS would disagree that all of these are issues to be addressed.
The latter proposal of a seven day a week NHS service seems to have garnered the most political comment space – mainly because it will require a massive step up in the GP workforce, and in hospital staff. Running GP Surgeries seven days a week, with out-of-office-hours appointments and other services made available to a population that find getting to the family doctor during regular working hours increasingly difficult seems eminently desirable. Indeed, there have been some pilot out of hours GP services set up in several parts of the country.
More pressingly, mortality rates for patients admitted to hospital at the weekends are noticeably higher than those admitted during weekdays – up to 16% higher on Sundays. This is mainly down to lower staffing ratios at weekends, fewer theatres in operation and much reduced scanning and lab services at weekends. Making sure that the same essential services are running all weekend could have a significant impact on patient survival and recovery.
The major problem with this essentially sound idea is that it will require more staff, paid at higher rates for working unsocial hours. It will require more money for the running and maintenance of complicated medical equipment, heating and lighting, etc. It cannot be a cost neutral exercise.
And herein lies one half of the problem. The NHS will need another £30 billion a year just to keep ticking over at the current rate, let alone with any increase in service provision, such as those proposed. £22 billion, the NHS Executive claims it can find from efficiency savings, and £8 billion is being committed by government. But where is the extra cost of a 7 day per week NHS going to come from (as yet we have no figures)?
The second issue is staff. While we may be able to recruit more nurses from overseas (potentially depleting the health workforces of other nations), we are not going to be able so readily to recruit more GPs. The current intake of GP trainees is running at only 70% of the total needed – and that gap has gone up year on year. Newly qualified doctors are put off becoming GPs as they talk to those already in the profession and see the huge hours spent on the paperwork of managing the practice, let alone taking on their roles as commissioners within the CCGs. And the Secretary of State for Health admitted to the BBC that about half of all newly qualified doctors would have to train as GPs to fulfil the staffing need . It is also worth noting that new GPs take at least five years to train.
Talking with CMF GP members (many of whom also face critical funding shortfalls due to the withdrawal of transitional relief), it is clear that the stress of being a GP is,for many, becoming overwhelming. At the same time, mounting costs of running a practice mean that for many, their take home pay is shrinking as their workload goes up.
Many nurses are also getting stressed, their pay frozen for most of the last five years, with no prospect of that ending. Some unions are now claiming that the government will fund the increased service provision by cutting overtime pay – although the government deny this. Nevertheless, there is a real risk of industrial action by nurses, and a steady exodus of experienced nurses and midwives from the professions (projections suggest a decline in the nursing workforce of between 0.6 & 11% between 2011 & 2016).
Commitments to preventative medicine, rethinking and re-prioritising primary care and developing joined up health and social care planning and provision will also all take time, money, staff and goodwill. They are all good ideas in practice, but they have huge resource implications.
A notable omission in this speech was maternity care, which is struggling with a shortfall in midwives to meet the rising birth rate. Elderly care also was only referred to tangentially, and which likewise is a growing need with a shrinking resource and staffing base. We do face huge challenges in the years to come!
And yet we also have arguably one of the best health systems in the world, and certainly one of the most efficient. We expect a huge amount from the NHS – maybe more than it can now give. Gaps will appear, but where the NHS can no longer meet all the needs and demands that we place upon it, there is room for others to step in. In primary care, much of the need is for social support, training in life skills, providing a listening ear. Not all of this can or should be supplied by a GP – some of it can be taken on by practice nurses and nurse practitioners, counsellors, community chaplains, voluntary groups, churches, etc. In most practices, especially the more innovative ones, this has been happening for years, and is having a huge , positive impact. However, so much more could be achieved if more practices, more voluntary groups and more churches engaged in this kind of partnership.
Much of what GPs get used for are the sorts of social support that the local Vicar, Minister or Parish Priest would have undertaken in the past. Health promotion is being done now in churches through mothers and toddlers groups, through Parish Nursing projects, etc. It is time for more churches to reengage in the primary healthcare field as has been done so successfully with debt counselling, food banks and street pastors over the last few years? All it would be doing is reclaiming role it held for most of church history, and a role it still performs in much of the developing world.
Faith Action addressed the issue of working with the church to address social and health need in their Faith Manifesto for the General Election. It is time for Government, local authorities, the NHS and other state sector providers to look at how they can work effectively with the church as part of a wider engagement of society with our community health needs.