Recently appointed Health Secretary (and deputy Prime Minister) Therese Coffey is making headlines for all the wrong reasons. When announcing a plan to allow pharmacists to prescribe antibiotics to ease GP pressures (controversial in itself) this week, she admitted that she had dished out antibiotics to her friends when they had been ill. This—understandably—had the medical community up in arms, prompting a slap on the wrist from Number 10.
But the damage had already been done. NHS staff have for years been responsible gatekeepers of such drugs, understanding that growing antibiotic resistance is a significant world issue—and that the message she sent was therefore deeply problematic. If that wasn’t enough, Coffey courted more anger when she said in a televised interview that there would be no pay rise for nurses, and that ‘if they don’t like it, they can go elsewhere.’ How she thinks the NHS can carry on when it is already short 40,000 nurses is anyone’s guess.
These multiple cases of myopia are signs of a health secretary completely out of her depth, and at odds with the medical profession. They do not bode at all well for the future of a service already on the brink.
Neither do the actual plans in place for that service. At just 3,500 words, the ‘Plan for Patients‘ Coffey reiterated at the recent Conservative Conference earlier this month displays a distinct lack of substance characteristic of the Tories’ approach to the NHS over the last twelve years. Put simply, there is nothing here that shows a real understanding of the scale or nature of the immediate problems at hand.
Bad For Our Health
Coffey begins her report by suggesting, in the sixth richest world economy, that retired NHS staff and members of the public in the form of volunteer labour are the immediate solution to the staffing crisis we face. Consecutive Conservative governments have ignored workforce planning for years, meaning vacancies have reached a dangerous level at 132,000. Despite these numbers, the amount of medical school places is still being capped, and frontline staff are being denied a pay rise in line with inflation.
The answer to this crisis is not to bring in those who should be enjoying their retirement, or worse, to exploit the voluntary efforts of members of the public. A grown-up approach would be to properly pay staff for their efforts while offering them the genuine support they need to do their jobs well. Instead, the promised review into NHS staffing has been continually kicked into the long grass, meaning it has been nearly twenty years since it was addressed. The report, most recently promised for October, now reportedly seems unlikely to appear this side of Christmas.
Coffey then goes on to express her wish to reduce the amount of cardiovascular disease and Type 2 diabetes, and consequently the pressure they place on the NHS. Yet her government has also expressed a desire to abolish regulations around junk food advertising and cut the so-called ‘sugar tax’, which dissuaded consumers for opting for unhealthy food choices. This is the same government that has slashed the public health budget by 24% since 2015/16. As the Health Foundation reports:
Stop smoking services and tobacco control have seen the greatest real terms fall in funding with a 33% reduction. But there have also been significant real terms reductions for drug and alcohol services (17%), sexual health services (14%), drug and alcohol services for young people (11%), and children’s services (5%).
Coffey has also confirmed that the government’s long-awaited tobacco plan (which could have saved thousands of lives) may never come to fruition, and has previously voted against measures that aimed to restrict the effects to children of passive smoking, citing that it should be a person’s own choice. A previous minister from her own party, Dan Poulter MP, told the Guardian today that she was ‘putting ideology above the nation’s health.’
What we are witnessing is a straightforward denial of the past decisions that led to this crisis in the first place. It’s worth pointing out, too, that the government have now very quietly rescinded the offer of a Covid vaccine to all children now turning five who were previously eligible, despite schoolchildren being a main driver of infection. Meanwhile, nutrition-related diseases like gout, scurvy, and rickets are seeing a resurgence thanks to austerity policies and the levels of deprivation and malnutrition that recent economic decisions have exacerbated.
Pitting Workers Against Patients
The Plan for Patients then sets out that this government will make sure that anyone who needs a GP appointment will get one within two weeks. While this is a goal for which all practitioners will undoubtedly strive, it’s again a resource challenge, and not something technically in Coffey’s gift to even try and enforce. Imposing yet more arbitrary targets on GPs without the tools to implement them will not help doctors do their job or allow patients to be seen any faster—instead, it could lead to even less retention.
Coffey also promises to ‘prioritise so patients with urgent needs are seen on the same day, including opening up time for more than a million extra appointments over winter’. But as health policy analyst Roy Lilley points out, the provision she offers falls far short of what’s required: ‘last year GPs delivered over 300m appointments. An extra million is less than one percent. To be frank… this is not much of a plan. It’s largely the response to Covid, rebadged.’
The Health Secretary also promises to inform patients by publishing data on how many appointments each GP practice delivers, and the length of waits, and to require the local NHS integrated care boards to ‘hold practices to account’. This performance monitoring as a response to a lack of appointments—again, caused by understaffing—is moving the deckchairs around on the Titanic, and its primary achievement will likely be to add yet more stress to an already demoralised and grossly overworked workforce. As GP Dr Nick Mann told Keep Our NHS Public:
‘Introducing league tables for accessing a GP appointment (another old idea from NHS England) in a workforce crisis is utterly stupid and purposefully incendiary. This government has a one-track playbook and it’s driving us into an ever-deepening hole. Patients cannot afford to indulge their games any longer.’
Coffey writes about creating more capacity in hospitals, but this is restricted to the use of 7,000 virtual beds or wards. As previously explored, virtual wards do not free up time: beds equate to staff, and patients still need to be monitored at home, so this is in reality just a rehashing of existing capacity—and may even lead to less quality of care for patients in the longer term.
Next comes the backlog. One suggestion is that the NHS ‘maximise the use of the independent sector’. The pandemic gave this government convenient cover to utilise the private sector to support unprecedented demand (though the amount of work they carried out in reality was minimal); once something that the Conservative government sought to keep quiet, this is now actively promoted and celebrated. It’s yet more revenue that will not be spent in the NHS, instead going to line shareholders’ pockets.
And finally, there’s care. Instead of injecting additional funding into the NHS as is required, Coffey intends to take £500 million from the NHS budget to fund social care. On this, Lilley again raises an important point:
‘…without an allocations model and a handle on using the money to improve the wages and training for front-line care staff, I can see it used for paying off the overdraft of some nearly-broke domiciliary-care companies and create[ing] care-package cost-inflation.’
The fact is that we have no guarantees on the use of this money, which is already a robbing-Peter-to-pay-Paul scenario. It’s a gamble—and if this government’s trajectory so far is anything to go by, their gambles tend not to pay off.
What About NHS Staff?
GP and member of Keep Our NHS Public Dr Helen Salisbury writes in the British Medical Journal that:
‘…the real shame of this plan is in its language: the not-so-subtle pitting of patients against GPs as the government reassures patients that it’s on their side. I struggle to see who or what the government thinks is on the other side (apart from disease, suffering, and untimely death).’
To work well for all it serves, the NHS needs to be a partnership between patients and staff. But there’s no acknowledgment whatsoever in this document of the immense burden on healthcare workers, no recognition that they are still suffering the effects of a worldwide pandemic or of the relentless pressures which may hamper their ability to fulfil their roles.
Patients do not exist in isolation. Healthcare professionals are on the same side, and only want the best for those they care for. In order to do that, they need an environment which also recognises and supports their needs. If Coffey (and this government) cannot grasp this basic fact, any ‘Plan for Patients’ is doomed to failure.