This week, the escalating pressures on A&E departments during the post-Christmas period has featured heavily in the media, exacerbated by the Red Cross’ suggestion that it was having to support hospitals due to a “humanitarian crisis” in the NHS. Theresa May denied the claim during an interview with Sky News, and it has subsequently emerged that the Royal College of Emergency Medicine has begun “early discussions” with the Department of Health about a long-term investment and staffing plan to support A&E departments. The Government has stated there will not be any “further funding this year”, but did not comment on any potential future funding settlements. The Labour Party placed further pressure on the Government to address the current difficulties in the NHS during an Opposition Day debate in the House of Commons.
The Prime Minister has also hired her first health adviser since taking office, after being criticised for failing to prioritise the role during her first six months in power. Her new adviser, James Kent, trained as a doctor before moving into the private sector, and joins Number 10 from his role as a management consultant at Boston Consulting Group, where he specialised in “payers, providers, and health care systems.” He also focused on driving “BCG’s work on value-based health care and the implications of real-world outcomes on health care.” In addition to criticism for not hiring a dedicated health adviser, the Prime Minister has previously been under scrutiny for the concentration of power within her policy team held by her joint chiefs of staff, Fiona Hill and Nick Timothy.
Finally, the Prime Minister is now understood to have launched a review of the integration of health and social care policy before Christmas. This has entailed the secondment of civil servants such as the Department for Education’s director general for children’s services, Paul Kissak, to the Cabinet Office, and is intended to produce an internal report by March.
NHS Chief Executive encounters difficulties with Downing Street
Relations between NHS England’s Chief Executive Simon Stevens and Downing Street were strained this week, following continued public disagreement over the amount of funding given to the NHS following the Five Year Forward View. Theresa May told Sky News last weekend that the NHS had been given “more funding” than required, after ministers said that it had asked for £8 billion and been given £10 billion. In response, Stevens told the Public Accounts Committee on Wednesday that NHS England will indeed be getting an extra £10 billion over the course of six years, but that this is not the same as saying that the NHS will receive more than asked for over five years. “It was a five-year forward view, not a six-year forward view”, he said.
Stevens’ “political interventions” were reported to have irritated No 10 before he appeared in front of the Public Accounts Committee – following repeated comments on alternative to solutions to funding health and social care – with aides accusing him of being “insufficiently enthusiastic and responsive” to meeting the challenges currently facing the NHS. His latest comments have provoked reports that his position could be at risk if his interventions continue. The Telegraph cited a government source as suggesting that Stevens was doing a good job running the NHS, but would have to “calm down” to keep his job in the long-term.
Prime Minister unveils mental health plans
Theresa May has this week announced her intention to “transform” mental health support, in what was viewed by many as an attempt to underline that her Government is addressing issues beyond Brexit. Although not offering any additional funding, the Prime Minister said she would speed up the delivery of a £67 million package to improve digital access to mental health care and build on £15 million of investment to “provide and promote new models of community–based care such as crisis cafes and community clinics.”
The plans – which are set out in the Government’s response to the Five Year Forward View for Mental Health – will focus on early intervention for children and young people. Notable measures will include:
- Offering all secondary schools in the country mental health first aid training over three years;
- Trials on strengthening links between schools and NHS specialist staff, including a Care Quality Commission-led review of children and adolescent services across the country;
- A green paper on transforming services for children and young people at schools, universities and for families;
- Support for NHS England’s commitment to eliminate out of area inpatient placements for children and young people; and
- A ringfenced £15 million fund to expand community support for people with mental health problems including new crisis cafes and community clinics, building on the £15 million already used to create new places of safety.
Unveiling the plans in a speech on Monday, the Prime Minister said: “I want us to employ the power of government as a force for good to transform the way we deal with mental health problems right across society, and at every stage of life.” The Chairs of the Education and Health Committees, Neil Carmichael MP and Dr Sarah Wollaston MP, released a joint statement in response to the announcement, welcoming the focus on children’s mental health but warning that “if long-term improvements are to be achieved then schools and health services must be given the proper resources, support and expertise so they can work more closely and effectively together.”
Transcripts of NHS Sustainability Committee evidence sessions published
The House of Lords’ NHS Sustainability Committee has released the transcript of the evidence session that the Health Secretary Jeremy Hunt attended before Christmas, as part of the Committee’s inquiry into the long-term sustainability of the NHS. Mr Hunt addressed the issues of workforce planning and public health in his testimony, saying that the NHS needed to take a more strategic approach towards workforce planning, and that the UK will need to spend a greater proportion of its GDP on health and social care and recruit more doctors and nurses over the coming decades. He said that increasing the number of doctors and nurses is of vital importance, as putting money in without having the doctors and nurses there to deliver the extra care will cause inflation in the prices paid to the workforce – “which is very nice for them but is not necessarily what the taxpayer intended”. Strategic workforce planning is not a problem that can wait, he added, indicating that the time needed to train doctors requires that the Government act now.
Later in the session, when Baroness Featherstone argued there is a need to spend money on public health, and asked what assessment his department has made about its impact on public health, Hunt responded that he did not accept that a public health budget being cut automatically means that the Government is unable to make progress on big public health issues. “There are some efficiencies that can be made”, he said, “but there are some big things that you do in public health that happened under the last Labour Government, such as banning of smoking in public places, that have a huge impact on public health which are not about expenditure.”