The road to get the NHS back on its feet will be long – and will require pragmatism as well as a vision. Adam Sampson, Chief Executive of the Association of Optometrists, suggests five ways to kickstart the process
Almost three months in, the character of the Labour government could not be clearer. ‘Service’, ‘competence’, ‘pragmatism’ – those are the watchwords. Yes, there is a commitment to long-term change. But for the time being, the Prime Minister Sir Keir Starmer is calling on the need for “raw honesty” to sort the immediate, short-term crises.
A case in point was the government announcement that it will start a lifelong support scheme for victims of the contaminated blood scandal before the end of the year, following a damning public inquiry. This follows a high-profile interim independent review of the Care Quality Commission (CQC) in July by Dr Penny Dash, which identified “significant failings” at the regulator. This led Health and Social Care Secretary, Wes Streeting, to say he was “stunned by the extent of the failings of the institution that is supposed to identify and act on failings…CQC is not fit for purpose.”
The backdrop for the NHS is stark. Public satisfaction with the NHS hit a record low before the 2024 general election, according to Health Foundation and Ipsos polling of over 2000 people, in new data released this month.
Mr Streeting has made it clear that cutting hospital waiting lists, sorting out the doctors’ industrial action, and urgently addressing the collapse of NHS dentistry comes first. There is no talk of longer-term reform yet: it is the immediate that matters.
Nor are there promises of new money; to the contrary, the Chancellor has stated that in order to meet the recommendation of the Pay Review Bodies, Treasury is asking all departments to find savings totalling at least £3bn ahead of the Autumn budget, including measures to stop all non-essential spending.
That Treasury is taking a hard line with DHSC is scarcely a surprise. Rachel Reeves has already indicated her intention to investigate the billions squandered on inadequate or surplus PPE during the Covid pandemic.
In reality, there are real questions about the readiness of DHSC to deliver to the Labour Government’s new ambitions, particularly within the budget available. Returning to the infected blood scandal, whatever the roles of the various doctors and politicians involved, it was overseen by officials, some of whom are still in post. While Sir Brian Langstaff’s report was elegantly worded, its deconstruction of the evidence given by those officials was devastating. The question to ask is what further scandals will emerge? The failure to implement the recommendations of a succession of reports on the systemic problems in NHS maternity services, for example, leaves the Department dangerously exposed, with pressure building for a root and branch public inquiry.
There is growing awareness of the financial cost of such failings. Clinical negligence claims represent the second largest liability on the government balance sheet (after the cost of decommissioning nuclear power stations). The NHS now spends more on compensation for birth injuries than on maternity services themselves.
Back in 2017, the National Audit Office criticised the Department for having no effective response to the growth in clinical negligence costs, then running at £1.6bn a year. Fast forward seven years, and last month’s Public Accounts Select Committee response to DHSC’s annual report noted that not only had that figure grown to £2.6bn, but that the Department is “without an effective plan to minimise the future costs of the scheme”.
However large, the bill for future claims against the NHS is dwarfed next to the financial challenge posed by the bill for social care for a rapidly ageing population – a challenge to which we still await the Department’s policy response. It is unfair to criticise officials for failing to crack such a famously difficult nut, but the lack of any significant contribution to the debate does illustrate another legitimate challenge about the current state of DHSC: its policy capability. The decade-long hollowing-out of civil service policy capability resulting from government cuts has played its part. In addition, policy coherence does not come easy in an environment where responsibility for the direction of healthcare is split between DHSC and NHS officials. There are signs that Ministers have already understood this issue: Mr Streeting’s welcome speech at Richmond House was notable in reaching out to DHSC and NHS officials alike.
The Department can look to other nations for policy inspiration. The Nordics and New Zealand, among others, have implemented solutions to the unchecked growth of clinical negligence liability, and there is an existing suite of recommendations from the various reviews about how to improve the safety of maternity care. Implementing these steps will require officials to learn the lessons of Langstaff and adopt a less defensive mindset to external feedback – and put the “not invented here” bias to one side.
More profound will be the challenge for a department dominated by hospital and doctor-centric thinking to give substance to the new administration’s desire to rebalance policy for a Neighbourhood Care Service, framed around prevention. Patients rightly worry about waiting lists and limited GP appointments; as CEO, I represent 17,500 optometrists across the UK who have the clinical skills and equipment to make a difference, providing more care closer to home.
Here are five ways we can start the work of change.
First, we need to navigate the ideological debate about the use of the private sector alongside the public; this includes addressing the variable quality of NHS contracting, which has the potential to enable secondary care independent providers to cream off simple operations.
Second, we need to look afresh at the mess that is healthcare regulation; responding to the quality and regulatory challenges of new technology and AI will be critical.
Third, while harnessing the opportunities that AI and other cutting-edge technologies bring, in the short term we need to make sure the digital basics work; for example, sorting out IT connectivity between primary and secondary care, and electronic patient records.
Fourth, the main political parties have all been supportive of NHS Long Term Workforce Plan, but we need to flesh out the details to improve productivity; using the skills and experience of the primary care workforce will be a step in the right direction.
Fifth and finally: as the PM has said, we need a commitment to service, managerial competence and pragmatism in government. According to the book of academic essays edited by Sir Anthony Seldon, a byword for political neutrality and rigour, the vast majority of Ministers in the last 14 years have conspicuously failed to demonstrate those qualities. With a new team of Ministers in place, providing more capable leadership than their predecessors, that work of change can begin in earnest.
Progressive Britain and the Association of Optometrists will be delivering the Labour Party Conference fringe event, ‘Moving care closer to home: after 30 years of policy failure – what now?’, with Stephen Kinnock at 16:30-17:30, on Sunday 22 September.
