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Connell C - LB Mar 2022

Industry view: To-do list for the new secretary of state

Following a dramatic week in which the UK Prime Minister Boris Johnson has resigned, Steve Barclay has been appointed as health secretary to replace Sajid Javid and more than 50 government appointees quit, we ask healthcare experts what they think of the current political situation and what needs to be a priority for the new secretary of state.

Here’s what people had to say…

Professor Martin Green, chief executive of Care England tells HealthInvestor UK: “I think the top of the priorities list for the new secretary of state should be to deliver far more money from the levy to social care. We need at least half of that levy immediately in order to fund the reform agenda to levels that will make the sector sustainable and attractive to investors.”

David Hare, chief executive of Independent Healthcare Providers Network adds: “Bringing down waiting times is the public’s number one priority for the NHS and the new secretary of state must see this as his primary task with a renewed effort to make better use of the independent sector as part of that push.

“Patient choice has for too long been a policy in name only and there is a real opportunity to send a strong message about the importance of giving patients genuine choice over how and where they receive their care.

“The NHS’s willingness to partner with external providers has long been very mixed, but the NHS cannot recover within the public sector alone and focusing attention on better collaboration with the private and voluntary sectors will be key.

“Finally, the new secretary of state should also work with his colleagues in the Treasury to relieve the burden on the NHS by examining options for incentivising people to take out private medical insurance.”

For Vincent Buscemi, partner and head of independent health and social care at law firm Bevan Brittan, the critical issue for the new secretary of state is to address the workforce shortages and capacity across the NHS and social care. “Health and social care must be considered together. Fixing the funding for an already overstretched social care system would help to ease the pressure on the NHS.

“This goes hand-in-hand with the significant NHS backlog, with approximately seven million people on the waiting list, which is expected to rise to over 10 million by 2024. This needs to be managed and include the independent sector within the solution to ease ongoing pressures, while also delivering urgent and emergency care,” Buscemi added.

Robert Kilgour, entrepreneur and Scottish care home group Renaissance Care’s chairman tells us that health and social care is fully devolved to the Scottish government. He says: “The government should urgently establish an ‘all sector’ (NHS, local authority, voluntary, and independent) ‘cost of elderly care’ review to establish a level playing field for elderly care provision by benchmarking current costs across all sectors. This would allow for all future elderly care costs to be properly monitored to avoid waste and also enable better planning, targeting and taxpayer value for all future expenditure.

“The government should announce a 10-year funding plan and a 10-year workforce strategy and learn from Scotland with its National Care Home Contract and its higher Carer Living Wage. An entrepreneurial injection should be given to the Better Care Fund by the establishment of an advisory board. The government should appoint an ‘elderly care czar’ with a detailed brief and powers to act.

“It should immediately ‘fully’ restore (double) the student nurse bursary to match Scotland. More nurses should be trained, existing nurses encouraged to stay in the profession and retired ones enticed back.”

All restriction quotas and related costs on nurses coming into the UK should be removed and immigration exceptions for skilled carers coming into the UK should be introduced according to Kilgour.

“The government should cut the overseas aid budget and redirect monies to improving social care and improve liaison between itself and the social care sector.”

He concludes: “Care workers are ‘care professionals’ – the government should launch a PR campaign promoting the value to society of all carers to improve morale and to help staff retention and staff recruitment”

Commenting on UK Prime Minister Boris Johnson’s resignation Kilgour also told the Scottish Daily Mail: “In an increasingly crowded field, Penny Mordaunt is the real deal, the standout candidate to lead and united the Conservative Party and serve as prime minister with strength, integrity and a capacity to move the country past the many challenges it currently faces.”

Jyoti Mehan, chief executive of healthcare group Health Care First Partnership, says: “On top of his list should be to take the wider lessons learnt from the downfall of Boris on the importance of integrity – and apply this to setting the direction and the next chapter of the health and care sector.

“However controversial this may be, it’s time to be fully open and transparent about the structure, the funding and the focus of the entire health sector going forwards… using primary care as an example we have had enough reviews, discussions and papers. Whatever the desired direction it’s time to set it out and then let us deliver against it. This constant state of restructuring leaves us in limbo and second-guess. The public sector loves discussion and consultation which is great when things are great; it’s now time for some decisive action.”

Bhavna Keane Rao, managing director at BKR Care Consultancy, says: “What a whirlwind it’s been in Westminster – a proper revolving door! The new health minister’s to-do list must include an overhaul of the inefficient regulatory system with a more joined-up efficient and cost-effective system. A simple structure must be introduced. The government needs to host a discussion with those in the know-how and not the usual suspects – but those who are in the business and know their onions.”

She points to the importance of the Integrated Care System out of the hands of the politicians and the need for a discussion on how to remove politics from health and social care as well as an adult discussion on the NHS and its partnership with social care.

“The government needs to professionalise the care workers and introduce a register for all care workers in England,” she concludes adding that these topics are not straightforward but why would one want to settle for anything other than the best?

Jill Mason, partner and head of health and care for law firm Mills & Reeve says Steve Barclay is going to be a busy man. “There is just so much happening in the world of health and social care – isn’t there always, but 2022 seems particularly intense. The chief executive of NHS England, Amanda Pritchard, recently said that ‘the last 900 days have been tough but the next 900 days could be tougher’. What a time to become secretary of state for health and social care.”

Mason listed the 10 things Barclay will have fighting for his attention in his red box – in no particular order, adding that there are many more:

  • Staffing – affecting both health and social care with knock-on effects for both.  Recruitment and retention are probably the top challenge. 
  • Healthtech is so important to get right.  Digital transformation is on everyone’s lips. We have just had the policy paper ‘Data saves lives: reshaping health and social care with data’.  The Integration White Paper in February stated a key ambition is for every health and adult social care provider within an ICS to reach a minimum level of digital maturity, with these providers connected to a shared care record for individuals by 2024. But only 40% of social care providers have electronic care records. In light of huge staffing issues, healthtech is more important than ever. Related to this is the use of data which needs to be smarter with modelling, targeting and to be predictive.
  • Social care – Wholesale reform is required. It’s important to remember that his new job title covers both health and social care. Delayed discharges need to be tackled.
  • Integration – Integrated Care Systems only went live just over a week ago – they are important drivers for integration. Barclay will need to get to grips with system, place and neighbourhood. Bringing together different parts of the system, providers must collaborate in both the public and independent sector
  • Covid-19 – there are rising admissions and the latest concern with rising infections relates to blood supplies. The Covid Public Inquiry has only just had the terms of reference finalised – what will be the lessons learnt and how quickly will we get there?
  • Health inequalities – this is not just a problem for health to solve. Good relations across departments is needed.
  • Mental Health – driving through the Mental Health Bill to amend an Act nearly 30 years old. There are going to be substantial resourcing requests to enable the right care at the right time
  • Cancer referrals at all-time high – there are now more than 10,000 people with suspected cancer waiting more than 104 days.
  • Community diagnostic centres – investment is needed in early diagnosis to save money in the long term
  • Prevention – starting from a different place. We need to keep people healthy, particularly given demand is currently exceeding supply. There is a need to think about and do things differently.

Rob Finney, chief operating officer at investment firm Tristone Healthcare adds: “There’s real hope that change is coming in social care. While the final recommendations of the Independent Review into children’s social care may be uncomfortable reading for many, it’s this level of challenge that is needed to drive long-term improvement and to meet demand.  

“Every individual who receives care and support deserves to be healthy, safe and happy. When we see organisations failing people, as a whole sector we need to learn. Why do systems and people fail the most vulnerable people in our society?  Good providers have a good safeguarding culture which allows for real lesson learning when things don’t go right. But that only happens when the safeguarding values of the organisation are lived by everybody in it.  

“The government has an important role to play in setting the culture of social care by having high expectations of what the sector delivers, and high support for it to do so.  The review into the deaths of Star Hobson and Arthur Labinjo Hughes commented that, ‘Trust, shared values, and identity are crucial behavioural factors in frictionless sharing of information between professionals.’ This is true of the relationships between government and the whole social care sector.  

“There is clearly also some work to be done to encourage talented individuals into the industry and inspire and incentivise them to become future leaders. Identifying those people who have the potential to succeed is crucial – the earlier the better – so they can be supported through their career journey and armed with the skills and mindset required to take the business on to the next chapter.  

“The government must work alongside industry leaders to define a national workforce strategy/people plan that looks at staff recognition, value and reward; investment in training, qualification and support; career pathways and development; building and enhancing social justice, equality, diversity and inclusion in the workforce; and effective workforce planning across the whole social care workforce.” 

Dr Charles Armitage, former NHS doctor and chief executive and founder of healthcare firm Florence, says: “We’re in the midst of the greatest health and economic emergency in history. NHS hospitals and care homes are still battling rising Covid-19 cases while perilous staff shortages are driving vital healthcare workers out of the profession in search of better pay.

“The scale of the worldwide healthcare staff shortages is one of the greatest threats to health globally. For the public, inadequate numbers of staff is a risk to both access to care and quality of care. For staff, it leads to stress, burnout and a lack of support for the existing workforce who are imperative to society. Systematic reform is needed to fix the broken care staffing model for good, and it’s crucial Steve Barclay puts staff shortages at the top of his agenda in his newly appointed position. We hope, with a new health secretary in place, these issues will finally be given the attention they need.”

Last but not least, Homecare Association’s chief executive Dr Jane Townson said in a press release: “Social care and health services are interdependent, together representing 10% of GDP, and we urge the new secretary of state to give equal attention to both.

“Demand is outstripping supply and workforce shortages are at record levels. Councils are reporting high levels of unmet need in the community and NHS hospitals are struggling to discharge people back home due to inadequate capacity in home care. Delayed discharges mean that hospital beds are unavailable for new admissions, which contributes to increased ambulance waits, cancelled clinics and cancelled operations. This makes it difficult for the NHS to respond in a timely way to emergencies and to reduce waiting lists, contributing to avoidable deaths.

“Poor pay, terms and conditions of employment have long been a problem for the home care workforce, particularly in the state-funded part of the sector which represents 70% of the whole. These stem from inadequate funding by central government and poor practices in commissioning and purchase of home care by public sector organisations. Indeed, the government’s expenditure on home care represents only 4% of the amount spent on the NHS.

“In recent years, the home care sector has also been adversely affected by Brexit, Covid-19 and now international conflict. Tightening of labour markets, pressure on supply chains and rising energy costs are fuelling inflation. This is leading to a rapid rise in the cost of living, which is placing further pressure on low-paid workers and their employers. In home care, high fuel costs are a particular issue. Home care workers are also struggling with no or low pay while following government guidelines to isolate after a positive Covid-19 test.”

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