10-12 - NHS: Victorian era

A new Health (and Social Care) Secretary always creates expectations in the NHS – which might be a polite way of saying most clinicians and managers tend to think that the new one can’t be as bad as the old one.

Some come with a pet ideology intended to save the health service, which gets torn apart upon contact with reality (Andrew Lansley).

Some arrive with a promise to stand up to vested interests, which proves quite difficult when the vested interests turn out to be the entire NHS medical staff (Jeremy Hunt). Some are Matt Hancock. And some sit there and don’t really seem to do very much at all (Steve Barclay).

So, what of Victoria Atkins, new into cabinet following Rishi’s November reshuffle? On the expectation-o-meter she is presently scoring fairly well – commentators point out that she is from the more moderate, pragmatic, centrist wing of the Tories.

Labour says she has a track record of working well cross-party and she is also relatively unknown, bringing little political baggage into the role.

But Atkins will quickly be confronted with that reality again. The NHS continues to be in the tightest of spots and will need careful steering through the autumn statement in late November (when we find out how much or little money it will have) and the winter (when the already dire capacity levels are bedevilled with extra pressures).

The NHS needs capital investment and a new workforce settlement – or strikes will continue, backlogs will get worse, the vicious lack-of-capacity cycle will continue – and that’s without even acknowledging the ever-increasing demographic and long-term condition demands on the service.

While the Long Term Workforce Plan says some sensible things about recruitment in the future – critics such as Saffron Caudery at NHS providers say the real issue is retention – how can they keep staff in the service right now, going into these very winter pressures?

There are three things, therefore, that the new Health and Care Secretary needs to get to grips with: the money, the staff and the performance of the service.

On the first, her relationship with Jeremy Hunt at the Treasury, where she was Financial Secretary, may position her favourably with the Chancellor for a reasonable cash settlement.

On the second, so far, we have one incidence of Atkins engaging the staff, via a recorded message to the NHS Providers annual conference in Liverpool the day after her appointment.

Her remarks were: she will ‘get around the table’ to find a ‘fair and reasonable resolution’, to the strikes and rightly asserted that waiting lists will only come down if the staff are on board.

She plans to work with staff to overcome the challenges in the health service and ‘take the long-term decisions that will build a brighter future for our NHS’.

And on the third, my colleague at HSJ, Ben Clover, pointed out that it was “interesting she’s a Lincolnshire MP, a place with one of the worse waiting times/performance/recruitment issues. Her constituency postbag might give her a bit more insight into the effect that this has on people. Her predecessors’ constituencies were a lot less troubled”.

Additionally, she will have personal experience of NHS long-term condition services as a type 1 diabetic.

Is it too early to say that we might be in for a new era of political sensibleness in the NHS after the last few years of turmoil? Probably – expectations ruin everything after all.

The NHS Providers Conference was also a good place to take in the major themes, in terms of NHS need, priorities, developing structures and solutions to some of the clinical and productivity issues we’ve just explored.

Development of pharmacy
If I had to pick one emerging theme that I think will be a big story for pharma in 2024, it would be the emergence of pharmacy as a far more significant stakeholder group.
Pharmacists have been hitting the headlines as they are intended to become the ‘first point of contact’ in the NHS for a variety of things.

Under the new primary care recovery plan, they will be directly prescribing contraceptives and treating patients directly for sinusitis, sore throat, earache, infected insect bite, impetigo, shingles and uncomplicated urinary tract infections in women, all without the need to get a GP appointment or a GP prescription.

Additionally, we’ve seen how in primary care networks, clinical pharmacists attached to each organisation are often the driver of pathway change.

But that’s not all. From 2025 all new registered pharmacists will, as part of their training and registration, become independent prescribers. And this will give them huge clout in medicines decision-making.

It’s clear that the new Victoria Atkins-run DOHSC will be looking for whatever solutions to the workforce crisis, the capacity crisis and the GP access crisis, and that pharmacists can contribute a lot to easing those burdens in the short to medium term.

Moving to elective recovery
Another huge theme at the conference and central to the entire NHS recovery, is getting on top of the elective backlog.

This is currently being spearheaded by the Elective Recovery Taskforce – formed last year to identify ways to cut waiting times. In August it published its plan to maximise independent sector capacity to treat NHS patients more quickly.

I’ve written about increasing use of the private sector before and I’m sure I will write about it again; suffice to say more and more private healthcare entities are getting NHS contracts and it’s unclear how on top of this pharma is.

A lot of this involves diagnostics, whose acceleration is key to recovery. Of the thirteen new community diagnostic centres (CDCs) – eight of them are independently run.

This is going to become par for the course and it is attendant upon pharma to find out who operates them and how, if you want to message them on improved diagnostics for your therapy area.

But it’s not just diagnostics – treatment will increasingly be carried out by the private sector.

The NHS is trying to use data to identify potential opportunities for the independent sector to support patient care and expand training opportunities for staff.

This is definitely something industry should be getting behind as it starts to have conversations with the health service about the wider pathway and how all elements of it can be streamlined.

It can be a player in these conversations too and equip itself with local knowledge about how patient treatment could be sped up through using all available capacity and service lines.

Accelerating system collaboration
After years of being revenue generators in competition with local rivals, hospitals are now expected to collaborate with each other. And after years of being in separate silos, secondary care is supposed to work with primary care, community care and pharmacy.

Under the NHS Long Term Plan, we are seeing cross-sector collaboration, but perhaps not at the rate that NHSE would like – with normal arguments about ‘governance’ (who’s in charge of what) often hamstringing progress.

How well this is going depends on the culture and set-up of the system that you’re working with.

What I can tell you is that through my work with clinical and managerial stakeholders it is still surprisingly rare that key consultants in a disease area meet regularly with primary care, clinical nurse specialist and pharmacy stakeholders – and they absolutely need to.

This is an area where pharma can support, via roundtables, sponsored meetings and supporting the co-authoring of position statements, proposed amendments to guidelines and so on.

Victoria Atkins faces an uphill struggle with the NHS on those key metrics of reducing the backlog, improving access and enhancing system capacity.

It may still be some time until patients and staff see significant improvement to all this and it will cost, both via a better deal for staff and more capital investment.

It’s not at all clear that this is going to come in the required amounts and at the desired pace.

But this can be an opportunity for pharma – seeking out projects at a local level as a starting point, where the industry can point out routes to this and become a genuine partner in transforming care and recovering the NHS.

Who knows, projects in Lincolnshire might also suddenly find an unexpected spring in their step!.

Victorian era

Three network

New balance

Final analysis