The Government has once again come under fire for failing to set out long-term plans to address health and social care issues following the Queen’s Speech yesterday.
As expected, the Queen’s Speech set out a bill to legislate for the Government’s proposals in its earlier white paper on health and social care reform.
These will take forward the biggest reforms to the NHS in a decade.
However, the speech did not announce any new funding for the NHS, rather reiterating funding announcements made at the Spending Review 2020 and the Budget 2021, such as funding for reducing the elective backlog and money for new diagnostic equipment.
It is disappointing and disheartening that the Government has, once again, kicked the issue into the long grass, which means the very-real risk that no real progress will now be made on this issue during this parliament
And it once again failed to address plans to reform social care, merely announcing that proposals ‘will be brought forward,’ but with no timetable for reform or a funding settlement, which is urgently needed.
More widely, a key focus was on the Government’s manifesto promise to ‘level up’ the United Kingdom.
And health will have a vital part to play at the heart of this mission, and the recovery from COVID-19.
Responding to the speech, a spokesman for the NHS Confederation, a membership body representing organisations that plan, commission and provide NHS services in England, Northern Ireland and Wales, said: “The proposals laid out today are to be welcomed and are a step in the right direction in helping to redress some of the damage that has been wrought, not just on the health service, but on the whole population during the COVID-19 crisis. “The NHS has faced an unprecedented battle over the past year and has at times come very close to breaking point, so the announcement of additional funding in March will go some way to addressing the impact of the pandemic.
Clarification needed
“However, the detail of this investment will be crucial, and we will await further clarification in the coming months and as part of the forthcoming Comprehensive Spending Review.
“We have previously stated that the NHS will need a new multi-year settlement because of COVID-19, and we will continue to make the case to government on this ahead of the Spending Review in the autumn.”
And he called on ministers to offer assurance to the healthcare sector that it will provide clear messaging to the public that the backlog in elective procedures will not be resolved quickly and that waiting times may have to be managed differently as the NHS continues its recovery from the pandemic.
Any reforms must not be subject to overly-prescriptive guidance, should be delivered at a realistic pace, and must enable decisions to be made at the most-local level
On the proposed reforms to the Health and Social Care Bill, he added: “These are the most-significant set of reforms the health service has seen for a decade and there is broad support across our membership.
“We anticipate that the proposals on integration and collaboration will help frontline services and our members to move towards a model of fully-joined-up patient care.
“That said, any reforms must not be subject to overly-prescriptive guidance, should be delivered at a realistic pace, and must enable decisions to be made at the most-local level.
“Those in charge of running community-based health and care services are best placed to understand the needs of their communities.”
Richard Murray, chief executive of The King’s Fund health thinktank, also queried the timing of the new bill, saying: “Political leaders must be overwhelmingly confident that they have the right and enduring ‘answer’ to the question of the best organisational structure for the NHS, and also be just as confident that ‘right now’ is the time to launch it.
“It is unwise to begin a refit of the NHS ocean liner in the midst of a hurricane.”
On the lack of clarity over social care, the NHS Confederation spokesman said: “It is disappointing and disheartening that the Government has, once again, kicked the issue into the long grass, which means the very-real risk that no real progress will now be made on this issue during this parliament.
“As the NHS Confederation’s Health for Care campaign has repeatedly stated, the NHS and social care are sister services. If one suffers, so does the other, and the COVID-19 pandemic has shown how fragile and in need of reform England’s social care system has become.
The proposals laid out today are to be welcomed and are a step in the right direction in helping to redress some of the damage that has been wrought, not just on the health service, but on the whole population during the COVID-19 crisis
“A well-funded and good-quality social care sector is vital to a healthy nation and a strong and well-performing NHS.
“Social care reform is therefore urgently required and we need a timetable for reform now, not at some distant future point, and this must be coupled with significant long-term investment.”
The future of social care was also at the centre of concerns voiced by Pat Cullen, acting general secretary and chief executive of the Royal College of Nursing.
And she called for investment in recruitment amid a countrywide shortage of nurses.
Ignoring social care
She told BBH: “The Government has again missed the opportunity to finally address social care in this Queen’s Speech.
“Ignoring social care is the same as ignoring the NHS - the pandemic shows their fates are intertwined.
“Together, they make up a system that is desperately in need of investment - with workforce shortages the top concern.
“The Government must use the Health and Social Care Integration Bill to go much further and finally get to grip with these issues.
While the Government outlined its agenda for NHS reform today, it’s deeply disappointing that the Queen’s Speech has once again failed to deliver a detailed plan which sets out the radical change we need on social care
“Nursing staff make up the largest part of the workforce and are seeing some of the biggest shortages.
“This Bill must address this by making the Secretary of State responsible and accountable for planning and funding of the workforce.
“We hear about more beds and new hospitals, but we are still missing the investment in the nursing staff that will be needed as the whole health and care system fights to recover.
“Unless there is real investment as well as accountability for building the workforce many more will miss out on the care they need.”
More widely, NHS trust leaders are calling for greater clarify, reassurances and safeguards in a number of areas.
Chris Hopson, chief executive of NHS Providers, which represents NHS acute, ambulance, community and mental health services, said: “First, trusts want to ensure their operational independence, and that of the wider NHS, is protected.
“Second, they want to be in the driving seat when it comes to making changes to local services to improve care and keep patients safe. “And they want to ensure there is no confusion or overlap between what they and the new Integrated Care Systems do.
“Trust leaders also want reassurances they won’t be inappropriately instructed to restrict their spending on new equipment and buildings, risking quality of care.”
We hear about more beds and new hospitals, but we are still missing the investment in the nursing staff that will be needed as the whole health and care system fights to recover
And he said that, on top of the £1billion one-off funding pot to help clear the backlog for non-urgent operations, and £325m for diagnostic equipment, as a bare minimum the NHS needs at least three years extra dedicated funding, on top of what was promised in the May settlement.
“While the Government outlined its agenda for NHS reform today, it’s deeply disappointing that the Queen’s Speech has once again failed to deliver a detailed plan which sets out the radical change we need on social care,” he added.
“The Prime Minister made a personal commitment to fix social care once and for all. He must now be true to his word.”
Key points
- The Health and Care Bill: The speech sets out a bill to legislate for the Government’s proposals in its earlier white paper, Integration and Innovation, aiming to enable the integration of services, collaboration with local authorities, and addressing health inequalities across the country. This includes the establishment of statutory integration care systems (ICSs) and the Healthcare Safety Investigation Branch (HSIB), removing legal requirements for mandatory tendering of NHS services, completing the merger of NHS England and NHS Improvement (NHSEI), and making the combined organisation more accountable to ministers, plus some public health measures like banning junk food adverts before 9pm
- The NHS recovery plan: Although no new funds were announced during the Queen’s Speech, the total package of additional funding allocated to the NHS for COVID-19 is now £92billion, including £63billion for this year and £29billion for next year. This includes £325m in capital spending for new investment in diagnostic equipment to improve clinical outcomes, to assist the NHS with recovery of non-urgent services, and to address elective backlogs. On top of previous investments of £450m to upgrade accident and emergency facilities and £24 m to extend the NHS 111 service to become a single point of access for urgent care, the Government plans to transform urgent and emergency care to prevent inappropriate attendance at emergency departments, improve timely admission to hospitals for patients in emergency departments, and to reduce length of stay
- Social care reform: The speech announced that proposals on social care reform ‘will be brought forward;, but there was no further detail on a timetable or any funding to enable this to happen
- Prevention: Following a green paper on prevention in 2019, the Government used the Queen’s Speech to reiterate several, mostly non-legislative, policies to improve prevention of ill health. These are focused on reducing obesity, improving air quality, and reducing smoking and drugs use; for instance, delivering the Government’s Healthy Weight Strategy, which it published in July 2020; and past spending commitments such as £100m funding for healthy weight programmes. As had already been announced, a new Office for Health Promotion, sitting in the Department of Health and Social Care and led by the chief medical officer, will be responsible for delivering the parts of this agenda that do not sit with either NHSEI or the new UK Health Security Agency, following the closure of Public Health England
- The Mental Health Act: The Queen’s Speech made reference to measures that will be brought forward to support the mental health of the nation, building on the white paper on reforming the Mental Health Act which was published in January. The Government also announced a Mental Health Recovery Action Plan which will help address the impact of the pandemic on the nation’s mental health and wellbeing
- COVID-19 vaccination programme: For phase 2 of the vaccination programme, the Government is following JCVI advice to continue to offer the vaccination based on age, starting with the oldest remaining cohort (40-49 years old). The Government is alsostarting to plan for a potential booster campaign later this year and is working with vaccine suppliers to work out which vaccines could be effective as a booster shot and to design new vaccines specifically targeted at variants of concern. Over the longer term, regular boosters are likely to become a regular part of managing COVID-19
