RCP president Andrew Goddard explains what the government’s legislative agenda means for the NHS workforce, integrated care, clinical research and efforts to tackle health inequalities.
The Queen’s Speech is an opportunity for the government to set out the laws it wants to pass. A lot has changed since the last one, in December 2019, when the priority was to ‘deliver the UK’s departure from the EU on 31 January’.
This year’s speech opened with a commitment to ‘deliver a national recovery from the pandemic that makes the United Kingdom stronger, healthier and more prosperous than before’. While unsurprising given the context, it is nevertheless very welcome that health is central to the government’s agenda. I was also pleased to note that the key areas of focus are the same as our influencing priorities, which the membership led the way in setting in 2018.
What we have seen over the last 14 months is that our health and care system operates at capacity, with little room to deal with emergencies at the same time as delivering timely, routine care. We now face significant backlogs that will take years to clear, and while the £160m announced by NHS England this week to tackle waiting lists and support elective recovery will help, what we really need is a long-term plan to increase the health and care workforce.
Workforce
We hope the new health and care bill will play an important role in delivering such a plan. The bill’s key aim is to enable greater integration across the health and care system. This will be done through the creation of statutory integrated care systems, and rolling back aspects of the 2012 Health and Social Care Act. These are both positive developments and should - backed up by health and care professionals on the ground making things work - mean better care for patients.
But the health and care bill also needs to put in place the mechanisms to deliver better long-term workforce planning. The RCP is calling for regular independent assessments of workforce needs and a requirement for government to respond, as is the Academy of Medical Royal Colleges.
Last month, the Health Foundation, Nuffield Trust and The King’s Fund wrote to the secretary of state for health and social care about the same issue. They said that “now is the time to set systems in place to avoid major workforce shortages in the future. England needs to plan for the long term based on an objective, independent understanding of how many staff the service needs. The upcoming NHS Bill offers an opportunity to put in place a system to support better workforce planning.”
Similarly, the NHS Confederation, NHS Providers, the British Medical Association, the Royal College of Nursing, the Academy of Royal Medical Colleges and Unison wrote to the secretary of state about ‘the chronic undersupply of NHS staff’. They called on the government to ‘clearly outline the workforce requirements for delivering the NHS Long Term Plan across different parts of the country.’
Social care
Better long term planning is also needed in social care. The pandemic has further exposed the lack of funding for the sector, and the unhelpful divide that still exists between social care and the wider health system.
A sustainable funding settlement is urgently needed to ensure all patients receive high-quality joined-up care in the coming years as the UK population ages rapidly. This will ease the pressure on hospitals by reducing the number of people who need to be in hospital in the first place, and make it easier for them to leave more quickly.
The government reaffirmed that ‘proposals on social care reform will be brought forward’. While this is welcome, the Prime Minister pledged to ‘fix the crisis in social care’ on his first day in office. Given that was nearly 18 months ago, we now need to see detail.
Public health
One issue on which we did see very welcome detail was obesity. A total ban on online junk food advertising alongside a 9pm TV watershed takes steps towards preventing negative eating behaviours, especially important for children if we are to encourage healthy lifestyle approaches from a young age.
But action such as this needs to be part of a wider cross-government strategy to understand and tackle the causes of health inequalities. The creation of the new Office for Health Promotion and the suggested Office for Health Disparities provide the opportunity to take this forward. Whether we are talking about ethnicity, gender or socioeconomic status, it is clear that inequality is caused by the structures of our society. The only thing that will make effective change is cross-government action.
Clinical research
With the development of COVID-19 vaccines and the success of the RECOVERY trial in establishing successful treatments such as dexamethasone, the value of research has never been more widely understood. The government therefore understandably committed to ‘the fastest ever increase in public funding for research’, including the creation of a high risk/reward Advanced Research and Innovation Agency.
But we need to ensure clinical research in the NHS is properly supported. The government’s vision for research in March rightly argued that clinical research needs to be embedded in everyday care and ‘is everyone’s business across the NHS’. This will need the government to ensure that NHS trusts have the support and incentives to undertake research activity. And, of course, this also comes back to increasing the workforce so that staff have the time to be involved in research.
Looking ahead to the spending review
Much of the proposed action in the Queen’s Speech is welcome and should help to improve both the nation’s health and how our health and social care system function. This is especially true of the health and care bill, social care reform, and legislation to restrict junk food advertising.
But the multiyear spending review we expect in the autumn will be crucial. The RCP will continue to make the case for the investment that we urgently need to expand the NHS workforce, reform social care, and improve population health through increased support for our public health system.