Winter is just around the corner, and with it will come pressure on the NHS like none we've seen before.
Our recent report, State of the provider sector, is an eye-opener for the government: the great majority – 85% of the 183 leaders from 121 trusts who responded to the survey – are more worried about this winter than any before in their NHS careers.
Severe staff shortages are chief among concerns for health and care services, along with social care capacity struggling to keep up with demand and tight budgets. The survey also sheds light on fears about the likely pace of backlog recovery with only just under half – 48% – of leaders saying their trust is on course to meet end-of-year elective recovery and cancer targets. We have reached a critical point.
Trust leaders across acute, ambulance, mental health and community services are doing all they can to shore up their resources and are working with partners across health and care to prepare for winter. Measures to support services and staff wellbeing include cost-of-living initiatives, increasing workforce numbers through additional recruitment and retention initiatives, introducing "patient action trackers" to help manage discharge and flow, programmes connecting GPs and hospital colleagues, and frailty response cars run by ambulance, community, and hospital colleagues to help vulnerable patients. These are just some of the brilliant and crucial innovations that have been introduced to support patients as the NHS faces rocketing demand.
The health service is, according to another NHS leader, facing an "onslaught" this winter.
Co-Director of Development and Engagement
One chief executive told us they're concerned about being able to sustain high-quality services over winter, while a chair pointed to staff vacancy rates, the threat of industrial action, the cost-of-living crisis, COVID-19 resurfacing and winter pressures as precursors to "a perfect storm". The health service is, according to another NHS leader, facing an "onslaught" this winter.
Staff burnout was another big worry for trust leaders, with an overwhelming majority of respondents to our survey – 93% – saying they are concerned about it across their workforce, and 80% concerned about morale. Meanwhile, more than four in five – 84% – said it's unlikely their trust will end the financial year in a better financial position than it ended 2021/22. Nearly all – 94% – were worried that not enough investment is being made in social care.
In this unprecedented context, last week's autumn budget, delivered by chancellor Jeremy Hunt, will provide some much-needed mitigation against the impact of inflation for trust leaders. This includes the announcement of an additional £3.3bn for the NHS over each of the next two years, and funding for social care, which is being welcomed as a sign that the Treasury has listened to the stark warnings from frontline NHS leaders.
As part of a broad coalition of over 100 organisations, we particularly welcome Hunt's commitment to publish a comprehensive workforce plan next year, including an independent assessment of NHS workforce needs. For this work to have proper impact, it's essential this assessment be published in full – with an explicit commitment to provide the necessary funding to enact its findings.
Investment has now fallen significantly below that of comparable European countries.
Co-Director of Development and Engagement
However, with inflation now at 11.1% – the highest in 40 years – the NHS still faces challenges ahead. Having entered the pandemic following a decade in which investment fell well below the long run annual average since its inception, it has struggled to keep pace with growing and changing demand from an ageing population.
Investment has now fallen significantly below that of comparable European countries, on top of which funding from the government for the next two years doesn't take into account pressure on pay costs in future years. While, as NHS England has said, this additional cash should allow the NHS to focus on key priorities, the service is still facing its most stretching efficiency savings and potential cuts to spending on transforming services, including community diagnostics and mental health.
The huge difficulties facing wider public finances, along with inflation, will also intensify the cost-of-living crisis – and in so doing trigger a surge in demand on an already-overstretched NHS. Trust leaders know better than anyone the tremendous toll this is taking on staff and patients.
Social care is also a core concern as we approach winter. As many as 13,613 people are in hospital beds when they could be recovering at, or closer to home because of a need for investment in social care and community capacity. Governments of all colours have been ducking difficult decisions on social care reform, which harms patients, staff and the wider health and care system.
Day in, day out, trust leaders worry about staff morale, a rise in resignations and retirements, below-inflation pay awards and the cost-of-living crisis.
Co-Director of Development and Engagement
So, while the additional funding for social care unveiled in the Autumn Budget was welcomed by trust leaders – an increase of up to £2.8bn in 2023/24, and £4.7bn in 2024/25 – they share the frustration felt by many that meaningful social care reform is being held back indefinitely with a delay to the charging reforms proposed by Sir Andrew Dilnot.
Day in, day out, trust leaders worry about staff morale, a rise in resignations and retirements, below-inflation pay awards and the cost-of-living crisis. The impacts are not just being felt by their staff but also patients, many of whom are worried about making ends meet, and experiencing worsened health conditions particularly if they have limited access to social support, warmth and nutrition.
Leaders are doing all they can, but steps taken locally will not be enough to adequately tackle the scale of the socio-economic challenges we face. The government faced difficult choices in the Autumn Statement last week. We look forward to seeing them urgently follow through with their newly announced financial support and the publication of a long-term workforce plan, as well as take immediate action to address the successive years of under-investment in social care. In return, trust leaders will continue to pull out all the stops to tackle care backlogs, support staff and patients, and meet agreed priorities.
This blog was first published by the BMJ.
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