Writing for The Leaders Council, NHS Trust director Mashhuda Kazi shares her views on the government’s Health and Care Bill and the impact it will have on the health service.
Through the pandemic, the NHS has been under tremendous pressure. Staff have been clapped for showing an incredible level of courage and resilience, yet the daily reality through the pandemic has been starkly different. Despite NHS and healthcare workers being on the frontline and shouldering the burden of immense stress, we bear the burden of patient dissatisfaction, complaints, understaffing and inter-systemic tension. Burnt out and exhausted NHS staff have taken a substantial amount of sick leave and there have been a wave of resignations from within the health service.
I was expecting the Health and Care Bill to be encouraging to NHS and healthcare workers and to empower them. Instead, I felt disappointed reading the Bill, which has now received Royal Assent by Her Majesty the Queen, forming it into a Health and Care law on April 28, 2022.
This Bill certainly found itself subject to parliamentary ping-pong between the House of Commons and the House of Lords more so than its predecessors. The Act is not fit to serve the purpose of supporting the new, modern NHS to function.
The Bill formalises the implementation and operations of the Integrated Care System [ICS] from July 2022, which is a positive. The ICS brings together the NHS, local government, and wider system partners to collaborate and form a productive partnership at the heart of healthcare planning.
The ICS would have an overview of all system partners, joining them together in their geographical areas as well forming collaborations across ICS systems. It is a much awaited and welcomed opportunity for everyone involved in who wishes to deliver seamless patient care delivery, as well sharing best practice, good models of working, and shared learning across the NHS health economy.
But the Bill addresses little else in terms of issues, including workforce challenges and the social care sector. Yet, however fragmented it might seem we can be hopeful that the ICS plan is indicative of a future holistic approach.
This new law also gives the secretary of state for health and social care greater powers to scrutinise and intervene in NHS matters and increases accountability. The health secretary would hold the right to intervene, which is of serious concern to local NHS system partners since it removes their autonomy.
The NHS, local and wider system partners are already working in ‘silos’, mostly due to the restricted agenda and cuts in funding. The system is restricted across the health economy mostly due to the lack of available resources. The system partners’ remit is ring-fenced and requires extensive business planning and processes for additional funding approval. This is also mostly blocked due to the incredible workload each health employee has.
The current picture of the NHS is very fragile and dire, organisations are struggling to get patients out of the hospital setting and back into the community, specifically those with complex care needs. These are blocking NHS beds when they could be redirected to other settings including residential and nursing care, but there are also shortages there too. Within the NHS, social care sector and local economy, professionals are holding MDT meetings frequently to facilitate complex discharges, but we often fail. The longer the patients stay in hospital, the risk of mortality increases.
The lack of available beds in the community and all-time high bed occupancy within inpatient wards in hospitals are major challenges. From my understanding and own personal scrutiny of the Bill, it doesn’t reassure me that complex hospital discharges will be able to be facilitated anytime soon and it seems bed-blocking is here to stay. To reduce demand on hospitals, there needs to be lengthy and serious discussions on prevention as an aspect of health. We must educate patients and upskill primary care practitioners in patient care management to help with preventative measures, for example with patients presenting with obesity who are at risk of further health complications.
The ICS holds Clinical Commissioning Groups, Local NHS Authorities and wider system partners accountable. However, the level of success of the ICS is yet to be determined. The purpose of the ICS is to understand the local population and socio-economic status so why do we need direction and greater scrutiny from the secretary of state? The Bill takes away local autonomy to organise services that align with the local population’s needs. The interference of the central political influence is contagious and it is highly likely that political agenda and more bureaucracy will filter into how our sector is run.
There has also been an ongoing challenge around recruitment and staff retention. Throughout the pandemic and beyond, the NHS has seen the most accelerated rate of resignation in its entire history. There are multiple reasons for this, including wide-spread harassment, bullying and discrimination within the health service. The Act fails to address the issue of discrimination and doesn't address the 'equity' issue. The Act, to some degree, at least does mention some things about acknowledging and tackling inequality.
The Act needs revision in its aspects of cultural shift and better knowledge sharing of it. The incentive of a salary increase is not a permanent solution for retention when measured against a highly unsatisfied, demoralised, and lesser motivated staff workforce. What retains staff is the showing of respect towards them as an individual along with robust training, development, and career progressions.
In this modern NHS, it was anticipated that this Bill would provide everything. The new ways of operation as set out in the ICS plan provide us with an opportunity to deliver reforms to system care on a local level, but this is overshadowed by the proposed politically-motivated interference of the secretary of state in how the NHS operates.
The bottom line is that the Bill makes noise about monetary values with a wider lack of focus on patient outcomes and staff experiences. I find this extremely disappointing since, fundamentally, the NHS belongs to patients, is paid for by taxpayers and needs a thriving workforce to function to the best of its ability.