Theres life beyond Brexit, according to the U.K. government. Nobody else seems convinced.
Prime Minister Theresa May visited a hospital in Liverpool on Monday to lead a carefully choreographed announcement of the new 10-year plan for the National Health Service. Designed to show the government is capable of doing more than just leaving the EU, the plan aims to “save almost half a million more lives” in the next ten years by focusing on prevention and making better use of digital health services.
With most domestic policy initiatives on hold because of Brexit, the government has promised a £20.5 billion spending boost by 2023-24 to back up its health plans — money May said will come in part from the windfall to be enjoyed when the U.K. stops sending money to Brussels.
But the reactions from health care providers focused largely on the uncertainties facing the NHS ahead of Brexit, both in terms of finance and the departure of EU27 nationals that will worsen staffing issues. (Few believe a Brexit windfall is likely despite the Vote Leaves red bus.) Lengthening wait times for services was another politically sensitive issue set aside in the governments announcement.
“This is not about miracles — money will be tight and staffing will remain a headache for years to come,” Niall Dickson, chief executive of the NHS Confederation, which represents health service providers, said in reaction to the plan. Warning of the risks of “over-promising,” Dickson said: “Our plea is that politicians be honest about the trade-offs that will be required and that we are realistic about what can be achieved given the ever-increasing demands of an ageing population.”
Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity
The announcement also suffered from the governments strategy of pre-announcements: major policy initiatives from new cancer screening to mental health service improvements had been widely previewed, leaving praise confined to celebrating the “vision” of tying those initiatives together.
Heres five reasons why the plan failed to match expectations.
1. Not enough money
Health groups say the £20.5 billion budget increase by 2023-24 unveiled in June is not enough to get the NHS back on track following years of austerity. The figure amounts to a 3.4 percent increase in funding, but think tanks such as the Nuffield Trust say a 4 percent boost is needed at least to “put the NHS on a sustainable footing.”
“Ultimately, there is a need for honesty about how far the £20.5 billion over five years will stretch,” British Medical Association (BMA) council chair Chaand Nagpaul said Monday. “World class care requires world class funding and the investment in the long-term plan will still leave the U.K. falling behind comparative nations like France and Germany.”
Britains Health Secretary Matt Hancock | Ben Stansall/AFP via Getty Images
Plus theres concern a no-deal Brexit would deplete the promised funding — “the extra costs and tasks required would eat up the first instalments, stopping progress dead in its tracks,” Nigel Edwards, chief executive of the Nuffield Trust, said in a statement.
Health Secretary Matt Hancock has promised the extra funds will be available “irrespective” of the outcome of Brexit talks with the EU, which doesnt quite fit with Mays suggestion it will come in part from money London will no longer be sending to Brussels.
2. Ignoring staffing woes
Staffing shortages are top of the list for nearly 60 percent of U.K. voters when asked where the extra NHS cash should be spent, according to a poll by The Times, but the governments plan kicks that can down the road.
The plan promises “NHS staff will get the backing they need” by balancing “supply and demand across all staff groups.” The funding for hiring, training and professional development of NHS staff “has yet to be set by government” and wont be published until “later in 2019,” it said.
Staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout” — Chaand Nagpaul, BMA council chair
The BMA, which represents doctors, and NHS Providers, which represents various NHS staff, cautioned the NHS will be hard-pressed to make good on the plans promises if it doesnt improve the staffing situation. One in 11 posts are estimated to be vacant and the situation is predicted to worsen after Brexit, with the Kings Fund, Health Foundation and Nuffield Trust predicting a shortfall of around 250,000 NHS staff by 2030.
Nagpaul of the BMA said doctors and staff “are routinely struggling to cope with rising demand and, as a result, are subject to low morale, stress and burnout.”
3. Hedging on waiting times
The governments plan commits to reducing waiting times for mental health services across the board, ranging from children to adults and community-based care to crisis situations.
But as the NHS continues to come up short on waiting times for emergency care and routine surgery, the new plan offers no clear path forward other than to say “sufficient funds” will be allocated to local NHS services to cut long waits.
NHS chief Simon Stevens | Tolga Akmen/AFP via Getty Images
“We also need immediate, practical solutions and the necessary investment for hospitals to deliver both in the long and short-term,” said Nagpaul of the BMA.
NHS chief Simon Stevens said there should be “tougher, faster” standards when it comes to emergency room waiting times in an interview with BBC Radio 4 on Monday, and suggested the existing four-hour guideline by which NHS progress is judged needed to be updated. “The problem with that is it doesnt distinguish between turning up at A&E with a sprained finger and turning up with a heart attack,” he said. He declined to commit to specific targets.
4. Mixed messages on prevention
One of the main pillars of the governments plan is prevention — stopping health problems before they start by trying to reduce smoking and drinking or increase exercise, for instance.
While many groups supported this move, they couldnt help but note the hypocrisy of the fact that government funding for local public health services has been cut in recent years. The latest projections are a cut of £85 million for 2019-20, to £3.1 billion.
“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again” — Nigel Edwards, chief executive of the Nuffield Trust
Nagpaul of the BMA urged the government to take bolder stances on issues such as a minimum unit price for alcohol and restricting sugar in food.
“The reforms we all know are needed to the way we pay for care have been kicked into the long grass again and again,” said the Nuffield Trusts Edwards.
5. Raised expectations
U.K. Chancellor Philip Hammond hit the nail on the head when he wrote in the Daily Mail on Monday: “The leaders of the NHS must now ensure they get the basics right. Alongside greater quality of care and ending waste, the public will demand that progress is made on the back of their investment.”
The widely-touted funding rise will leave people expecting a better and more efficient NHS, which requires delivery on the basics such as wait times that the plan doesnt address.
The governments major targets are focused around specific diseases: the plan aims to prevent 150,000 heart attacks, strokes and dementia cases, and 55,000 cancer-related deaths, and help 380,000 more people get treatment for anxiety and depression. As Conservative Party MP and health select committee chair Sarah Wollaston noted, some of the priorities mirror those set out in the previous five-year plan, “many of which remain unfinished business.”
“The last plan was undermined by the cuts to social care, public health, capital and training budgets and it is important not to see this repeated,” Wollaston wrote in a blog post.