Plus ça change – but is there new hope for the NHS?

In her latest column for Commentary magazine, RCP president Professor Jane Dacre outlines how increased scrutiny on the provision of social care could improve the fortunes of the NHS, amid the health service's ongoing crisis.

Each day, we learn of new problems in the NHS – beds are shut, operating rooms are not available, emergency wards are closed, essential services are shut down in order to make financial savings …

In spite of the efforts of doctors, nurses and other hospital staff, patient care is deteriorating. Acute hospital services have almost reached breaking point. Morale is depressingly low …

(…) An immediate overall review of acute hospital services is mandatory. Additional and alternative funding must be found. We call on the government to do something now to save our health service, once the envy of the world.

This quote could describe our current winter crisis – in fact, it is a statement made to the government just over 30 years ago by then president Sir Raymond (Bill) Hoffenberg, with Sir Ian Todd (then president, Royal College of Surgeons) and Sir George Pinker (then president, Royal College of Obstetricians and Gynaecologists). (Thank you to Kieran Moriarty and Ian Gilmore for reminding me of this important statement). 

Since that statement, I am the seventh consecutive president of the RCP to have raised the very same issues – in meetings with ministers and prime ministers, public statements and press conferences, reports and briefings. I myself wrote again to Theresa May a couple of weeks ago to stress the need for a long-term funding solution, including more funding for social care.

Much of the so-called ‘inefficiency’ of the NHS is related to problems in the social care sector.

Over those 30 years, the government response and consequent action has varied widely from supportive to dismissive – from the major investment into the NHS coupled with consultant expansion in The NHS Plan – through ineffective restructurings, which have not addressed the underlying funding deficit, to the situation we face now. Both the health secretary Jeremy Hunt and CEO of NHS England Simon Stevens have openly agreed with us that more healthcare staff are needed and last year agreed to an extra 1,500 medical school places for next year – a big win. However, it will take 5 years before those doctors begin to treat patients, and in the meantime we have severe shortages in many specialties. 

But is there a glimmer of hope? Much of the so-called ‘inefficiency’ of the NHS is related to problems in the social care sector – hospitals are full of patients, particularly frail older patients, whose transfer is delayed due to funding cuts, and staff and long-term care bed shortages in the social care sector. Is the increasing realisation of this turning the tide in government?

The addition of social care to the health secretary’s portfolio in the recent reshuffle, coupled with the reinstatement of a senior minister rather than junior for social care, has the potential – and at this stage only potential – to integrate services to provide a seamless experience to patients.

Both Jeremy Hunt and Simon Stevens have agreed that more healthcare staff are needed ... in the meantime we have severe shortages in many specialties.

Critics have been sceptical, as the Department for Housing, Communities and Local Government will still control the money given to local authorities to provide social care. But we must hope that the spotlight turned on the social care sector by a new ministry, and having a single point of responsibility (or blame!) will speed up consideration and action.

Jeremy Hunt has also been given the responsibility of preparing the green paper on social care for older people, to be published in the summer – his experiences as one of the longest serving health secretaries must inform him in finding solutions that will also decrease the pressure on the NHS.

So we now have a new opportunity to influence the green paper, using our experience of the innovative Future Hospital projects that delivered locally integrated services. We will be setting up meetings with the new department and continuing to lobby for an improved NHS, representing the interests of fellows and members, as we have for nearly 500 years since Thomas Linacre petitioned Henry VIII to set up the college.

Professor Jane Dacre is president of the RCP, an honorary consultant physician and rheumatologist at the Whittington Hospital, and director of UCL Medical School in London. You can follow her on Twitter.

This article appears in the February 2018 issue of Commentary.