The RCP has written to the Chancellor of the Exchequer with its recommendations for the Comprehensive Spending Review.
It is unclear whether the Chancellor will go ahead with the review given that he has cancelled this autumn’s budget. But the RCP believes it is important to set out its thinking on what is needed to set the UK on a new path, reflecting the value people have placed upon public services during the pandemic.
The RCP is calling for investment in public health and social care, which would reduce the demand on health services. The Local Government Association puts the Adult Social Care funding gap at £3.6 billion by 2024/25 and the Advisory Committee on Resource Allocation calculates that public health similarly needs an extra £3.2 billion.
Workforce planning in the NHS has failed to keep pace with patient demand. While the UK should always welcome the significant and vital contributions of international staff, we need to do more to move towards self-sufficiency in training of doctors by doubling the number of medical school places by the end of the decade.
The NHS must also adapt to manage growing health inequalities, an ageing population, high prevalence of mental illness, constant technological innovation and unexpected challenges such as COVID-19.
The UK has a world-leading clinical research sector, but some regions do not experience the economic benefits in the form of job creation, and patients in these areas cannot access the most innovative treatments and medicines. The funding challenge for rural and smaller hospitals has been further exacerbated by the pandemic. More generally, we need to restart paused research because causes of ill-health other than COVID-19 have not gone away.
You can read our full recommendations below.
The Comprehensive Spending Review is an opportunity to set the UK on a new path. COVID-19 has shown how highly people value public services and how important it is that those services are able to respond to external challenges.
People across health, care and other public services have gone all out to respond to COVID-19. The government should recognise that commitment and invest in those services now so they – and the country as a whole - thrive in the future.
Reducing health inequality
We wrote to you ahead of the budget in March, saying it was an opportunity for the Government to make inroads into its manifesto promise to ‘invest in preventing disease as well as curing it’. Given the pandemic and its impact, keeping that promise is even more important.
As we know, the next 18 months are likely to be extremely challenging as we seek to sustain the economy while protecting the health of the nation. This creates an opportunity for the Government to focus on its promise to ‘level up’ the country.
The case is clear for a national strategy for coordinated cross-governmental action to reduce health inequalities. A good start would be investing in data collection and analysis so we better understand the drivers of ill health and what is effective in tackling them.
A healthier population would have been better able to deal with COVID-19; while the full picture isn’t yet clear, it does appear that our high levels of obesity have contributed to hospitalisations and deaths. And a healthy population is an active population, helping the economy thrive by working, paying their taxes and using fewer public services.
We therefore reiterate our March call to invest in public health and social care, which is necessary if we are to reduce the demand on health services. The Local Government Association puts the Adult Social Care funding gap at £3.6 billion by 2024/25 and the Advisory Committee on Resource Allocation calculates that public health similarly needs an extra £3.2 billion.
Adequate investment is particularly important as the National Institute for Health Protection is created and a new structure is designed for the delivery of public health functions. If the arrangements are not accompanied by significant funds, we will not improve the health of the nation and will not be as prepared as we could be for future crises.
Expanding medical school places
Workforce planning in the NHS has failed to keep pace with patient demand. As a result, the UK has to rely on international staff to fill shortages across the NHS.
While the UK should always welcome the significant and vital contributions of international staff, we need to do more to move towards self-sufficiency in training of doctors. The NHS must also adapt to manage growing health inequalities, an ageing population, high prevalence of mental illness, constant technological innovation and unexpected challenges such as the recent pandemic.
Modelling by the Royal College of Physicians (RCP) and Royal College of Psychiatrists shows that we should double the number of medical students in the UK by the end of the decade. The NHS interim people plan and Simon Stevens himself have both acknowledged the need to further expand medical school places.
The demand for medical school places following the A-level results this year again demonstrates the demand for a medical career. And the temporary and successful lifting of the cap on medical school places is an opportunity to introduce a planned expansion.
The RCP has been working with a number of bodies, including the Medical Schools Council and the Royal College of General Practitioners, to develop an economic model to assist with planning for an expansion of medical school places. The model will be outlined in a report due to be published in November, which includes contributions from stakeholders such as Health Education England and the General Medical Council. In the report we also focus in detail on the costs associated with such an expansion using work commissioned from the York Health Economics Consortium.
In line with these calls, the Government should invest in expanding training places in medicine. This is particularly important given the increased number of emergency admissions under medicine year on year, and the ageing and increasingly frail population.
Expanding clinical research
The UK has a world-leading clinical research sector, but this research activity is not distributed evenly across the country (see appendix). Some regions do not experience the economic benefits in the form of job creation, and patients in these areas also cannot access the most innovative treatments and medicines.
A report by KPMG UK, commissioned by the National Institute for Health Research (NIHR), summarises the macroeconomic benefits and the boost to NHS finances from the UK’s strong clinical research sector. It found that in 2018/19:
• clinical research backed by NIHR contributed £2.7 billion to the UK economy and generated over 47,000 jobs
• for each patient recruited onto a commercial clinical trial, on average the NHS in England saved £5,813.
A key issue hampering a fairer regional distribution is NHS workforce capacity. In January 2020 we found 57% of physicians wanted to be more involved in research but were unable due to time.
The problem of low participation was particularly acute in rural hospitals, where 40% of physicians not participating in research said they would like to. Rural NHS trusts find it particularly difficult to support their workforce to become involved in research given the higher costs they face, as highlighted by the Nuffield Trust.
This funding challenge for rural and smaller hospitals has been further exacerbated by the pandemic. One of the key short-term destabilising hits to the UK’s capacity to conduct clinical research is funding. UKRD and NHS R&D Forum summarise well the commercial funding shortfalls that are affecting NHS research in their July 2020 report.
The Academy of Medical Sciences has estimated the costs of providing dedicated time for research. In a pilot across 10 NHS trusts, the cost of 20% of consultants having 20% of their time protected for research was between £21.7 and £25 million per year. The Government should conduct another such programme, targeting ten NHS trusts where research activity is low, and in regions where research activity is also low.
As the UK’s chief medical officers and Professor Steve Powis recently outlined in a letter to trusts, we need to restart paused research because causes of health other than COVID-19 have not gone away. The pilot we have outlined will help that, as will investment in the medical workforce that frees up time for clinicians to do research.
The impact of the pandemic would have been much worse if the Government had not acted so quickly and invested in the population. Providing income and business security must have been a difficult decision, but it was done without delay and the confidence that it was the right thing to do for the economy and individuals. We urge you to stay that path –invest now and reap the benefits in the future.
We will be more than happy to discuss these proposals in more detail with officials.
Professor Andrew Goddard President, Royal College of Physicians