The Carer’s Post

NHS Leaders Facing “Drastic Measures” To Make Ends Meet Health leaders in England are calling on the next government to protect local NHS organisations from having to further cut staffing levels to make ends meet at a time when the needs of their patients are so high. In a survey of NHS leaders across trusts, integrated care boards (ICBs) and primary care in England, some local NHS organisations are already cutting or freezing posts to balance their books. They fear local services are trapped in a cycle of short-termism where immediate cuts to meet financial targets are having to be prioritised over long term plans to improve and transform local services. The survey was carried out during late April and early May – a time when the NHS has been coming to terms with the “flat” revenue settlement set in the Spring Budget. The NHS has been set an annual efficiency target of 2.2%, despite many organisations starting the financial year in a worse underlying state due to industrial action and other cost pressures. As the NHS Confederation survey shows, many local NHS organisations are facing much higher efficiency targets that will impact on their staffing levels. The rate of NHS productivity growth has averaged 0.9 per cent over the past 25 years, with the NHS often delivering higher productivity improvements than the wider economy. However, the NHS leaders responding to the survey said that they need, on average, to make efficiency savings of 6% in 2024/25, with local services facing targets ranging from 1.6% all the way up to 11%. Recently, the Institute for Fiscal Studies found that real-terms spending on the NHS had risen less quickly than was pledged at the last general election five years ago. This squeeze on NHS spending is likely to be compounded by the main political parties committing this week to no further tax increases, which the IFS say will further constrain spending on public services. In response to this, some health leaders are having to take “drastic measures” to balance the books, with cuts to agency spending, freezing vacancies and cuts to clinical and managerial and administrative staff the most effected. This is to cover what is estimated to be a larger projected deficit in the financial plans of local integrated care systems (ICS) than has been seen in recent years. This could lead to further cuts to capital and other budgets. Cuts to staff come at a time when the latest data shows there are over 100,000 vacancies across the NHS in England, including nearly 9,000 medical posts. This short-term risk to freeze or cut posts could be seen to go against the NHS Long Term Workforce Plan’s commitment to grow the NHS’s headcount so that it can meet the needs of patients and respond to rising demand. The main political parties appear to agree that the NHS must grow its workforce, yet without appropriate levels of funding locally that are matched to the efficiency asks of the NHS, many health leaders feel as though they have no…

🚨 Major NHS Reforms Announced for Accountability & Excellence 🚨 The UK government has just unveiled a comprehensive package of NHS reforms aimed at ensuring that every patient receives the highest standard of care possible. With a zero-tolerance policy on underperformance, these changes seek to address longstanding challenges head-on, improve outcomes, and create accountability at every level. Key measures include: Tougher performance standards for hospitals and healthcare providers Increased transparency for patients on quality of care metrics Enhanced support & intervention to uplift struggling NHS trusts Health and Social Care Secretary,Wes Streeting emphasised that these steps are necessary to restore trust and improve services across the NHS. This is a bold move aimed at prioritising patient care and rebuilding the NHS with a commitment to excellence. What are your thoughts on these new standards for the NHS? Do you believe they will drive positive change? 💬 #HealthcareReform #NHS #PatientCare #Accountability #HealthcareInnovation

The UK’s NHS - an organisation and system in need of reform? Further to my post on taxation in the UK I want to shine a light on the UK’s National Health Service [NHS]. Founded just after World War 2, the NHS is now Europe’s biggest employer. It consumes almost £200Bn of Government spending in the UK, accounting for at least 22.4% of the UK’s government spending in 2022 [latest year for this data] a figure that is probably closer to 24% in 2024. Despite protestations from NHS staff, some MP’s and campaigners it’s funding has increased year on year but it’s productivity is declining. The graphic below published by the BBC [who are generally very supportive of the NHS] shows that since 2019……… - the NHS workforce has increased by +23% - NHS spending [budgets] has increased by +19.1% - But the number of patients treated by the NHS has only increased by +3%. Now I know some commenters will say “but the funding was behind inflation”. That is not factually correct. The UK’s inflation was well below 2% until mid 2021 and up to that point the NHS budget was increased by amounts well above inflation. And even if it was not increased in line with inflation why is the number of patients being treated only up 3%? It just doesn’t make any sense and we need to know why. This poor productivity is unsustainable and must be addressed. I cannot explain it and would welcome sensible comments from healthcare professionals on what they think is, or know to be, wrong with the NHS. Is it no doubt, at base level, a management issue but I would ask the following….. - Are the investment priorities [primary vs secondary care vs community care] used to allocate this massive budget correct ? - are staff productive and if not, why? - Do the various NHS trusts around the UK share best practice routinely and is this coordinated by an accountable division with the NHS? - How should productivity be measured in the NHS - are the metrics standardised and agreed ? - Are the medical and administrative managers responsible and held accountable for productivity ? As a manager with experience of managing large complex organisations I am familiar with similar issues but I have never seen such poor performance in a “profitable” private enterprise. Put simply, a private company would never survive if it performed like the NHS. So we need to challenge our Government and the NHS itself to address this issue as it is a major factor in the UK’s poor overall productivity. Poor healthcare results in an unhealthy society which in turn damages the private sector of the economy due to sickness related absenteeism, educational sub achievement etc etc. I look forward to the comments, especially from within the NHS community but regardless of who comments - be considerate and positive. These are rational questions, deserving of well thought through and fact based answers.

£38bn Extra Per Year Needed To Revive The NHS New analysis published by the Health Foundation’s REAL Centre projects a potential £38bn shortfall in the funding needed to improve the NHS by the end of the next parliament. With the pledges made by both the main political parties so far falling a long way short of this, the analysis raises serious questions about the trade-offs facing the next government in balancing the funding needed by the NHS, pressures on other public services and levels of taxation. The Health Foundation analysis shows that health care funding in England would need to rise by 3.8% per year in real terms – broadly in line with the historic average - over the next ten years to meet rising care needs and deliver significant improvements in the NHS. This includes higher annual growth of 4.5% in the first five years as the NHS recovers from Covid and invests in modernising services, adding up to an extra £46bn of funding in 2029/30. This compares with an increase of almost £8bnif the health budget grows in line with the planned growth in public spending factored into the Office for Budget Responsibility’s economic forecasts for the next parliament, leaving a funding gap of £38bn. This funding would be enough to tackle waiting times for care over a ten-year period (a slower timescale than the two main parties have pledged), prioritise prevention and invest more in primary, mental health and community care. The main political parties have all promised to deliver similar improvements but have yet to set out a convincing plan for how they would fund them. The authors also highlight the need to allocate a significant chunk of the additional spending to capital investment. Health capital spending would need to rise from almost £13bn this year to £21bn in 2029/30and £27bn in 2034/35to tackle the crumbling NHS estate, add bed and diagnostic capacity, and improve IT systems. This would leave a £9bn gap in capital investment by the end of the parliament compared to spending rises in line with OBR assumptions. The Health Foundation’s work with Ipsos shows that around half of the public (47%) would prefer to see an increase in taxes to maintain the current levels of care and services provided by the NHS. This compares to just 11% who would like to reduce spending on other public services to maintain current levels of NHS care and 9% who would reduce the level of services provided by the NHS to avoid increasing tax and spending. Anita Charlesworth, Director of the Health Foundation’s REAL Centre, said: ‘The health service is in crisis and all the main political parties have said they want to fix it – yet the funding they have so far promised falls well short of the level needed to make improvements. ‘Politicians need to be honest with the public about the scale of the challenge the NHS faces and the reality that an NHS fit for the future needs long-term sustainable investment. Honesty about this has so far been conspicuously lacking f…

The more I research the NHS and where they spend the money the more I suspect that more money is not the answer but a fundamental change in how money is spent. The attached research shows how the acute care sector ie hospitals have swallowed nearly all the increased funding leaving primary healthcare and community healthcare starved. Micro sums are spent on health prevention and wellness and the primary care sector funding restricts their operation throwing even more pressure on the ultra expensive hospital sector A return to community health with cottage hospitals or health hubs are a part of the answer. However in return for more funding the primary care sector has to accept more public oversight. A local village school or secondary Acageny has to account to a board of non executives drawn from local community. Every pound spent is subject to scrutiny GP practices have no similar oversight Talking to local GP’s it appears that mistrust of GP’s means that money is allocated in small ring fenced sums with no incentive for efficiency. GP’s refused to join the NHS when first founded and they have remained a private contracted service since Now is time to apply a carrot or a stick and in return for more oversight more of the pie should be spent in the Non acute sector #NHS.

NHS - National Health Service or National Horor Show? As somebody with more to thank the NHS for than most, I am in total dismay as I listen to the endless reports of its impending demise. The thing that hurts most, is the futility of the efforts of the totally outstanding frontline staff, those who truly care about the standards of service and its delivery, day-in, day-out! I have been around a long time, and as a Veteran I genuinely appreciate growing old, because not everybody gets that chance. Over the last 3 years I have been in and out of hospital more times than I care to remember, being ill for the first time in my life; again, I’m thankful for my recovery and owe my life to the NHS. However, I feel that there is insufficient clarity around why the NHS is in the state that it undoubtedly is. Putting the political grandstanding to one side, I feel the people deserve to be focused on the facts, which in my view can be summarised as follows: - throughout its 75 year life the NHS has lacked a sustained level of investment, irrespective of the government of the day. FACT - the organisation is no longer FFP and must be reviewed and restructured as a national priority. - the level of bureaucracy within the organisation has increased year-on-year (note: currently c47% of NHS FTE are not clinically qualified). FACT - there is a total imbalance in the numbers of clinical versus non-clinical staff. This must feature in the review and be reduced significantly. Money will be saved. - the current NHS budget is now set at £192bn, a real-time increase of £21bn in cash terms; according to the Health Secretary, Wes Streeting, this will only “paper over the cracks”. FACT - the “blame game” and point scoring must stop. The problem must be given cross-party priority; if ever there was a “joint” responsibility, this is it! - the growth of the UK population has not been controlled appropriately in recent years and a working solution must be identified and implemented as soon as possible. FACT - the current strain on the NHS and its A&E capability is costing lives NOW; this is inhumane and unacceptable. This needs immediate attention and resolution, so if the politicians are listening STOP THE POINT SCORING, PULL TOGETHER AND GET IT DONE BEFORE OUR NHS IS CONDEMNED TO HISTORY! #supportnfixourNHS

Keir Starmer has made the prime target of the NHS is reducing waiting lists,  but will that stop the NHS Titanic from sinking? I heard a fabulous analogy today from Mark Burns today. (https://lnkd.in/e4KWvsCh ) "A ship is sinking and everyone is busy manning the pumps. The boat has now stopped sinking, but you cannot stop pumping or it will sink further. You are stuck, so you need to allow some people to stop pumping and go and fix the holes" This is an excellent analogy for public service and the NHS in particular. NHS waiting times are simply about bailing faster to stop the boat from sinking. Better pathways, more capacity, speedy everything. But we are not preventing the demand from coming in. We are measuring our ability to bail it out. The problem is our funding targets and KPIS are based on how much water we bail out of the boat. This is what makes Keir Starmer’s waiting time target for the NHS so odd. The idea that a busy NHS is a good NHS. That the more the work the NHS produces the better it must be. Whilst the core function of our NHS and the health and social care system is actually to maintain the health and wellbeing of society…. actually stopping the ship from sinking. Don't get me wrong we do need to keep bailing as fast as possible to keep the ship afloat, but we must also need to look at the wider problem. Why have the waiting lists got so bad? Where is the demand coming from? What can we do to reduce and better manage that demand? It is far less work to capture the demand quickly where and when it comes into the boat. Rather than chasing around scooping it off the floor. Also where does that water go? It seems like much of the problems the NHS ships out actually go straight back in. Unless we are careful, we are basically bailing water into our own boat! But also the more work we bail the more demand we are putting on social care. (Then blaming social care for not having capacity). Which also rebounds the water of demand back into the NHS. The best way to reduce waiting lists is to reduce pressure on the bailers. That can only be done by reducing demand. So the best way to reduce waiting lists is to focus on fixing the boat. NOT to focus funding and attention on treating people as fast as possible.  Leaders need to take the initiative in reducing waiting lists in not just creating creating a good flow of work, and optimising that, but actually seeing the big picture understanding how we can stop the waves of demand coming in. The KPIS and targets of the NHS and healthcare should not only focus on bailing faster, but how we navigate our ship to calm waters for our public services to be effective and productive. Creating a service that our public most need. #NHS #healthcare #health #funding #productivity

Future of the NHS: Health Officials Out Of Ideas and Remarkably Complacent, PAC Finds The Government’s NHS ambitions run counter to officials’ lack of ideas or drive to change, according to a report published today. In the context of a worsening financial position for the NHS, the Public Accounts Committee warns that, while Government’s forthcoming 10-year plan will be essential to the health service’s recovery, senior health officials seem to be unambitious when it comes to taking the radical steps to begin to implement it. The Government has laid out its planned ‘three big shifts’: from hospital-based to community care; from analogue to digital; and from treating ill health to prevention. However, in questioning both the Department for Health and Social Care (DHSC) and NHS England (NHSE), the PAC found that officials do not seem ready to prioritise these shifts – agreeing with the Government’s aims, but arguing they are difficult and should take place only slowly, over the long-term, and not at the expense of patients now. This risks letting slip a golden opportunity to take significant decisions for the longer-term benefit of the nation’s health, at precisely the moment where ideas to meet the level of change required would be highly desirable. The PAC’s report calls for the development of the 10-year plan to ensure enough funding is allocated to future-proofing the NHS, particularly on prevention, community healthcare, and digital technology. Recommendations The report makes specific recommendations in each of these three areas: •On community healthcare, the report finds that the long-held ambition to move more care from hospitals has stalled. It recommends that NHSE ensure that more funding, year on year, is spent in the community, in line with its own ambitions. •On prevention, it is likely that refocusing from treating sickness to prevention will require a similar shift of funds in the same direction. The PAC recommends that a definition be reached for what counts as prevention spending; that officials set out the funding increases required to achieve it; and for local systems to be given the required flexibility and autonomy to direct funds to the right areas. •On the switch to digital, the PAC’s report warns of glacially slow progress in parts of the NHS. A number of trusts still work with fax machines, and NHS providers are often still too reliant on paper records. The report calls for plans to reduce this reliance on paper within 18 months, and a specific deadline to end the use of fax. The report further notes unconvincingly optimistic assumptions underpinning current plans of annual productivity gains* of 2% by 2028-29, calls on Government to give local health bodies earlier certainty about how much money they will have, and highlights perverse incentives around vaccination funding for GP surgeries which could be seeing more deprived areas losing out. Sir Geoffrey Clifton-Brown MP, Chair of the Committee, said: “The c…

⭐️The Future of the NHS: Reform or Collapse?⭐️ The recent Darzi NHS report has sent shockwaves through the UK, as Prime Minister Keir Starmer addressed a critical issue: 100,000 avoidable deaths due to overstretched NHS services. This shocking statistic leaves the public rightfully angry, as the outgoing government has been blamed for failing to protect one of the country's most cherished institutions. We are becoming an increasingly sick society, with 2.8 million people now inactive due to long-term health issues. It’s not just a health crisis but an economic one, and a return to good health must be a priority. Labour, under Starmer, has been given a clear mandate for change, and in his words, "The NHS might be broken but not beaten." What happens next could determine whether the NHS survives or collapses. 🔷The Need for Reform: A Health System at a Crossroads The NHS, founded 76 years ago, promised free care at the point of use—a model that remains fundamentally right. However, it’s no longer adapting to the current challenges. The answer to saving the NHS is not just pouring more money into it but fixing broken systems. This includes upgrading outdated technologies, streamlining discharges to free up hospital beds, and ensuring that social care supports rather than hinders this process. 🔷A 10-Year Plan for NHS Transformation The government is now working on a 10-year plan, focusing on three core areas: 1. Analog to Digital Transformation: The NHS must move fully into the digital age. This includes using technology to detect and manage conditions, empowering patients through the NHS app for referrals and appointments, and fully integrating digital records across services. 2. Shift from Hospital to Community Care: Too much care is still centered around hospitals, but for the NHS to survive, there must be a shift towards community care. This means integrating health and social care so people can be cared for safely at home. 3. Prevention over Cure: Bold steps must be taken to focus on preventing illness rather than just treating it. With the rapid development of new technologies, there is a growing opportunity to address issues before they become chronic. 🔷A Future of "Challenge, Change, and Hope" Starmer ended his address with the hopeful slogan: “Challenge, change, and hope.” This encapsulates the vision for a reimagined NHS. However, while social care was acknowledged as a critical partner to the health system, it was notably absent from any concrete future plans or funding strategies. This remains a significant gap in the broader conversation about healthcare reform. The road ahead is challenging, but with a clear focus on reform, technology, and prevention, the NHS may still have a future worth fighting for. The stakes couldn’t be higher, and time is of the essence. Now, the public waits to see if the government’s words translate into meaningful action.