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Setting out a vision for long-term NHS reform will win goodwill of frontline staff

4 min read

No leadership can inspire confidence unless it is tackling long-term challenges with wisdom and courage

Thérèse Coffey is an inspired choice for Health Secretary: a no-nonsense, details person with an impressive track record of delivery including responsibility for huge changes to the benefits system delivered seamlessly during the pandemic. The fact that she is also Deputy Prime Minister further underlines the priority with which the NHS is seen.

She may feel she has to choose between her natural instinct to be a reformer and the political imperative to “keep the NHS quiet” ahead of an election. I was under similar instructions as health secretary but ultimately found it was a false choice: no leadership can inspire confidence unless it is tackling long-term challenges with wisdom and courage – and nowhere needs that more right now than the NHS. Battered after a pandemic, facing a brutal workforce crisis, and with the biggest waiting lists in its history, morale is low. But it would be a miscalculation to say it cannot get even lower – not least with the prospect of a winter flu season around the corner.

So it was encouraging to see some sensible short-term measures to ease pressure this winter. Coffey’s recent announcement on additional money for social care will help free up some of the 13,500 beds taken up by people who should be looked after by the social care system.

But the missing detail was long-term reforms that could break the cycle of long waits, burned-out staff and declining standards. Top of this is workforce reform to end the shortages we now see in nearly every specialty. The government has promised a long-term strategy to make sure we are training enough doctors – but we have been waiting for it for more than a year. The government voted down an amendment to the Health and Care Act that would have made this happen. The then health secretary would not even commit to publishing any numbers. But what is the point of a workforce plan if it cannot answer the simplest of questions: how many doctors, nurses and midwives will we need in 10, 15 and 20 years’ time, and are we training enough to get them?

It would be a miscalculation to say NHS workforce morale cannot get even lower

Of course, we know the answer: despite the six new medical schools announced in 2016, we are not training enough, which is why 24 per cent of NHS doctors are foreign-trained despite huge numbers of highly talented young people being turned away from medical schools every year. This year we even cut the number of medical school places. In my recent book Zero, I lifted the lid on the haphazard way in which workforce numbers are negotiated between the Treasury and Department for Health and Social Care. It is a failed and flawed system, and any plan that does not reform it will fall at the first hurdle. Sorting it out will not mean there are more doctors and nurses on wards next Monday – but will give much-needed hope to every young person joining the NHS that workforce shortages will be solved over time.

There are other badly needed reforms: fixing the social care system, removing the national targets that turn patients into numbers and going back to people having their own GP. Setting out a vision of such reforms will not prevent a tough winter – but will earn the loyalty and goodwill of the frontline staff on whom we will be depending on in the challenging months ahead. It will also show the country that Conservative commitment to the NHS is about more than words – it is about taking difficult decisions to reform a much-loved institution so that it continues to stand the test of time.

Jeremy Hunt is Conservative MP for South West Surrey and chair of the Health and Social Care Select Committee

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