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We need radical action and government leadership to put the NHS on a sustainable footing


4 min read

The escalation of strikes is making this one of the most challenging periods in history for the NHS – especially as trust leaders were already bracing themselves for one of the toughest winters to date.

“I have seen nothing like it in over 30 years,” is how one highly experienced NHS chief executive put it when we asked leaders to share their experiences of the pressures the NHS faces. He was not alone.

The impact is there for all to see. The latest NHS performance figures highlight the growing pressure with record long waits for urgent and emergency care and bed occupancy at worryingly high levels. Difficulties discharging patients remain a major pinch point with around 14,000 patients a day still in hospital despite being medically fit to leave. This stark figure lays bare the longstanding lack of social care capacity, the need to invest in community services and difficulties moving patients through the health and care system.

Each day of industrial action leaves patients and the NHS in a more precarious state than the last

This is all happening against a backdrop of an increasingly discontented and overstretched NHS workforce as well as growing industrial action, which shows little sign of being resolved. Despite hopes of a breakthrough in recent talks between the government and trade unions, these have, disappointingly, proved to be something of a damp squib. With more strike action announced by both nurses and ambulance workers in recent days, including the daunting prospect of co-ordinated action on 6 February, it is now more important than ever that talks between the government and unions focus on pay for this financial year if we are to avert further action.

Trust leaders and their teams are doing everything they can to minimise the impact of strike action on patients while supporting their staff, but the disruption to patient care is deeply concerning. Each day of industrial action leaves patients and the NHS in a more precarious state than the last: lengthier waits, thousands of appointments cancelled and knock-on effects as patients who delayed seeking care on strike days present with more advanced or complex conditions later down the line.

The first back-to-back strikes by nurses in January hit trusts and patients hard: more than 5,000 procedures, 20,000 hospital appointments, 30,000 community appointments and 1,700 mental health appointments had to be rescheduled due to industrial action. As this dispute intensifies, patients are paying a heavy price.

There have been glimmers of light, including a recent reduction in elective care waiting lists and progress to eliminate 78-week waits by March – a remarkable achievement given the circumstances. As with the pandemic, health leaders have been working tirelessly with partners across trusts, primary care, mental health, community services and social care to provide each other with mutual aid and support through the worst of the crisis. We have also seen urgent community response teams playing an important role helping ease pressure on ambulances, particularly on strike days by ambulance workers.  

But ask any trust leader and they’ll tell you this isn’t the way to run a health service. To truly tackle these problems, more needs to be done nationally to boost the resilience of the NHS. We’ve seen the government try to tackle some of the challenges facing the health service through the recent Downing Street summit and the announcement of a £250m commitment to ease the strain on NHS beds while increasing capacity.  

Funding and quick-fix initiatives will help paper over the short-term cracks. But what we really need is a long-term commitment from the government and national NHS leaders that focus on the fundamental fault lines hindering the health service’s ability to do its job day in, day out. 

Better support for social care must be at the top of everyone’s agenda. On a daily basis, trust leaders see the legacy of the failure by successive governments to commit to social care reform and the detrimental impact this is having on patients, communities, staff, and the wider health and care system.

We need to see a capital investment plan to replace outdated facilities, diagnostic equipment and technology that has long been promised but is yet to be delivered. Funding to tackle the staggering £10.2bn maintenance backlog and decisions on the New Hospitals Programme, which are compromising quality of care and hindering productivity, are long overdue.

We also need to see urgent action on the NHS workforce. NHS staff are pulling out all the stops in the face of severe workforce shortages, escalating demand and outdated buildings to provide care in the most challenging circumstances. Serious talks, including on pay, need to take place between health ministers and unions without delay.

What we’re seeing now is unlike anything in the memory of the NHS’s most senior leadership. The NHS and its staff continue to show dedication and innovation in these incredibly challenging times, but we need radical action and government leadership to put the NHS on a sustainable footing now, and in the longer-term.   


Saffron Cordery, NHS Providers interim chief executive

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