Engage: Time to level with public about the scale of challenges facing the NHS

Public commitment in the NHS risks being put “on the line” without greater transparency about the challenges it faces, a new report warns.

Research by NHS Providers, the body representing NHS trusts, found that more than nine in 10 leaders feel there has not been enough public debate about the growing pressures they are experiencing.

While the NHS has seen “welcome” Government funding pledges, it is trying to meet rising demand amid 100,000 staff vacancies, a £6 billion maintenance backlog and “no firm decisions on social care, public health, capital and training budgets”, the body says.

The head of NHS Providers has called for greater realism “about how much the NHS can deliver” and of the “current level of operational instability, which place significant constraints on how quickly the new NHS long term plan can be delivered”.

Chris Hopson (pictured) said: “It is very striking that over 90% of trust leaders are worried that there hasn’t been the full, frank and open national conversation about the severe pressures facing the NHS and how much these constrain what it can deliver.

“It’s an uncomfortable debate to have. The Government wants to be seen as an effective steward of the NHS. NHS England and Improvement want to be seen to lead the service effectively. And frontline leaders want to provide outstanding care to every patient.

“But we need greater realism about how much the NHS can deliver, and how quickly, given where we currently are and the challenges we face.”

He added: “Unless we level with the public about how long it will take to recover from where we are and how quickly we can deliver the NHS long term plan, public commitment to the NHS is on the line.”

According to the King’s Fund think tank, public satisfaction with the NHS fell to 53% in 2018 – the lowest level for more than a decade.

One community trust leader told the NHS Providers report, entitled The state of the NHS provider sector: “There is debate but given the focus on Brexit I don’t think we are anywhere near having the sort of conversation we need with the communities we serve about the choices and challenges ahead.”

Leaders from 54% of the trusts representing hospital, mental health, community and ambulance services responded to the survey.

Only 29% are confident that their trust has the right numbers, quality and mix of staff to deliver high-quality healthcare to patients.

The same proportion are confident that progress towards ‘system working’ – working collaboratively with other NHS trusts, GPs and local government – in their area will move fast enough within the next 12 months to help them deliver the plan.

More than half (54%) do not believe the necessary support is in place to properly join up working between GPs and hospital and community care.

Some 90% of trust leaders are worried about a lack of investment in social care in their area, while 77% are concerned about a lack of investment in public health and prevention.

And 72% are concerned about whether their trust can make the capital investment needed to maintain and modernise the NHS estate and equipment.

Cumulatively, these challenges mean that trust leaders are concerned at their ability to deliver “the positive and ambitious aspirations” set out in the NHS long term plan, NHS Providers said.

The body is calling for a “funded, credible final NHS workforce plan”, a full, multi-year capital settlement, “sustainable” funding for social care and public health, and greater clarity on the quality standards the public should expect and appropriate resources.

UNISON head of health Sara Gorton said: “The report highlights the devastating impact of short-term planning and long-term underinvestment in health and social care. It lays bare the damaging effect on patients and staff.

“Health bosses clearly know services can no longer rely on goodwill to stay afloat, and that many of their staff are at breaking point.”

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