I enjoy writing this column because it makes me read and reflect and I hope it encourages you to delve deeper into some of the areas that I highlight. This month, I would encourage you to read the Times Health Commission report (2024). Slyvester (2023), chairwoman of the commission, explained that:
‘The Times Health Commission has been set up to consider the future of health and social care in England in the light of the pandemic, the growing pressure on budgets, the A&E crisis, rising waiting lists, health inequalities, obesity and the ageing population.’
Experts visited multiple healthcare facilities, and held fortnightly evidence sessions, with witnesses including senior doctors, nurses and midwives, as well as politicians and other health experts.
Last year, the Nursing and Midwifery Council (NMC) was asked to submit evidence and meet with the members of the commission; and was quoted in the final report:
‘Andrea Sutcliffe, chief executive of the Nursing and Midwifery Council, insisted that the workforce was the foundation of the NHS and social care. ‘So many solutions that people come up with depend on, “We're going to have this wonderful new machine,” or, “There's a new building,” or, “There's a different drug that we could have”. But actually, health and social care is about people. It's about the people who are using those services and it's about the people who are delivering those services. It is about so much more than money. It's about us using the resources that we have to the best effect, and paying attention to the environment within which people are working. ‘People are leaving earlier than they anticipated … because they're burnt out, they're exhausted, they can't get the support from their colleagues. They're not able to deliver the quality care that they would want to. They're not saying, “We're leaving because of money”.’
The NMC's core suggestion to the commission was that workforce sustainability and cultural issues were centrally linked. This is reflected throughout the report and supported by multiple other submissions. The report states:
‘If you can get the culture right then it would make safety a lot easier to achieve. It's about how humans interact, how humans work together and how humans best perform.
‘Improving the working conditions for doctors, nurses and other healthcare professionals is not just important for staff but also for patient safety.’
Two of the NMC's recommendations were included in the report:
- Professional development and training must be offered at all levels to give staff a greater sense of career progression
- Social care must be included in the NHS workforce strategy.
The commission made several other recommendations pertinent to nursing, such as:
- There should be more on-site childcare and flexible work contracts to allow those with caring responsibilities to remain in the workforce
- There must be a zero-tolerance approach to bullying, harassment, assault and racism
- The health service needs to provide affordable and healthy staff canteens, night transport or parking, a comfortable staff room, private spaces for clinicians to decompress and a place to get a hot drink
- The private sector should be expected to support and fund medical training, including offering work placements to junior doctors and student nurses.
The Commission has produced 10 priority recommendations that it wants to see implemented, these are summarised below.
- Create digital health accounts for patients
- Tackle waiting lists by introducing a national programme of weekend high-intensity theatre lists
- Reform the GP contract
- Cut student loan debts for doctors, nurses and midwives who stay in the NHS. Debt should be cut by 30% for those staying 3 years, 70% for 7 years and 100% for 10 years
- Introduce no-blame compensation for medical errors
- Establish a National Care System giving the right to timely, appropriate support. Equal but different from the NHS, it should be administered locally and delivered by a mixture of public and private sectors
- Guarantee that all children and young people requiring mental health support can get timely treatment and rapid follow up
- Tackle obesity
- Incentivise NHS staff to take part in research by giving 20% of senior clinicians 20% protected time for research
- Establish a Healthy Lives Committee.
Multiple stakeholders' responses so far, including those of the Royal College of Nursing, British Medical Association and the NHS Confederation have been positive about the report's recommendations. This report will now shape the discussion among politicians about reform to the health service.