Former Conservative Secretary of State for Health (2012-2018) Jeremy Hunt, who now chairs the Commons Health and Social Care Select Committee has been  has recently commented on a report produced by them on NHS staff shortages.

He said:

           “Tackling the shortage must be a “top priority” for the new prime minister when they take over in September.  Persistent understaffing in the NHS poses a serious risk to staff and patient safety, a situation compounded by the absence of a long-term plan by the government to tackle it”

Almost unbelievably, the report found, if the statistics are correct, that England is now short of 12,000 hospital doctors and more than 50,000 nurses and midwives. It called it “The worst workforce crisis in NHS history”

More than 6 million (I in 9 of the population) people make up a backlog of patients waiting to be seen or needing treatment, made much worse by the inability to offer treatment during the Covid-19 crisis. Extra staff are also needed to keep up with rising demand as the population gets older and healthcare becomes more complex and technologically advanced (when it works….)

There was concern about maternity services, with more than 500 midwives leaving the health service between March 2021 and March 2022.

Yet the Government insists that the workforce IS growing and that NHS England IS drawing up long term plans to recruit more staff.

“As we continue to deliver on our commitment to recruit 50,000 more nurses by 2024, we are also running a £95m recruitment drive for maternity services and providing £500m to develop our valued social care workforce,” he said.

The committee also heard evidence from former Health Secretary Sajid Javid that the government was not on track to deliver its manifesto commitment to increase the number of GPs in England by 6,000.

But reports say that GP’s are leaving the profession in droves and many others have turned to working part-time.

Where are all these new staff going to come from?

Rishi Sunak, one of the two remaining candidates for Leader of the Conservative Party and thus the next Prime Minister,  plans to eliminate one-year waiting times by September 2024 and get overall numbers falling by next year. We’re not sure he’s told us quite how yet.

He also says he will introduce a £10 “no-show” charge for patients who repeatedly miss appointment slots.  He said in the Sunday Telegraph:

”Patients would be given the “benefit of the doubt” the first time they missed an appointment without providing sufficient notice, but that further absences would incur a £10 charge. The system would be “temporary” as Covid backlogs were cleared”.

Again, “the former chancellor gave few details of how the fine system would work”.  We’re not sure how that would be enforced either and a system that cannot be enforced is pointless.

Dr Gary Howsam, vice chairman of the Royal College of GPs, agreed that patients missing appointments was “frustrating”, but charging for appointments was “not the answer” and was likely to impact vulnerable patients most.

He said:

“It would fundamentally change the principle that the NHS is free at the point of need”

which has always been the underlying principle and pillar of the NHS. No-one wants to go back to times when people died because they couldn’t afford medical treatment.

Mr Sunak’s team said GPs and hospital trusts would be allowed to use their discretion to waive a fine in exceptional circumstances.

To our mind, it is likely to cost more to try and enforce any “fine”, especially if you have to employ teams of people whose job it is to decide what constitutes “exceptional circumstances”, whether discretion should be used and administer an appeal system. Even parking fines have that.

Liz Truss, the other leadership candidate, wants tax cuts worth £30 billion, but at the same time, does not want to “decimate public” services. She has not, however, explained how this can be achieved, particularly as she also wants to scrap Rishi Sunak’s health and social care levy as well.   That wasn’t a popular levy, but it offered something by way of sustaining a struggling NHS.

Truss says she will “restate the existing manifesto commitment to building 40 “new” hospitals” It is unclear how many of these will be actual full new hospitals and how many merely additional departments or refurbishment.  It could be as few as 5.  She has also said she would go ahead with existing plans made under Boris Johnson for an £86,000 cap on the amount individuals would have to pay towards their own care, despite pledging to cancel the tax rise earmarked to pay for it.

But even if there were new hospitals built (whether that be 5 or 40), where would the staff come from to run them or the money to sustain them?  Since Brexit, it is harder for overseas workers to come to Britain and this is where we have traditionally recruited NHS staff from.

It just seems to us that neither candidate has really addressed the NHS situation.

The NHS is in crisis, but it has been staggering along for years.  We know Covid-19 dealt it a hammer blow from which it hasn’t yet recovered.  We don’t have answers either, but we’re lawyers, not politicians.

What we do know as clinical negligence lawyers is that we are getting more and more enquiries where there appears to be a delay in first of all getting an ambulance, then getting seen and getting treatment and then being followed up after treatment. These are not by any means all delays due to the Covid emergency, which does offer the NHS an understandable defence to a claim made only on that basis. These delays can be and are, fatal in may cases.

National Health Service Resolution, responsible for claims against the NHS, tells us that the cost of claims is rising and fatal claims can attract high levels of compensation, especially where young children are left without a parent. But this is the knock-on effect of a failing and under-funded NHS.

A hard truth is that the NHS was brought into being at a much simpler time when people did not live so long and we didn’t have the medicines and treatments we have now to enable people to live longer and with a better quality of life.  In 1948, over 70 years ago now, the speed of development of healthcare just could not have been predicted-nor the cost.

We don’t know what the answer is and there will no doubt be comments to the effect that lawyers should stop making claims against the NHS.  We can’t deny that the overall cost of clinical negligence in England rose from £582 million in 2006 to 2007 to £2.2 billion in 2020 to 2021, but a lot of this represents the rise in costs of caring for injured people, especially children with birth related brain injuries. 

But these people have been injured through no fault of their own and need looking after.  It costs. That’s not their fault.

The government is taking steps to reduce costs by bringing in “fixed costs” for clinical negligence claims as they have done for personal injury claims which are largely met by insurers.  Initially, this will apply to claims under £25,000.00, but we have little doubt that this figure will rise to claims probably under £100,000.00.

But the politicians cannot ignore the NHS problem forever.  It is a huge great, grey elephant in the room. And it’s not just sitting there quietly minding its own business.  It is positively rampaging.

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