LONDON – Meet the new boss, same as the old boss. Britain’s health service is back in the hands of Mr Steve Barclay, who initially took on the role in July when Mr Sajid Javid quit as health secretary and triggered the summer’s Conservative leadership contest.

Mr Barclay was replaced last month when Ms Liz Truss became prime minister but now returns to the job as part of Mr Rishi Sunak’s new government. It’s a topsy-turvy set of events, but one that’s typical of Britain’s political instability and deepening social discontent.

The National Health Service faces an unprecedented crisis. England has a hospital waiting list of 6.8 million people, A&E departments are so full that some patients are not being seen for 12 hours, and the delays to cancer specialist visits in September were the second-worst month on record.

Furthermore, nurses in England are currently voting on whether to strike over a below-inflation pay offer, raising the prospect of walkouts during winter – the time of year during which the NHS comes under the most intense pressure, when flu and Covid-19 cases spike.

A strike would only add to the NHS’s staffing crisis. Nurses are quitting their jobs in record numbers – more than 40,000 left the NHS across England in the 12 months ending June this year, data compiled by Nuffield Trust show. That amounts to a loss of 11.5 per cent of the workforce, the highest in more than a decade.

The NHS is also increasingly reliant on immigration to fill posts: in the 12 months ending March 31, 2022, nearly half of all new nurses and midwives came from outside Britain, according to the Nursing and Midwifery Council. When he was last in post in August, Mr Barclay told The Telegraph that he planned to ”significantly increase” hiring staff from overseas for roles like social work despite it being politically risky in a bid to save hospitals from emergency conditions.

Earlier this week, the Department of Health and Social Care said the overall NHS workforce grew slightly in July from a year ago. However, the numbers of doctors and nurses in certain specialisms fell compared to a month ago or to the levels seen in the winter months last year.

‘You’ve got the love’

This week NHS England launched a recruitment drive, with a series of commercials showing the heroic deeds of nurses in a bid to inspire new applicants. As pain specialists help a child with cancer, and intensive care nurses tend to a victim of a road accident, a cover version of “You’ve Got the Love” plays in the background. 

“Sometimes it seems that the going is just too rough,” the lyrics go – a refrain that comes worryingly close to describing the NHS, according to many of its workers.

Staff shortages can be extremely dangerous for patients. A study in the BMJ showed that adding registered nurses to shifts lowered the risk of patients dying on the wards, with the addition of the most senior nurses having a greater effect than less experienced ones.

The research also found that filling gaps with agency or support workers does nothing to lower death rates. Policy-makers should therefore focus on retaining experienced nurses already working in the NHS, according to Prof Carol Propper, who teaches economics at Imperial College Business School and worked on the study. 

“Trusts are going to be experiencing nurse shortages and they need to be proactive to take care that those nurse shortages don’t escalate, that people don’t get burnt out, that people don’t get sick,” said Prof Propper.

Workloads

Staff shortages can trigger a vicious cycle where remaining workers become overworked and stressed, and feel more inclined to leave the job themselves. Nurse Lifeline, a charity that offers a telephone listening service, said it frequently takes calls from inexperienced workers being asked to handle big workloads. 

“Recently there’s been a lot of newly qualified nurses being left to run a ward on their own,” said Ms Teresa Griffiths, the charity’s chair. “That increases their stress.”

Nurses’ pay fell 5 per cent in real terms between 2011 and 2021, according to The Health Foundation charity, with unions arguing that some workers now prefer jobs in shops or even Amazon warehouses to the NHS. 

The Healthcare Workers’ Foundation said it has seen a “massive spike” in NHS staff requesting hardship grants. In the past month, nurses have asked for money toward essentials like a refrigerator, an oven, a mattress for a child, and a mortgage payment after a relationship broke down.

“It’s just dreadfully sad,” said Julie Child, the charity’s chief executive officer. “The cost of living is causing the grants to go up.”

For the first time in its 106-year history, the Royal College of Nurses is asking members to consider striking in a bid to increase pay. Research from elsewhere suggests that strikes worsen patient outcomes, with a 2010 study from the National Bureau of Economic Research in the US showing that hospital mortality increased by 19.4 per cent for patients admitted during a strike.

Peak capacity

To get through the winter, NHS England is setting up “war rooms,” to deal with what it says could be one of its toughest seasons in history. These sites would be data control centers that would manage capacity, diverting ambulances to A&E departments with enough space, and noticing when near-full hospitals need mutual aid. 

Ms Griffiths from Nurse Lifeline said that in the past, the winter rushes in the NHS would be followed by calmer spells during the warmer months, when staff could recuperate. But now it is constantly operating at its peak capacity all the time. “Those winter pressures are equal throughout the whole year, so there is no letdown,” she said.

Mr Barclay, the new health secretary, is far from popular in the NHS. Officials bristled at his “hard-edged” manner when he held the role in the summer, according to the Health Service Journal, where he was reported to have described the NHS as a “bottomless pit, resistant to change and unaccountable.”

In August, Mr Barclay said the NHS needed to “sprint” to avoid an emergency this winter. Yet instead of focusing on the health service, the government has been embroiled by infighting and the fallout from former Chancellor of the Exchequer Kwasi Kwarteng’s disastrous mini-budget. 

As Mr Sunak and Chancellor Jeremy Hunt – a former health secretary himself – get to work, Britain now faces the prospect of painful cuts to public spending. That threatens to pile more pressure on crucial public services, including the increasingly stretched NHS. BLOOMBERG