Our response to the NHS 10-year health plan

Our response to the NHS 10-year health plan

The 10-year health plan for England is full of ambition and we welcome the acknowledgement that the NHS needs to make big, bold changes in order to be sustainable.

We welcome the scope and aims of the vision presented and we eagerly await concrete details of how this vision becomes a plan and of how anaesthetists can play their part in it.

Clinical priorities

The Association strongly supports the plans aim to create a ‘smoke-free generation’. We have published guidelines relating to the impact of smoking on peri-operative and post-operative outcomes. Reducing the number of smokers will have a positive effect on population health by reducing rates of lung cancer, preventable cardiovascular morbidity and mortality, coronary heart disease and other related preventable disease. Smoking costs an estimated £2bn per year to the NHS, reducing the incidence of smoking in the population would significantly reduce this figure, positively impact surgical outcomes and lead to significant reductions in smoking related avoidable excess-mortality and disease.

We also strongly support the focus in the plan on reducing the obesity epidemic. As Obesity Health Alliance members we welcome all the pledges to reduce access to unhealthy foods and drinks as well as the proposed actions around advertising. Obese patients have an increased risk of complications at intubation and their airway can be difficult to manage. Recovery time can also increase leading to long hospital stays.

While we welcome the acknowledgement of the impact of harmful alcohol consumption, as Alcohol Health Alliance members we are disappointed by the absence of many evidence-based policies to tackle alcohol harm – including minimum unit pricing, restricting alcohol marketing, and reducing availability – from the plan.

Patient safety

We welcome the confirmation that the Health Service Safety Investigation Branch and Patient Safety Commissioner will be continuing. Their investigative work is a crucial part of patient safety and we hope their independence and scope will be maintained in the new structure. We welcome the plan to revitalise the National Quality Board and believe the Association has a key role to play in this body.

Workforce

We repeat our previous warning that – without significant increases in workforce it is difficult to see how the plan’s ambitions can be realised. Currently the number of consultant anaesthetists is around 1,900 (15%) short of what is needed. As two thirds of patients staying in hospital have contact with anaesthetists, this shortage is being felt by patients, with roughly 1.4 million operations and procedures unable to take place each year. While the pledges in the plan around restoring the NHS constitutional standard of 92% of patients beginning elective treatment within 18 weeks are to be welcomed along with the ending of corridor care, it is difficult to see how this can be achieved without a significant increase in workforce. We hope that the workforce strategy addresses this shortfall when it is published later in the year.

As we called for in our 2024 manifesto, the NHS needs to become a better employer – we are pleased that the plan acknowledges current failings and is prioritising improving the staff experience which will in turn improve retention. The suggested Staff Treatment Hubs are a great first step.

The aim to ensure every single member of NHS staff has their own personalised career coaching and development plan, to help them acquire new skills and practice at the top of their professional capability is welcome but without adequate funding or time set aside for it is unlikely to succeed. We look forward to receiving more detail about how this will work in practice. The aim to reduce the amount of irrelevant training currently required is a welcome one - and something that may go some way to allowing the new development plan to operate.

We welcome the acknowledgement in the plan that there is a toxic culture in many parts of the NHS with workplace bullying frequently reported – it is unfortunate that the plan does not include more ways to tackle this. We do welcome the pledge to act more quickly on concerns raised by staff.

The plan to introduce a new NHS payroll system is also welcomed. We know from our members the amount of frustration the current system causes.

Specialty training in anaesthesia is currently very over-subscribed with 6.5 applications for every place. While the pledge to create 1,000 new specialty training posts over the next three years until it is clear where these places will be, it is not possible to know if this is enough to fix the current shortages. We hope that all specialties will be considered before the final allocations are made.

The plan to ‘train to task’ could lead to fragmentation of care with professionals being trained to deal with specific issues or procedures without the ability to see the patients’ health holistically – something doctors are taught to do through their training. Given the workforce shortages mentioned above, we would also be interested to understand more about how these ‘train to task’ roles will be supervised.

Consultants and some SAS doctors are autonomous providers of anaesthesia and require no supervision. The plan should not lose sight of the value of training resident, SAS and LED doctors to become autonomous providers of high-quality anaesthesia and make sure that training opportunities are not lost to other providers of care. We are pleased that the plan supports the Association’s call for proper recognition of SAS doctors and a more streamlined approach for those not in formal training programmes.

Our response to the consultation on the regulation of NHS managers was clear: we believe that regulation should be introduced for this group. At present, unregulated managers make decisions that directly impact patient care outcomes; however managers are not at present held to the same level of responsibility as clinicians for any failure of care. We also stated in our response that there should be a process to ensure that managers who have committed serious misconduct can never hold a subsequent management role in the NHS – and we are pleased that both of these issues have been identified and addressed in the plan.

Information technology and AI

While the focus on the use of technology including AI in the plan is to be welcomed, we know from our members that the current NHS digital infrastructure is simply not fit for purpose. Members regularly report issues with hospital Wi-Fi which is overloaded and slow making clinical work difficult especially during peak hours. Others have reported being forced to use mobile data instead of Wi-Fi which can be expensive and unreliable. Persistent shortages of computers is another issue regularly reported across trusts. Without addressing these basic issues, it is difficult to see how the plan’s grand aims around AI can ever be achieved. In any event, AI tools need to be developed with the involvement of clinicians from the start of the design process to make sure they is fit for purpose.

We welcome the pledge to introduce a single patient record. At the moment, accessing patient notes often requires using multiple different, noncommunicating software programmes. This can lead to situations where essential patient data such as previous anaesthetic records are inaccessible across different trusts. Different specialties within the same hospital often use separate, non-communicating systems, which contributes to fragmented care and has further implications for patient safety. In addition, the introduction of single sign-in is a positive move.

The plans for a new platform for proactive planned care are to be welcomed, especially if it is designed for the NHS by the NHS. However, it needs to be mandatory that all NHS provider organisations use the new system – opting out could lead to the current situation being replicated where multiple different systems are in use.

As the plan progresses, we look forward to receiving more details around the ways the NHS app may be used and are especially interested in how it may be used to communicate with health professionals and for patients to give feedback. It must be recognised that communicating with patients in new ways will have a significant impact on our members and their time and this must be planned for.

Patient voice

We are unclear how the pledge to offer patient ‘more choice and a voice in the system’ will lead a reduction in the health inequalities and would welcome more information on this. Patient reported outcomes and experiences data could be a vital part of improving the patient experience but without more information it is difficult to see how this will work in practice – for example how will the opinions be interpreted and acted on? It is important that any feedback given by patients is used in a timely and appropriate manner with a mechanism in place to catch any trends.

We have concerns about the proposed Patient Power Payments. As described, this policy appears open to abuse with patients able to withhold payments for vexatious reasons. Without a strong mechanism in place to assess feedback and complaints, it is difficult to see how this would operate.

While we agree that fragmentation of services does not benefit any patients – especially those with the greatest needs – it is important that any plan to overcome this issue does not create other problems. In the current system, clinical expertise is often concentrated in large centres to create hubs of excellence where clinicians have deep and broad experience of their area of specialism. Duplication of services at multiple locations can be inefficient and expensive and may require additional workforce that the NHS does not have. Moving services out into the community risks losing these benefits and could see a worsening – rather than improvement – of patient experience.

The proposed introduction of league tables need to be tackled in a cautious way, learning from previous mistakes – both from within healthcare and from other sectors such as education – to make sure the data produced is meaningful and easy for patients to interpret without being oversimplified.

As the Department for Health and Social Care and NHS England are integrated and NHS England is eventually abolished, we welcome any savings made from removal of duplication and plans to design the centre. We look forward to receiving more information about how this integration will occur.

Conclusion

The Association of Anaesthetists welcomes the positive vision that this plan presents. Now we need concrete details to begin the work. We want to be part of the planning process and we stand ready to join in.