“I want to use the opportunity of this biggest hospital building programme in a generation to think differently about how we approach the NHS estate.” Those were the words of Health and Social Care Secretary, Steve Barclay, speaking at the NHS Providers Conference in Liverpool earlier this week (November 16).
Yesterday, the Chancellor, Jeremy Hunt, confirmed the New Hospital Programme (NHP) would still go ahead, in spite of widespread cuts to Government spending commitments in the Fiscal Statement.
Lack of progress on projects within the NHP, together with a lack of clarity around the programme and whether sufficient funding will, ultimately, be available have caused many senior NHS leaders to raise their concerns around whether it will be able to deliver what the NHS needs. One of those was Interim Chief Executive of NHS Providers, Saffron Cordery, who spoke out quite strongly on this issue including in an interview in HEFMA’s Pulse Magazine (Sept/Oct 2022).*
The Health Secretary stressed that one of his priorities is how the latest technology and trends are used to improve outcomes for patients and ensure the taxpayer’s money is well spent. However, he did point out that nine of the last 10 hospitals built in England came in over time and over budget. He used the Royal Liverpool Hospital as an example – arguably not a good example because of the unique circumstances that impacted this project with the collapse of Carillion – however, the point he was seeking to make is a valid one. “There is an urgent need to change how all NHS buildings are constructed in the future,” he said. “This means moving away from bespoke designs by local Trusts and instead having national standardised designs built through modern methods of construction, where the construction time on site is much quicker, the operational performance is delivered quicker, and the environmental features are better integrated into the build.
“And the central evaluation process within government, which to date has been a sticking point for many Trusts, can be streamlined because of the greater consistency of design.”
Mr Barclay also acknowledged the “huge concerns” around the RAAC problem (reinforced autoclaved aerated concrete) in certain hospitals, which “needs urgent attention.” Addressing the chief executives of all affected Trusts, he said: “I understand the seriousness of this issue and I am committed to delivering the government’s commitment to eradicating RAAC from the NHS estate.
Elsewhere in his speech the Health Secretary said that supporting the workforce is his top priority. However, whilst he thanked NHS staff for their efforts and recognised the extraordinary pressures this winter is likely to bring, he did not elaborate on how support for the workforce would be manifested.
A second priority, he added, is the recovery plan, and he went on to provide more detail of the previously announced £500m Adult Social Care Discharge Fund, which aims to support the prompt discharge of patients who no longer need to be in a hospital bed, into social care. Delayed discharge of such patients is not only bad for their health but is having a negative impact on the ability of the NHS to tackle the elective care backlog.
The fund will be provided to Integrated Care Boards (ICBs) and local authorities with the first tranche provided by early December and the second distributed at the end of January.
Local areas will be allowed to determine how they can speed up the discharge of patients, with suggestions including the purchase of supportive technology, boosting domiciliary care capacity, or funding physiotherapists or occupational therapists to support recovery at home. The government will keep a close eye on the impact of how funding is used and use that data to inform future decisions on funding.
“Tackling delayed discharge must be an effort that spans a number of different areas across health and care, with social care, primary care and community services all working together with hospitals,” Mr Barclay said.
“I want to move away from blame being attached to particular parts of the system for problems that arise but are the consequence of issues that have arisen elsewhere in that complex system.
“Delayed discharge needs to be much more of a team effort, where everyone plays their part, and where decisions on where risk sits within a local system are best made by those closer to the issue.”
Two new appointments have also been confirmed to support the “relentless” focus on the elective recovery work. Orthopaedic surgeon Professor Sir Tim Briggs will take up a new role as Clinical Lead for the Elective Recovery, alongside his leadership of Get It Right First Time. Sarah-Jane Marsh becomes Deputy Chief Operating Officer and National Director for Urgent and Emergency Care. She will work closely with regional teams and Integrated Care Systems (ICSs) to deliver a transformation of urgent and emergency care and make sure patients get the right care, in the right place, at the right time.
In a final pledge to leaders, the Health Secretary stated: “I will play my part to try and reduce the number of top-down requests that you face, devolve decision-making to a greater degree, and allow those closest to the patient to better balance how risk is addressed - given the complex landscape in which you all work. And I will set a much higher bar within government to any new legislation, which so often creates undue distraction.”
