- Lord Darzi’s report into the state of the NHS
Lord Darzi’s report concerning his independent review of the NHS was published on 12 September 2024. We have yet to review the report, however the HSJ’s publication on the report and Roy Lilley’s e-letter on the report are detailed below:
(a) The coverage by James Illman for the Health Service Journal (HSJ) with the title “Darzi: NHS ‘unlikely’ to meet performance targets in five years” reads as follows:
>Lord Darzi says it’s ‘unlikely’ performance standards can be ‘restored in one parliament’
>Verdict in much-anticipated review follows Labour’s manifesto committing to restore the standards within five years
>Review suggests meeting targets possible over 10 years and does not appear to suggest reforming standards
Labour is “unlikely” to meet its flagship manifesto commitment to restore the NHS’s constitutional waiting times during this parliamentary term, Lord Darzi has warned.
The former Labour minister made his downbeat verdict on the party’s key manifesto pledge in his government-commissioned review of NHS performance, published today.
The wide-ranging 142-page report, an Independent investigation of the National Health Service in England, details a litany of problems, and places much of the blame for them on a lack of investment by the last government, particularly in capital and infrastructure.
On key areas covered by constitutional waiting time standards, the report sets out how cancer targets have not been met since 2015, long waits for elective care have been “normalised”, and A&E “is in an awful state”.
The review concludes: “I have no doubt that significant progress will be possible [on waiting times] but it is unlikely that waiting lists can be cleared and other performance standards restored in one parliamentary term. Just as we in the NHS have turned around performance before, we can do so again.”
This is in sharp contrast to comments before the election by Wes Streeting, now health and social care secretary, that Labour was committed to restoring all constitutional performance standards – covering elective, A&E, cancer and ambulance services – in a first term in office.
Mr Streeting said at the time: “We know that these are challenging [commitments]. If I think about the range of performance standards, we know that on UEC [urgent and emergency care], that’s a tougher challenge than on the elective backlog…
“That’s why we’ve been working with some of the best minds across the system to help us [on emergency care delivery]… and that’s what’s given us the confidence to make that commitment.”
HSJ asked the Department of Health and Social Care last night if the government stood by that commitment, considering Lord Darzi’s verdict. It had not directly responded to the question at the time of publication.
Analysis by waiting list expert Rob Findlay for HSJ published in May suggested Labour’s election pledge to restore the 18-week elective target within five years is feasible.
However, the 95 per cent standard for the four-hour A&E target has long been viewed by NHS leaders as a target which will not be met again without huge investment in hospital capacity, for reasons set out in this HSJ editorial from April.
Lord Darzi’s report does not appear to propose ditching any of the constitutional standards – despite NHS England spending several years trying unsuccessfully to do precisely this as part of its ‘clinical review of standards’ which was launched in 2019, with the four-hour A&E target their main priority for reform.
In a media statement about Lord Darzi’s review, Mr Streeting said: “Today’s findings will inform our 10-year plan to radically reform the NHS and get patients treated on time again.
“The damage done to the NHS has been more than a decade in the making. We clearly have a long road ahead. But while the NHS is broken, it’s not beaten. We will turn the NHS around so it is there for you when you need it, once again.”
NHSE chief executive Amanda Pritchard said: “While teams are working hard to get services back on track, it is clear waiting times across many services are unacceptable and we need to address the underlying issues outlined in Lord Darzi’s report so we can deliver the care we all want for patients.”
(b) The coverage by Roy Lilley with the title “Started…” reads as follows:
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Lord Darzi’s report is out today. He writes; ‘Although I have worked in the NHS for more than 30 years, I have been shocked by He can’t be. He cannot be shocked. I don’t believe it. Anyone and everyone working in the NHS knows full well the state it’s in. The report is elegant and an easy read with graphs and graphics which will delight the PowerPoint makers. But, we know this stuff. The public who may not know the detail, know. Every time they visit a hospital or GP practice, know the NHS is struggling. Everyone on a waiting lists knows its busting a gut. So the question is, ‘what now’? What is the point of the report? If it is to buy Charmer time, to fiddle about with a ten year plan (expected next year) that will be out of date in a couple of years – then there is no point. If it is to beat the Tories over the head, why bother. They’ve gone. We know and Darzi confirms it, austerity, Lansley’s lunacy and covid did for the NHS. He doesn’t mention the strikes… but they didn’t help, either. With the exception of Covid, all the problems were made in Westminster. By politicians. What is the chance of another lot of politicians fixing it? For a government to profess they have no choice but to cut yer granny’s winter fuel allowance, where are they going to find the money to fix the NHS and look after her, when she falls victim to the cold. What happens now? The truth is… dunno. We can’t wait for another report, a plan, a strategy. The subtext of this report is, fixing the NHS is urgent. The report makes much of ‘building a healthy society’. Good idea but it’s nothing to do with the NHS. That’s the job of housing, environment, employment, education, food standards and safe neighbourhoods. To get that lot to march instep is to reform government, not the NHS. Moving care out of hospital? It’s fashionable to put convenience over cost. To do it you’ll need to change the tariff and disrupt Trusts fixed costs. Accept the double running costs of duplication between hospitals and the community. Give The Chancellor a heart attack at the capital costs of expanding the primary care estate and a huge investment in kit-n-caboodle. Don’t mention the cost of training an expanding the workforce. The report tells us, the principle problem that’s hobbled the NHS; austerity funding. The principle solution will be sensible funding and for a government that ‘has no money’ it’s difficult to see where HMG goes. Where’s the value in this report? There’s value in everyone knowing, I suppose? But, we know, the real value will be in the doing. How will that work. What will Labour do now? Where’s the plan to get 7.6m people off the waiting lists. The absolute people’s priority. All Labour have is a cockamamie idea to get people doing a bit of overtime. Where’s the plan to disaggregate waiting lists. Focus on the sectors and geography of highest demand and laser-guide resources. Where’s the plan to improve working conditions; Creche, car parking, 24-7 fresh food, flexi-rota, discounted home-loans. Where’s the plan to keep people; student debt-forgiveness, modernise medical training, family friendly employers. Where’s the plan to get IT working; with single log-in, data normalised, interoperable. Where is the hiring blitz for analysts to make data talk and tell us what to do better. Where’s the plan for bursaries to encourage the next generation of care workers in an international market that already has desperate shortages. Where’s the plan to get the basics working and… … the most important of all, where’s the plan to fix social care? I fear, for the foreseeable, Darzi will be HMG’s human shield. The go-to excuse… ‘we are working on a plan…’ The NHS is broken? That’s why Labour was elected… to fix it. They said they could. They said they were sleeves rolled-up ready… … they’d better get started. |
Interesting!
- HSJ article-Trust considers tough line on promoting minority staff
On 12 September 2024 the HSJ published an article by Alison Moore with the above title. The article reads as follows:
>LAS could make managers write to chief executive if someone from a minority ethnic background is not appointed
>Proposal comes from trust’s EDI committee
>Initiatives so far face ‘pushback from white colleagues’
An ambulance trust may require managers to justify to its CEO each time they promote someone else ahead of a colleague with a minority ethnic background to a senior role.
London Ambulance Service Trust’s equality, diversity and inclusion committee is suggesting the policy, which it described as “a step change in recruitment practices”, but the trust is still considering it.
It would apply to all promotions for Agenda for Change band 7 jobs and above. Hiring managers would be expected to detail to the CEO the steps they had taken to support individual applicants.
Roger Davidson, the trust’s chief strategy and transformation officer, said: “We are determined to ensure our recruitment processes are fair so all colleagues can build great careers. We have already made improvements for internal applicants by offering interview skills training as well as having independent members on recruitment panels.
“We will also be taking the concept used successfully in other NHS providers of requiring panels who don’t appoint internal black or minority ethnic colleagues into more senior roles to provide feedback on why the applicant wasn’t appointed and what their development plan will be so they can be successful in the future.”
Chief executive of the NHS Race and Health Observatory, Professor Habib Naqvi, said: “Any steps to address deep-seated ethnic inequalities in the workplace must be welcomed so long as they are evidence-based and meaningful, and not short term, tokenistic gestures.
“This proposal can help the service to address the issues of bias by introducing a critical level of accountability in decision-making. We cannot afford the cost to staff and patients that results from unfairness in the way organisations appoint, treat and develop a significant section of the NHS workforce.”
Like many trusts, LAS has a large number of staff with a Black, Asian or other minority ethnic heritage, but they are concentrated in lower grades, especially Agenda for Change bands 2 and 3.
Nearly one in four overall are from a minority ethnic – and 38 per cent of new joiners – but there is a big gap in some roles, including paramedics.
The EDI committee report to last week’s trust board said: “[Black and minority ethnic] candidates are two times less likely to be successful than white candidates at job interviews with issues with recruitment process.”
LAS is taking various actions to increase the proportion of minority ethnic staff in ambulance operations and 999 services and plans a “specific focus for all leaders to be held accountable for reducing discrimination and creating an inclusive LAS”.
The paper highlights progress in some areas – with an increased proportion of minority ethnic staff saying the trust “provides opportunities for progression” and a doubling of the number of paramedics from a minority ethnic background over the last five years.
It notes, however, “pushback on BME issues from white colleagues” and a “significant cultural challenge”.
About time something significant is being done, so it is no surprise that white colleagues are pushing back
- HSJ article-Provider investigating “racism and bullying” complaints
On 9 September 2024 the HSJ published an article by Joe Talora with the above title. The article reads as follows:
A community services provider has launched an investigation into its staff culture, following concerns including racism and bullying.
Sirona Care and Health, a major provider of NHS and council-funded community services in the south west, told HSJ: ”Our staff have stepped forward to tell our leadership about unacceptable behaviours – both experienced within Sirona’s staffing body and towards our colleagues from patients/service users.
“It is incumbent on all of us, led by our board and senior leadership, to listen and take decisive action towards the culture we want to build.”
The news follows the resignation last month of Sirona’s chief executive and chair, Sue Porto and Amanda Cheesley, although there is no suggestion either of them have been accused of bullying or racism.
Sirona is the main provider of community health services in Bristol, North Somerset, and South Gloucestershire, and one of the largest healthcare social enterprises.
Speaking at a recent staff question and answer session, interim chief executive Julie Sharma said the former chief executive and chair stepped away from their duties in May “to allow the organisation to carry out an investigation into a whole host of things”.
She said it would cover allegations of racism and bullying in the organisation, but that these allegations “are not directly related” to the former chief CEO or chair.
During the question and answer session, Ms Sharma said the organisation was committed to sharing a “lessons learned” review with staff once the investigation had concluded.
She said: “One thing that’s really important when you lead organisations, particularly as you go up the ladder and you work at the very senior level, is you do have to take responsibility and accountability for how that organisation moves forward.
“What we will now be doing is having a look at all of those issues and how do we absolutely ensure that we set the culture that we want to see in Sirona, that we actually do eradicate these behaviours at every level in the organisation that are just not acceptable.”
Sirona told HSJ it would not comment further on the resignations, but said its interim CEO was ”reaffirming the commitment from our board and senior leadership to eradicating any behaviours which are not aligned with our values”, and “taking responsibility and accountability for creating a welcoming, supportive and safe culture where everyone feels valued”.
It added: “These reviews can take time but we will continue to reassure our staff about the intent and extent of commitment from Sirona’s leadership to eradicating any instances of unacceptable behaviour and building on successes.” It also pointed to a recent race equality award it had achieved
Only time will tell!