In his first public acknowledgement of the crisis facing the health service since taking office last month, Steve Barclay said ministers face a ‘real sprint’ to prepare the NHS for the months ahead
The NHS is staring down the barrel of one of its worst winters on record with a triple whammy of Covid, flu and the cost of living crisis set to batter understaffed hospitals, the new Health Secretary warned today as it emerged police officers are being sent to ambulance callouts amid a paramedic shortage.
Steve Barclay said ministers face a ‘real sprint’ to prepare the NHS for the months ahead and promised to relax recruitment rules and launch a hiring blitz to get the health service ready for the cold months, when it faces extra pressures.
A surge in coronavirus cases, a bad flu season and deteriorating health among Britons due to soaring food and energy prices are expected to exacerbate the crisis within NHS this winter, he said.
He has told civil servants to ‘work at pace’ on a plan to ‘significantly increase’ overseas recruitment of NHS staff to prepare for the looming crisis.
He wants to hire thousands more foreign medics from countries which produce more nurses than they need, including India, Sri Lanka and the Philippines.
And he said social care could benefit from hiring foreign nurses whose English is not good enough to work in the NHS, since the language requirement to work in care homes is lower than in hospitals.
The NHS is short of tens of thousands of nurses and around 6,000 GPs. But the issue in social care is even worse, where there are 105,000 vacancies. A lack of staff in social care has created a logjam in hospitals because elderly patients cannot be discharged into care homes.
Meanwhile, it emerged today that police officers in England and Wales are spending up to a third of their time on non-policing matters, including picking up the NHS staff workload.
Officers in armed response vehicles, who are trained in first aid and defibrillators, are being pulled away from tackling crime to to mental health crises and transport cardiac arrest patients to A&E.
Mr Barclay called for bold decisions on staffing to be made now, before Rishi Sunak or Liz Truss are appointed as Prime Minister next month, or it will be ‘too late’ to save struggling hospitals.
The NHS crisis has seen the backlog for routine hospital treatment soar to a record 6.6million and A&E performance plunge to a record low — with more than 700,000 Britons waiting more than 12 hours so far this year.
There have also been record ambulance response and handover waits.
The NHS backlog for routine treatment grew from 6.4million to 6.6million in May, the latest month with data, meaning one in eight people in England are now waiting for elective care, often in pain
Ministers have admitted that the NHS will fail to meet a key deadline to treat all patients who have been waiting for treatment for over two years for routine treatment by July. The number of patients queuing for more than two years, which only started to be logged in April 2021, peaked at nearly 24,000 in January. But 8,028 patients were still queuing by May
Heart attack patients waited more than 50 minutes for an ambulance on average in England last month — nearly triple the NHS target. There were more than 300,000 category two callouts in June
Some 22,034 people had to wait more than 12 hours in A&E departments in England in June from a decision to admit to actually being admitted, NHS England said. The figure is up from 19,053 the previous month, but still below a record of 24,138 in April, which was the highest for any calendar month in records going back to August 2010. The number waiting at least four hours from the decision to admit to admission stood at 130,109 in June, up from 122,768 the previous month. A total of 72% of patients in England were seen within four hours at A&Es last month, down from 73% in May
More in-depth data, published by hospital executives in their own board papers, reveal the true toll was closer to the 34,000 mark over the same timespan. This metric measures the number of 12-hour waits between when a patient arrives at A&E until they are admitted, discharged or transferred. At the worst-affected trusts, just a handful of waits were recorded under the official measure. This includes Liverpool University Hospitals Foundation Trust, which registered 2,667 12-hour waits in its board papers for May but just four in the NHS publication for the same month. And Bedfordshire Hospitals Foundation Trust only reported one 12-hour wait in the routinely-published nation-wide log but stated there were 400 half-day waits in their board papers
Hospital nurses told they face filling in as cleaners amid shortages
Hospital nurses in parts of England have been told they may need to do shifts as cleaners due to the staffing crisis.
A letter from Luton and Dunstable University Hospital to nurses explained that they may have to work as a cleaner for part or all of their shift.
Hospital bosses said staff may even have to clean sluices – rooms where human waste is disposed of. Other tasks include sanitising touch points, such as door handles.
Nurses were also told they may need to answer phones and manage stock, according to the letter seen by The Times.
The trust admitted that the move came amid ‘some of the most challenging circumstances we have ever faced’.
But unions said the move was ‘insulting’ and a ‘terrible use of resources’.
More than 6.6million patients in England are waiting for routine hospital treatment, a quarter of A&E attendees are waiting more than four hours and ambulances have been left queuing for up to 20 hours outside hospitals.
Teresa Budrey, the Royal College of Nursing’s regional director for the eastern region, said: ‘To ask specialist nursing staff to spend a shift doing cleaning work is a terrible use of resources and takes them away from caring for patients.
‘They have a key role in providing continuity of care for patients with complex, long-term conditions.
‘To suggest this in the middle of a workforce crisis, which is putting patient safety at risk, makes it insulting for both cleaning and nursing staff.’
A spokesperson at Bedfordshire Hospitals NHS Foundation Trust told MailOnline: ‘We are proud of the way all our teams support each other during challenging periods.
‘As a result of the pressures we are currently experiencing, a discussion took place with senior medical, nursing and management leads to consider how we might ensure our ward teams could be given additional help during some of the most challenging circumstances we have ever faced.
‘Fortunately the actions detailed have not been necessary, and would only ever be considered where every option had been exhausted and following a wider conversation with those affected.’
Mr Barclay, 50, replaced Sajid Javid who quit last month after questioning the Prime Minister’s integrity and suggesting the Government was no longer ‘competent’ following a string of scandals and controversies.
In his first interview since taking the job, he set out the struggles facing the health service.
He told The Daily Telegraph: ‘We have very real challenges coming down the track in the autumn and winter, and as far as I’m concerned there needs to be a real sprint within Whitehall, and particularly in the Department of Health, to get ready for September.
‘Part of my role is to prepare for reasonable worst case scenarios. Obviously those pressures can come in different forms. It might be you get a bad flu, it may be Covid rates are higher than we would expect or like.
‘There’s an urgency of now to prepare, particularly in areas where there’s a long lead time. The decisions need to happen now, not wait until the autumn — by which time those lead times would put the resolution at too late a stage.’
Highlighting the extent of the challenges facing the health service, Andy Cooke, Her Majesty’s Chief Inspector of Constabulary, today warned that police were forced to respond to ambulance callers.
He told The Independent: ‘The ambulance service contacted the police to say ‘we’ve got this heart patient and we haven’t got anyone to send’.
‘Being first, last and only resort, the police will go. It’s right that they did go but that hides the problems we’ve got in the rest of the system.’
One officer, speaking anonymously, told the newspaper his force was regularly responding to paramedic callers.
Chief Constable Olivia Pinkney, the national lead for local policing, warned officers are being forced to sacrifice fighting crime and make decisions ‘they are not best placed to make’.
The police ‘should not be the service of first resort in these situations’, she said.
The Health Secretary said he has attended meetings on ‘how we prepare for pressures across Government’ in the winter months, including a surge in NHS patients.
Despite the latest Covid wave retreating — with cases plunging by a fifth last week — the NHS is expected to see another spike this winter, as Britons spend more time socialising indoors, where it is easier for the virus to spread.
Experts have said the rise should be no worse than previous waves seen this year, as long as Omicron remains the dominant strain.
But any increase in coronavirus hospitalisations would coincide with an expected onslaught in flu cases. The seasonal virus retreated over the last two years, as measures brought in to control Covid had knock-on effects for other viruses.
Health officials have warned of an ‘early influenza wave’ after Australia — which is currently in its winter — suffered an unprecedented early and fast outbreak across all age groups.
On top of Covid and flu, the cost of living crisis is worsening the public’s health. A survey of 2,000 Britons earlier this year found more than half reported that their health had worsened amid spiralling bills. Eight in 10 blamed rising heating costs, while three-quarters pointed to soaring food costs.
These charts, based on NHS workforce data, show the proportion of doctors and nurses joining the NHS in England based on where they originally trained. In both professions the number of UK trained joiners has decreased over time (red lines) whereas the number of non-EU trained professionals has increased (yellow lines). The proportion of EU professionals joining the NHS has declined over time, taking a sharp dive in the years after the 2016 Brexit vote
India and Pakistan are two largest non-UK countries that doctors currently registered to work in Britain originally trained in with about 30,000 and 17,000 respectively. This is followed by Nigeria, Egypt , Ireland, South Africa, Greece, Sudan, Italy, and Romania
This graph shows the country of training of all newly registered nurses and midwives in the UK over the past five years. Unsurprisingly, British trained nurses make the majority with about 120,000 joiners. India (about 21,000), Philippines (nearly 18,000) and Nigeria (nearly 5,000) are the biggest providers of overseas trained nurses and midwives registered to work in the UK
BARCLAY’S BULGING IN-TRAY LAID BARE
A record 6.6million people are in the queue for routine treatment in England and that number is expected to keep rising for another two years as patients flood back into the NHS following delays during the pandemic.
Hundreds of thousands of patients have been waiting longer than a year and hospitals are struggling to meet the Government’s promise to axe two-year waits by the end of this month.
More than 22,000 patients attending casualty units wait 12 hours or more to be given a bed, in conditions described by experts as ‘inhumane’.
Fewer than three-quarters of patients are seen within the four-hour target of arriving at overwhelmed emergency departments.
Meanwhile, figures on ambulance performance in May shows ambulances took an average of 51 minutes and 38 seconds to respond to category two calls, such as burns, epilepsy and strokes — more than double the 18-minute target.
Response times for category three calls – such as late stages of labour, non-severe burns and diabetes – averaged two hours, 53 minutes and 54 seconds.
Ambulances are supposed to arrive at nine in 10 category three calls within two hours.
SUMMER OF STRIKES
Mr Barclay also faces the threat of strikes as unions representing staff from doctors to cleaners demand a pay rise of up to 30 per cent, claiming the workforce is being underpaid.
Votes on industrial action are expected in the coming months in what has been dubbed the ‘summer of discontent’, which could cripple the NHS.
Social care staff are also quitting the sector in droves for better-paid and less stressful jobs in shops, supermarkets, pubs and hotels, meaning elderly residents could be getting substandard care.
With 160,000 posts currently unfilled, that has a knock-on effect on the bed crisis in the NHS because older patients cannot be discharged.
Mr Barclay will also have to decide whether to reimpose face masks or other light social restrictions that his predecessor opposed during expected Covid spikes in the coming months, and who to target with the booster vaccine rollout this autumn.
Mr Barclay will inherit Mr Javid’s white paper on health disparities that was due to be published next week and was supposed to set out how England will tackle smoking and obesity.
NHS WOKE ROW
He is also walking into the role amid a row about woke language making its way into NHS guidance after a series of revelations by MailOnline. Mr Javid had ordered health service bosses to revert changes which removed ‘women’ or ‘breasts’ from guidance on the menopause, womb cancer and breastfeeding to be more inclusive to trans people.
The new Health Secretary will be expected to get a grip on the crisis in general practice that has seen millions of patients struggle to see a family doctor or get an in-person appointment.
MailOnline’s analysis of official figures revealed just a quarter of GP appointments in England are face-to-face and with an actual doctor.
The rest are a mixture of virtual or telephone consultations and appointments led by practice nurses, physiotherapists and even acupuncturists.
Patient rights groups and some medics have said the problems in A&E are partly due to desperate patients turning up in emergency departments because they can’t access a doctor.
And medics have warned that patients have been left unable to afford travelling to hospital for vital treatment.
The Health Secretary also set out how decisions would come ‘much more quickly’ under his leadership and he would encourage NHS chiefs to take bolder action to deal with pressures.
He called for a fresh recruitment drive of thousands of foreign medics, especially from India, Sri Lanka and the Philippines which have more nurses than they need, in the coming months to meet soaring demand.
The Government should ‘work at pace’ to ‘significantly increase’ the number doctors from oversees, Mr Barclay said.
His comments come amid fresh concern about the UK’s reliance on foreign medics. BBC analysis of NHS Digital figures show the proportion of NHS medics recruited from abroad nearly doubled between 2014 and 2021.
One third of doctors recruited by the health service in 2021 came from overseas, compared to just 18 per cent in 2014.
Meanwhile, the share of UK doctors fell from 69 to 58 per cent between 2015 and 2021, while the proportion of British nurses fell from 74 to 61 per cent over the same period.
But Mr Barclay called for more foreign recruits, especially into social care. He warned ambulance handover delays ‘manifests itself with unmet need in the community’.
He has set up a group in the Department of Health to work ‘at pace’ to see ‘what is the scope of the opportunity’.
He said ‘significantly’ increasing international recruitment is one lever that could address the problems.
Mr Barclay added: ‘We don’t want people delayed on the ward — that is a bad outcome.
‘A big part of my focus has been giving a lot more ministerial time to looking at the issues on delayed discharge, on social care recruitment. If there’s pressure on the system and that requires more beds in the community, those beds need the workforce to go with them.’
Meanwhile, Mr Barclay described his longer term vision to ease pressure on the health service.
He called for family doctors’ workloads to be reduced — a reason cited by GPs for leaving the profession, reducing hours and retiring early.
Mr Barclay suggested that patients could book blood pressure checks through the NHS app, which would then be performed by pharmacists.
‘Not everything a GP is currently being asked to do needs to be done by a GP,’ he said.
Rishi Sunak, who is vying to be the next Prime Minister, last week called for £10 fines for repeat offenders who miss their GP appointments.
In response to the proposal, Mr Barclay said it is essential to understand the cause of missed appointments and ‘shine a light on that’.
The Health Secretary also called for hospitals use new technology and data to become more efficient and get rid of middle-management.
He has already ordered a ‘digital mapping’ of the NHS workforce to spot where members non-frontline staff are performing the same tasks.
Instead, there should be a hiring spree of data and software engineers and ‘fewer people filling out spreadsheets and communicating in emails in traditional ways’, Mr Barclay said.
It comes as Covid cases are rapidly collapsing in England.
Latest estimates from the Office for National Statistics show 2.1million people were infected on any given day in the week to July 26 (one in 25). This was down 20 per cent on the 2.6million logged the previous week.
Mr Barclay said he was confident the strictest Covid rules — such as ordering businesses to close and people to stay at home — are confined to the darkest days of the pandemic. Although, he did not rule out reintroducing curbs.
He said: ‘We’ve got over 10,000 cases in hospital at the moment, around a third of those are people in hospital because of Covid.
‘So there’s still a significant number, notwithstanding it’s summer and infections tend to spread more clearly in winter.’
However, he noted that the vaccine rollout and ‘huge amount of knowledge’ means the UK is in a ‘very different situation to when a consideration of lockdowns was taking place’.
WHO IS STEPHEN BARCLAY?
Mr Barclay went to Sandhurst military academy and served in the British Army before studying at the University of Cambridge. He has been the MP for North East Cambridgeshire since 2010.
He took on a series of junior frontbench roles where he became known as a hard-working, loyal and subservient minister.
Mr Barclay was promoted to the Cabinet in 2018 when Theresa May made him Brexit Secretary — a job he kept even when Mr Johnson took over, in a sign of his flexibility given their vastly different views on departing the EU.
He was demoted to No2 in the Treasury, during Mr Javid’s final days in No11, after his Brexit ministerial brief came to an end following the UK’s official departure from the EU.
He moved back to the cabinet 18 months later as Cabinet Office minister.
This February, a hasty reshuffle after a string of scandals including Partygate saw him appointed Mr Johnson’s chief of staff, which he juggled with his cabinet role of chancellor of the duchy of Lancaster.
The appointment highlighted Mr Johnson’s faith in the former lawyer from Lancashire.
The title used to be referred to as the most powerful unelected official in the UK and Mr Barclay was the first MP to hold the role.
He was part of a shake-up of No10 aimed at getting ‘grown ups’ in the room and stabilising his boss’s premiership, which ultimately failed after the Chris Pincher row.
His promotion to Health Secretary suggests Mr Johnson’s team do not necessarily blame him.