#DemandJavidsPlan: The Department of Health replies

Hannah Dewhirst

On the 22nd February we sent an email to Sajid Javid. This week we got a response.

Last month we wrote a letter to #DemandJavidsPlan, which 15,052 people signed, to highlight the state of emergency our NHS is in. On Wednesday we received a response from the Department of Health and Social Care (DHSC).

Whilst we appreciate their acknowledgement of our concerns, sadly, their reply does little to reassure us. And they failed to answer our 3 key questions; how does Sajid Javid intend to;

  • engage with healthcare leaders,
  • increase support for the current NHS workforce to ensure their safety and the safety of their patients
  • listen to doctors and scientists regarding COVID-19 policy, to safeguard the public

Their response begins by stating that COVID-19 has exerted an “unprecedented strain” on the NHS and that staff have “worked incredibly hard”. We have never disputed the exorbitant pressures the pandemic placed on our health service and in our letter we acknowledged staff have been working as hard as they can; but this summary does not give the full picture. 

The strains on our NHS which have led to the emergency we face today, where 6.1 million patients are waiting for treatment in England alone, existed long before COVID-19 struck. As the Public Accounts Committee noted just this week; the Department for Health and Social Care “has overseen years of decline in the NHS’s cancer and elective care waiting time performance and, even before the pandemic, did not increase capacity sufficiently to meet growing demand.”

This government must be honest about the roots of this crisis. More than a decade of underfunding, understaffing, and an acceleration in NHS privatisation have fundamentally weakened our public health service. Only with full transparency can we have a fully open national conversation about the steps we must now take to address it. The government must take full responsibility for the damage to the NHS that has happened on their watch. 

The DHSC response went on to justify the postponement of elective treatment during the peaks of the pandemic and we agree this was required. However their plans to tackle the resultant backlog leave much to be desired. In terms of funding, their response sought to reassure us that £8 billion more would be spent from 2022/23 to 2024/25, in addition to the £2 billion Elective Recovery Fund and £700 million from the Targeted Investment Fund would “protect elective activity”. £10.7 billion is certainly welcome but this is still not enough. As evidenced in a joint statement from NHS Confederation Chief Executive Matthew Taylor and NHS Providers deputy Chief Executive Saffron Cordery last autumn; the NHS requires an extra £10 billion each year over the next three years to avoid patient services from being cut.

We’d also question how another promise made in their reply, to “deliver around 30% more elective activity by 2024-25 than…before the pandemic”, can be achieved given the NHS staffing crisis. When we wrote to Sajid Javid in February NHS England had more than 90,000 vacancies. Now there are 110,192 unfilled posts across health services in England, with particular strain on primary care; as the number of GPs in permanent roles having fallen by 6.6% between March 2016 - March 2021, and we’ve had no national NHS workforce strategy in place since 2003. 

Alongside recruitment is the issue of retention; a word which only appears twice in the Government’s ‘Delivery plan for tackling the COVID-19 backlog of elective care’ which the DHSC’s reply advised us to read. Staff retention is a critical piece of the NHS jigsaw; following the 140,000 personnel - equivalent to one in nine - who left active service in the year to September 2021 and workplace issues uncovered in the the 2020 NHS staff survey, which found 13.1% of staff experienced discrimination at work and 44% felt unwell due to work-related stress. What measures will be taken to decrease work-related mental health illness?

And, if the Department sincerely wanted to show staff appreciation for their efforts over the pandemic, why did it only agree to a 3% pay rise (which also excluded Junior doctors) given the real-terms pay cut of almost 30% doctors have suffered since 2008. We asked both of these questions in our reply. 

There was also a worrying absence of plans to retain overseas healthcare workers specifically, who now represent 14.6% of all staff and whom our service relies on. What plans are in place to tackle the raft of high personal and financial costs they face; as highlighted by a recent BMA survey which found levels of racism in the NHS to be a ‘debilitating’ problem and Indefinite Leave to Remain fees, which have risen 15 fold in the last 20 years; to give just one example of the hostile environment this government has created. 

Another cause for concern in their reply was a claim that the government plans to make “full use of available capacity, both in the NHS and in contracted independent hospitals”. We’d strongly refute this government is making ‘full use’ of available capacity - particularly in ‘independent’ (read: private) hospitals. 

At the start of the pandemic, the private hospital sector and NHS England signed a contract requiring private companies to make facilities freely available to the NHS, in exchange for the NHS funding their operating costs, for an estimated £2 billion in the first year. The amount of NHS funded elective care work in private hospitals went on to fall by 45% compared to before the pandemic, and two-thirds of the private sector capacity that was block-purchased by NHS England was left unused over that summer; at a price tag of £400 million per month.

Outsourcing NHS treatments to private providers will never be an effective tool to solve capacity constraints since many doctors within the private sector also work in the NHS. Both draw from largely the same workforce; one is simply more expensive. And sadly, these wasted efforts look set to continue, with Sajid Javid personally authorising an additional £1 billion payment to 150 private hospitals - without them having to provide a single operation to the NHS - in January alone.

The DHSC reply also led us to question yet again, why the opportunity to address any of the above issues was squandered in the government’s Health and Care Bill, expected to return to the House of Commons shortly. During the biggest NHS crisis of our lifetimes, why has the Secretary of State chosen now to initiate another large-scale reorganisation, to cede power away from local healthcare leaders and to provide even greater opportunities for private providers to profit from our public services? The Bill is not mentioned at all in the DHSC’s reply. 

The final point our letter to Sajid Javid made was about COVID-19, as the pandemic is far from over. Sadly nothing in the Department’s response acknowledged the ongoing - and as of this week rising - case numbers, nor the strain this will continue to place on our health service. Far from following the science, the government’s abolishment of all public health measures such as mask-wearing and social distancing, and reassurances that we’re in a “very good position” with the virus ring very hollow.

Our February letter followed one in a similar vein we sent to Sajid Javid back in November. That previous email was met with silence. Three months on the situation had gotten even worse and so we wrote again. Both ultimately asked Sajid Javid to step up and take responsibility as our Secretary of State for Health and Social Care, which he has yet to do. 

While we were disappointed not to receive this response from him directly; any form of reply from the government is far better than none. And content aside, the very fact that we received this response from the Department of Health is something to celebrate. 

It’s a sign that we’re on their radar, a sign that we’re being heard, and a sign that we’re having an impact. And we were only able to achieve this because of every single one of you who joined us to #DemandJavidsPlan, so thank you. We’ve replied the their email with our questions, and will update you at each step with what we hear. 💙

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