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'Significant' Challenges Ahead for NHS, Managers Tell MPs

The NHS was not "remotely complacent" about the work needed to prepare for the forthcoming winter, a senior health manager told MPs.

Sarah-Jane Marsh, national director of urgent and emergency care, warned that signs were already pointing towards "significant" challenges for urgent and emergency care during the season, which followed a particularly tough 2022-23 winter.

Ms Marsh was among a group of NHS and Department of Health and Social Care officials who gave evidence on Monday to the Commons Public Accounts Committee  (PAC) in its investigation into access to urgent and emergency care. 

In March, the committee reported that the first year of the NHS' 3-year plan to recover its services was already falling short. And last month, the National Audit Office reported that access to urgent and emergency services was deteriorating in the face of increased demand and record bed occupancy rates, resulting in key operational standards being missed.

NHS Pressures

In opening remarks, Amanda Pritchard, NHS England's chief executive, said it had been "by far and away the worst winter that I can recollect in 25 years working for the NHS", and that pressure on the system had persisted into the warmer months. "We've just had the busiest day for A&E attendances ever, and we continue to see pressure not just on urgent emergency care in hospitals, but on GPs as well," she noted.

A central issue was a "population that is older and more complex and generally also sicker", Ms Pritchard explained. However, the problem was compounded by "higher levels of sickness in our staff" than before the COVID-19 pandemic, some of which was attributable to "mental health conditions and anxiety".

Professor Sir Stephen Powis, facing his 6th winter as national medical director at NHS England, admitted that the winter ahead would be "challenging" but said that the NHS had initiated preparations " earlier than ever before", with the emphasis on getting systems in place by September or October.

Ms Marsh said there were "early indications" from the southern hemisphere that there might be a "challenging 'flu season" looming, with the potential for further industrial action by health staff bringing additional uncertainty.

Hospital Bed Management Technology

NHS England hoped to extend the roll out of an electronic data management system to manage hospital bed allocations in real time from the current four to 16 trusts, and would "work to implement the system that we know works really well during the course of this year", Ms Marsh told MPs.

Asked to explain why it was not possible to initiate a "crash programme" to expand the system to all trusts, she explained: "It's not just the technology itself – it's the deployment, so it's having the expertise to get absolute value out of it."

Recruitment and Retention

Witnesses were questioned by the committee on staffing problems, with Mark Francois MP describing as "quite worrying" figures showing that around 9% of NHS workers had quit between 2022-23. NHS England projections for future staffing levels, based on the NHS workforce plan, were "quite heroic assumptions", he suggested. "There's no point winding the aperture of the recruitment tap if you can't put a retention plug in the sink," Mr Francois said.

Asked how the NHS would persuade healthcare staff to remain in the service, Ms Pritchard promised a range of measures, focused on "flexibility". She said: "Workload is another issue and we know that really matters, so if you don't feel you can do your best work, that really affects people's desire to continue to work in the NHS."

She acknowledged that "there are things that are outside our control, so pay is one of them".

The PAC plans to publish its report this autumn.