Governments came and went, Budget commitments were made and unmade, a big NHS IT programme was promised but never quite unveiled, there were few software deployments but three, big outages. And through it all, there was a sense that the NHS is truly reaching a crisis point. Highland Marketing looks back at the year as it unfolded in the Healthcare Roundup newsletter.
NHS England published its annual priorities and planning guidance, with ten priorities for health and care. Since these included investing in the workforce, tackling the waiting list, getting on top of the urgent and emergency care crisis, and improving access to primary care, most of them remained undone by the end of the year. In a digital section, NHSX said it would publish a ‘frontline digitisation minimum viable product’ for providers (7 January). Later in the month, the Health Service Journal suggested the digitisation of the acute sector would be the priority for NHS England’s transformation directorate as it absorbed NHSX (28 January).
The government published an integration white paper that added layers of complexity to the already complex structure for running integrated care systems. ICSs were told to have integrated care boards and integrated care partnerships and to operate at ‘place’ level. In its digital section, the white paper reiterated existing aspirations for interoperability and extended the scope of shared care records (11 February). At the end of the month, pay and conditions started to become an issue, as the government urged pay review bodies to give staff a 3% rise from the start of April. Unions called this “miserly” (25 February).
War broke out in Ukraine, sending fuel bills rocketing, and prompting NHS trusts to remove Russian companies from their supply lines while checking their cyber security. Health secretary Sajid Javid confirmed there would be a new digital maturity target for acute trusts – Level 5 on the HIMSS EMRAM model – while telling integrated care systems to “converge” IT systems in the process of achieving it. Also in the EPR space, Allscripts decided to sell its hospital business to N Harris Computer Corp, which renamed it Altera Digital Health, and Dedalus decided to drop Lorenzo clinicals in favour of the Orbis system it acquired from Agfa (4 March).
On 23 March, chancellor Rishi Sunak delivered what turned out to be the first of three budgets. In his spring statement, he said the Office for Budget responsibility was expecting inflation to reach 7.2% this year, eroding the real value of the NHS’ three-year settlement. Sunak’s response was to double the health service’s annual efficiency target, from 1.1% to 2.2% (25 March). To round out a bad month, Donna Ockenden’s review of baby deaths at Shrewsbury and Telford Hospital NHS Trust was published, the NHS staff survey registered a big drop in morale, and the British Social Attitudes survey registered a big decline in public satisfaction (1 April).
The new NHS financial year started with warnings that the NHS was being “weighed down” by the pressure on it. Matthew Taylor, the chief executive of the NHS Confederation, said “the brutal reality” was that “Easter is as bad as any winter” and called for government “realism” about the situation. In the first of a series of departures from NHS IT leadership positions, national chief clinical information officer Simon Eccles announced he was stepping down. And it was all change at System C, as Marcus Bolton and Ian Denley stepped back from their joint chief executive roles (14 April).
The Health and Social Care Act was passed, paving the way for a consolidation of arms-length bodies into NHS England and for integrated care boards to start work on 1 July. Digitalhealth.net promptly revealed that Matthew Gould, the chief executive of NHSX, was leaving (6 May). He eventually turned up again as the chief executive of London Zoo. UK inflation rose to 9%, forcing NHS England to re-jig its budgets and divert £1.5 billion to trusts. The Resolution Foundation warned inflation could push 1.3 million people into poverty, and the Royal College of Physicians warned that health was already deteriorating.
The government’s bizarre response was to delay the obesity strategy (20 May). NHS England also published the ‘Fuller stocktake’ of primary care it had commissioned from GP Dr Claire Fuller. The review suggested that primary care networks should evolve into ‘integrated neighbourhood teams’ so GPs and other services could support each other. Meanwhile, four hospitals in Greater Manchester were hit by an IT failure that left staff unable to access medical records, results or e-prescribing systems (27 May). The first of three big outages to impact the NHS in 2023 ran on into June.
The NHS Confederation held its annual conference in Liverpool, with chief executive Matthew Taylor calling for an end to attacks on the NHS by Boris Johnson’s administration. Health and social care secretary Sajid Javid flatly rejected calls for more funding and put the boot-in on “underperforming trusts” (17 June). Scotland published ambitious plans for a National Care Service. Ministers said it would “end the postcode lottery of care”, but unions said resources not “bureaucracy” were needed. Meanwhile, the mainstream media started to ask searching questions about Palantir, the IT company widely tipped to be the frontrunner for NHS England’s federated data system (24 June).
The Department of Health and Social Care published a digital strategy, ‘A plan for digital health and social care.’ The plan didn’t set out a new vision, but consolidated existing aspirations and targets, including the digitisation of acute trusts and the roll-out of shared care records (1 July). The following week, politics went into melt-down, as health and social care secretary Sajid Javid and chancellor Rishi Sunak resigned, and prime minister Boris Johnson was forced to follow suit. Johnson hung around until the autumn, and appointed a caretaker cabinet, with Steve Barclay taking up Javid’s job to widespread dismay (8 July).
The queen presented the four national health services of the UK with the George Cross in recognition of their years of service and their “exceptional efforts” during the Covid-19 pandemic. But soaring temperatures sent health services into melt-down (15 July). NHS England later calculated there were 2,800 deaths among over 65s in five ‘heat periods’ over the summer – and 3,271 excess deaths in total. NHS Providers said trusts needed to climate-proof their operations. As if to prove the point, Guys and St Thomas’ NHS Foundation Trust suffered the second big IT outage of the year when two data centres failed in extreme heat (22 July).
As “winter in summer” demand continued, NHS England issued a ‘dear colleagues’ letter urging commissioners and providers to start thinking about winter proper. Among other measures, the letter called for an additional 7,000 beds – many of them on virtual wards. Experts worried about the public health impact of rising fuel bills (19 August). Likely Conservative Party leadership election winner Liz Truss promised to address these while also cutting taxes (26 August). Supplier Advanced saw the third big outage of the year, when a ransomware attack took down systems used by mental health and community trusts, NHS 111, and social care.
Liz Truss duly won the Conservative Party leadership contest and became prime minister. Therese Coffey, her long-standing friend and campaign manager became her deputy and the third health and social care secretary of the year. Coffey declared that her priorities for the health service ran from a to d – ambulances, backlog, care, doctors and dentists. Think-tanks suggested extra NHS funding to account for inflation and a workforce plan should be priorities for an emergency budget (9 September). On 23 September, chancellor Kwasi Kwarteng instead proposed an unfunded energy price cap and tax breaks for the wealthy.
Kwarteng’s Budget implied borrowing on a massive scale, sending the markets into melt-down and leading to fears of huge public spending cuts instead. Think-tanks warned that Truss and Kwarteng were looking to “redraw the boundaries of the state” and right-wing commentators pitched in by floating the end of a tax-funded NHS. Nigel Edwards from the Nuffield Trust noted that an insurance-model might or might not improve responsiveness and quality; but would certainly increase inequality. At the annual Healthcare Efficiency Through Technology conference, NHS England CIO and NHS Digital CEO Simon Bolton acknowledged the pressure on NHS finances was putting digital transformation funding at risk (30 September).
The Royal College of Nursing launched a strike ballot and the British Medical Association said Coffey was pushing doctors the same way. However, the political crisis came to a head. Prime minister Liz Truss sacked chancellor Kwasi Kwarteng and asked former health and social care secretary Jeremy Hunt to take over (20 October). Hunt performed a screeching U-turn on his predecessor’s policies, but this wasn’t enough to save Truss, who resigned, leaving losing Conservative Party leadership contender Rishi Sunak to move into Number 10. Steve Barclay boomeranged back to the Department of Health and Social Care (28 October).
NHS England chief executive Amanda Pritchard outlined the scale of the task facing Barclay when she told the King’s Fund annual conference that the NHS was “facing tougher challenges now than when Covid arrived.” With integrated care boards barely four months old, she told them to look at rationalising roles and looking for economies of scale. The supposedly flagship Citizen Access project to let people automatically view new entries in their GP record collapsed (4 November). A week later, the British Medical Journal published a blistering editorial condemning the state of NHS IT generally (11 November).
After which, NHS England CIO and NHS Digital CEO Simon Bolton announced he is off to “pursue other interests” in January. On 17 November, it was Budget day again, as chancellor Jeremy Hunt delivered his autumn statement. Hunt found an additional £3.3 billion a year for the NHS – enough to stop headlines about funding falling in real-terms in the run up to the next general election. He also retained the capital budget that should pay for the Frontline Digitisation programme to deliver ‘minimum digital foundations’ to trusts. But he scrapped the social care reforms that former prime minister Boris Johnson once claimed would fix its crisis forever (18 November).
The Royal College of Nursing duly received a mandate for the first strike action in its history at organisations across England, Wales and Northern Ireland; but suspended its ballot in Scotland, where the government came up with a better offer. Unison and the GMB declared that ambulance workers had followed suit. NHS England brought its winter crisis plan on stream by announcing that 40 system control centres had gone live to use data to spot and address pressure (2 December). But as the year closed, the King’s Fund concluded that “a decade of neglect” had led to the NHS’ palpable and severe problems (16 December).