In its 75th year, the NHS got its latest much hailed 'plan': the NHS Long Term Workforce Plan. Running to over 150 pages, this document was greeted with no small amount of fanfare, and rightly so. It is the first plan in the history of the NHS to have a 15-year life cycle for staffing, and for all those involved in the delivery of medicine or the support of healthcare professionals, it is readily apparent why that is important.
There's not a warehouse full of doctors somewhere ready to be deployed, nor a fast-track route to get more GPs on the medical register by Christmas. Plugging NHS staffing and resourcing gaps will take some considerable time, but in the words of much quoted, ancient proverb: the best time to plant a tree was 20 years ago, the second-best time is now.
There is much to welcome in the plan, from £2.4 billion extra funding for the NHS over the next five years to an ambition to double medical school places to 15,000 a year by 2031. But above all the numbers, percentages and set piece commitments included, the narrative from the government and NHS England is squarely focused on workforce retention and increasing the money and other resources available for front-line patient care.
The MDU prides itself on being an unapologetic champion of our members, actively promoting your interests and seeking to influence positive change for healthcare professionals. As that campaigning organisation, we know only too well that there are glaring medico-legal issues facing the NHS workforce that need addressing if the ambitions set out in this plan are to be realised.
First, let us consider the push to maximise the amount of money and resource spent on frontline patient care. This is something the MDU supports wholeheartedly, but we cannot talk about harnessing every penny in the NHS towards front line patient care if billions of pounds every year are leaving the system in clinical negligence costs.
In September, the Department of Health and Social Care (DHSC) finally announced it was proceeding with its plan to cap legal costs in lower value clinical negligence claims. Before turning to those plans, it's worth highlighting what the Minister said in their forward to the announcement:
"Making the best possible use of NHS resources is vital. While spending on healthcare services has increased, supporting improvements in quality and safety, in recent years more of this money has been diverted for the purpose of addressing clinical negligence claims.
"Our analysis suggests that this is because the overall cost components of claims, including damages, have been growing at rates far higher than inflation and continue to rise rapidly.
"Between financial years 2006 to 2007 and 2022 to 2023, the annual expenditure on clinical negligence claims more than quadrupled from £0.6 billion to £2.6 billion, with legal costs comprising a notable proportion of this rise. These costs are funded from the core NHS budget and use resources that could otherwise have been spent on patient care."
Fixed recoverable costs in lower value clinical negligence claims: Department of Health and Social Care (published
31 January 2022)
The time has long since passed where any government can overlook this problem. Legal reform is needed, and it is needed now. The fixed recoverable cost (FRC) scheme that the government has just announced is a start, but it is precisely that - just a start.
It will be limited to claims valued up to £25,000, but the MDU believes for such a scheme to really yield meaningful results for the cost of clinical negligence, it needs to extend to a much higher value of claims. We have long campaigned for an FRC scheme that captures claims up to £250,000, and we are urging the government to begin planning now for how that could be delivered.
Capping legal costs is just one component of a package of reforms that the MDU has campaigned for. Our Fair Compensation campaign puts forward ambitious but deliverable reforms, such as the repeal of a 1948 law that still applies (specifically, S2(4) of the Law Reform (Personal Injuries) Act 1948) and means that personal injury defendants must disregard NHS care when paying compensation.
This means public bodies like NHS Resolution have to fund private care, so billions of pounds from NHS funds go out of the system, irrespective of whether the NHS ultimately ends up providing the care regardless - as a free at the point of use service.
There are glaring medico-legal issues facing the NHS workforce that need addressing if the ambitions set out in this plan are to be realised.
This must stop. After many years of campaigning for this, the MDU was pleased to see MPs on the House of Commons Health and Social Care Select Committee include it in their recommendations to government, following an inquiry into NHS litigation reform. However, the government is yet to formally respond to the report. We need a plan from government for legal reform, to finally address the cost burden clinical negligence places on the NHS.
Another aspect of the NHS Long Term Workforce Plan that needs considering in a broader context is workforce retention, another vital and laudable aim. But once again, you cannot have a conversation about improving workforce retention in the NHS if the regulatory system that doctors are subjected to is as outdated as the one they currently have. This does nothing for morale, and nothing for inspiring confidence amongst the profession that if they do find themselves before the GMC, they will be dealt with in the most timely, fair and proportionate way possible.
Healthcare professional regulatory reform needs to be higher up the parliamentary agenda. It is another issue we campaign tirelessly on, on behalf of our members. Notably, it is not only us calling for the GMC to have its legislation reformed; the GMC is calling for it itself. It is clear the regulatory regime envisaged 30 years ago is no longer fit for purpose, and in 2021, the government consulted on root-and-branch reform of regulators like the GMC.
Photo credit: Shutterstock
From a brand new three-tier fitness to practise process to agreed outcomes in cases, many of the proposals have the potential to be hugely positive. Legislation was initially promised in 2022 to give effect to these changes at the GMC, but we are still waiting.
Doctors deserve a reformed regulator. They have waited a long time for it. Between now and the next election, we are campaigning to secure that long-promised legislation from government. It cannot slip down the agenda again, and must go hand in hand with plans such as the NHS Long Term Workforce Plan.
The MDU knows what its plan is. It is to keep standing up for our members, and to be a strong voice for them with decision makers in government, the NHS and the regulators. We now want to know what the government's plan is on these issues; issues where the NHS workforce need to see delivery, so they can get on and deliver for patients.