TheKingsfund) '&imiae Sl House of Commons debate on the address: building an NHS fit for the future Summary The King's Speech to parliament on 7 November 2023 opened what is expected to be the last legislative session before the next general election. It comes at a time when political parties are finalising their policies for the electorate, when the health and care system is facing profound challenges, and when public satisfaction with the NHS and social care services is at an all-time low. We welcome the government's bold commitment to introduce a phased smoking ban and moves to restrict selling e-cigarettes to children. We also welcome the government restating its commitment to the NHS Long Term Workforce Plan. However, the legislative agenda is otherwise light on proposals to address the biggest issues facing health and care, and did not contain the promised and long-overdue reforms to mental health legislation. Ahead of the debates on the address scheduled for 9 and 13 November, this briefing outlines The King's Fund's response to the speech and the key health and care issues that we believe should be a priority for the government. Tobacco and Vapes Bill If the proposal to introduce a phased smoking ban and restrict the sale of e-cigarettes is passed into law, this landmark health measure would be a significant step towards preventing poor health, saving lives and reducing inequalities. Passing the smoking ban legislation would be a major milestone, and government should then have the courage to implement the ban quickly. Key statistics e Inthe UK, in 2021, 13.3% of people aged 18 years and over smoked cigarettes, which equates to around 6.6 million people. e Smoking is the primary cause of preventable illness and premature death, accounting for approximately 76,000 deaths per year in the UK. e According to the Health Foundation, a majority of the public view the state as playing a central part in addressing the main risks for ill health. ¢ Where government has previously taken action on smoking, it has helped to make progress. The 2007 ban on smoking in public places contributed to the decline in smoking prevalence, which has fallen from 22% in 2006 to 13.3% in 2021. NHS Long Term Workforce Plan We welcome the government restating its commitment to work with the NHS to deliver on the commitments in its NHS Long Term Workforce Plan, published in June 2023. The plan is the first comprehensive long-term strategy for the NHS workforce, and an essential first step to overcoming the current workforce crisis. It sets out how to boost staff numbers through increases in training and education, and how to improve efficiency through ambitious reform plans. However, the plan is weaker on retention measures, and fails to address the issues that contribute to high attrition rates across the NHS workforce. Crucially, there is still no long- term social care workforce plan to overcome the severe staff shortages in that sector. Key statistics e As at October 2023, there were more than 125,000 vacancies across the NHS workforce in England, excluding primary care vacancies such as GPs. o Latest assessments estimate there are 152,000 vacant posts in the adult social care workforce. e The most recent NHS Staff Survey found that 32% of staff often think about leaving their job. ¢ Having sufficient management and administrative capacity can free up clinicians' time and enable services to innovate more quickly. However, managers make up approximately 2% of the NHS workforce compared with 9.5% of the wider UK workforce. Since 2011, the number of managers in the NHS has stayed broadly the same, while overall staff numbers, demand for care, and the scale of activity have increased. Mental Health Act reform The notable absence of legislation to reform the Mental Health Act is deeply disappointing. Planned reforms, such as changes to the criteria for detaining people under the Act, have been carefully considered over many years, and it is worrying to see them deprioritised. Failing to bring forward these reforms risks widening health inequalities. Beyond the King's Speech Context Health and care services are in a perilous state. More and more NHS organisations are slipping into financial deficit, waiting lists have reached a record high of 7.8 million, and industrial action continues, while many services still struggle with high staff vacancy rates. Local authorities are also increasingly running into financial difficulty. According to the Association of Directors of Adult Social Services (ADASS), 'three-quarters of social care directors across English councils say they "aren't confident" about being able to fully offer the minimum social care support in their communities required by law'. By many measures, the nation's health is also in a poor state. Whether we look at life expectancy, levels of long-term ill health, inequalities, mental health, or the drivers of poor health such as obesity, England's recent record is poor and often compares badly to peer countries. Priority areas for action The King's Fund recommends that the government prioritise three areas that will help *fix' the urgent challenges facing the NHS and social care and improve people's health. Improve access to out-of-hospital care People are living longer with multiple, complex, long-term conditions but are struggling to access the primary care, social care and community-based services they need to manage these conditions. This means they may not receive treatment until their needs are more serious. Not only does this risk increasing pressure on hospitals already struggling to be as productive as they were before the Covid-19 pandemic, it can also be worse for people's health and more expensive for the taxpayer. There is a need for action - such as bolstering the community workforce, modernising primary and community care buildings and equipment, and implementing long-overdue reforms to social care - that would enable more people to access care in their community so that they can stay healthier for longer. Make careers in health and care more attractive Years of poor planning and fragmented responsibilities for the health and care workforce mean that staff shortages are widespread. The workforce crisis is at the heart of many of the challenges facing NHS and social care services in England. In some areas, the number of staff is increasing, but the health and care needs of the population are also growing and 3 the number of vacancies continues to outstrip the number of staff to fill them. Addressing chronic staff shortages and stemming the flow of staff leaving the sector is essential to enable services to better meet people's needs and to provide a higher quality of care, so that waiting times come down, and outcomes and public satisfaction improve. Actions such as reducing the pay gap between social care and NHS workers, funding NHS staff mental health and wellbeing hubs, and improving management, administration and leadership in the sector would help make working in health and social care a more attractive career. Tackle the biggest risk factors affecting people's health Many people in England are unhealthy and their health is getting worse. A healthy economy requires a healthy population. Tackling the poor health of the nation is not the job of the NHS alone; there is a broad consensus that improving people's health depends on a wider range of policies in areas such as housing, the environment and employment. If the next government wants to improve health and prevent people dying early, it should create an approach to improving health that spans all government departments, prioritises actions to reduce health inequalities, and implements measures that help people to make healthier choices. A quick first step would be to implement existing legislation to ban junk food advertising. Contact Gemma Umali Senior Press and Public Affairs Manager g.umali@kingsfund.org.uk 020 7307 2583 References Allen L, Briggs A, Burale H, Buzelli L, Cameron G, Dun-Campbell K, Gardner T (2023). Public perceptions of health and social care: what are the priorities ahead of a general election? [online]. The Health Foundation website. Available at: www.health.org.uk/publications/long-reads/public-perceptions-health-and-social-care- priorities-general-election# : ~:text=There%20is%20an,effective%20and%2069%25 (accessed on 9 November 2023). Association of Directors of Adult Social Services (2023). 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