Can sixth Health Secretary in 5 years avert another deadly winter crisis?

Samantha Wathen is Press and Media Officer for Keep Our NHS Public

In a dramatic cabinet reshuffle by Prime Minister Sunak following the sacking of Home Secretary, Suella Braverman, Victoria Atkins now replaces Steve Barclay as the new Secretary of State for Health and Social Care. Atkins is the latest in a long line of no less than six different Health Secretaries in the last five years, and just like the rest, has no experience or expertise in the field she now enters.

Atkins was previously a criminal barrister specialising in prosecuting serious organised crime. She is MP for the rural constituency of Louth and Horncastle MP, and worked for the Home Office between 2017 and 2021. There she was the Parliamentary Under Secretary of State for Crime, Safeguarding and Vulnerability and her brief included domestic abuse, honour-based violence, sexual exploitation and FGM.

In addition, the role of her department included assessing the danger to individuals from Covid during the early stages of the pandemic. During this time (in March 2020) the threat level of the virus was downgraded, coinciding with Government’s failure to secure enough good quality PPE to keep NHS and care staff safe. Atkins appeared on TV with Piers Morgan in a broadcast spot where she appeared to laugh at the situation. Over 2,100 NHS and Care workers have died from covid-19.

Following this appointment, Atkins was Minister of State at the Ministry of Justice, Minister for Afghan Resettlement between September 2021 and 6 July 2022 and led the Ministry of Justice’s work on prison operations and policy, youth justice, tackling violence against women and girls, and rape and serious sexual offences.

Atkins resigned from her positions under Boris Johnson’s premiership on 6 July 2022 following the resignation of key colleagues including Rishi Sunak and Sajid Javid. Johnson was then forced to announce on the following day that he too was stepping down.

Conflict of interest

The new Health Secretary is married to Paul Kenward, the Managing Director of British Sugar– one of the world’s largest suppliers of sugar cane and sugar beet. This opens up some rather obvious questions around her future commitment to obesity legislation and sugar taxes and is of huge significance considering that diabetes, heart disease and other major illnesses that can be linked to excessive sugar intake are key issues for the NHS and the health of the nation.

NHS funding boost rejected

Last week brought the news that, far from preparing the NHS for its busiest period, the Treasury has rejected health leaders’ pleas for £800m of funding to compensate for the financial cost of strikes and to prepare for winter. Despite months of negotiations, providers will now need to absorb these costs and find them from existing budgets, further impoverishing the NHS as it goes into its busiest period. This news follows a previous revelation in September that the Government’s announcement of an extra £200m would be held in reserve to pay for strikes and not in fact help with additional support for the NHS this winter.

Victoria Atkins was appointed Financial Secretary to the Treasury on 27 October 2022. In this role she will have been at least partly responsible for negotiating these decisions – now it’s her job to make that decision work

Responding to the announcement, Nuffield Trust Senior Policy Analyst Sally Gainsbury said:

To be very clear, this extra new money will not pay for additional patient services, it will merely paper over some of the holes in this year’s budget. As a result, resources will be spread even more thinly and NHS organisations will have to focus on emergency care and the most urgent of cases.

Matthew Taylor, chief executive of the NHS Confederation, also made clear the risks of cuts:

If it cannot be compensated in full, the NHS will need to understand from the Government how it intends to adjust expectations on what its services will deliver with the resources available.

There are now 7.8 million people on waiting lists (an increase of 20,000 since last month). This leaves another of Sunak’s key pledges in tatters while he busily tries to blame frontline doctors for the effects of his wilful neglect and underfunding. As the NHS fast approaches its busiest season it is not equipped to meet the challenges it faces as it heads into another record-breaking winter crisis.

It doesn’t add up

In January 2023 the Prime Minister announced his promise for emergency care over winter. This pledge included 800 extra ambulancesand5,000 hospital beds, paid for by £1bn worth of funding. Just how these beds would be staffed (as opposed to being merely a piece of urniture) was anyone’s guess given over 110,000 staff vacancies.

By April it became apparent that 800 extra ambulances would not materialise, and in fact nearly all of those referred to were merely routine replacements for old vehicles. The actual number of new ones delivered was around 51 according to a BBC Freedom of Information request which garnered results from the majority of trusts.

The 5,000 promised additional hospital beds fell woefully short of the 11,000 the Royal College of Emergency Medicine (RCEM) statement of what is needed in order to avert the horrendous scenes and hundreds of avoidable deaths we witnessed last year. By August 2023 a departmental press release stated that only £250m of the £1bn promised was to be made available – resulting in just 900 extra beds. Apparently, the plan was still to supply the remaining 4,100 by winter, but as of early November 2023, the NHS is still waiting.

But it gets even worse. Far from merely reneging on the promised additional beds, official figures from September show that bed numbers in acute hospital trusts were actually 3,258 lower than at the beginning of the year. This means that even with the extra 900, the NHS would still have 2,358 beds fewer than in January.

We are already in crisis

All this is set against a backdrop of an already emerging crisis before winter has officially begun. In recent weeks there have been black alerts/critical incidents declared at Nottingham, Cardiff, Portsmouth and Norfolk hospitals. Some of this has been exacerbated by the inability to discharge medically fit patients back into their communities owing to a lack of social care with some waiting months for the support needed to discharge them.

What is the Government’s plan?

Last Thursday the RCEM responded to the news. Vice President of the College, Ian Higginson said on X (formally Twitter) that the Government had ‘Underwhelming plans, poorly implemented, and [there was a] sense of denial/normalisation of harm to patients and staff.’

President of the RCEM, Dr Adrian Boyle said in the College’s official statement that:

…We are heading into another extremely difficult winter and we don’t have the beds that we desperately need. Our worst fears are becoming manifest, increases in attendances, increases in admissions, increases in dangerous and harmful delays – all not being matched with the necessary increases in beds. The pledge to deliver 5,000 beds continues to go unmet, and it is affecting patients, their care and the whole system...It is appalling and unacceptable. Without the necessary action, ambulance queues outside A&Es will become more frequent, along with the heart-breaking patient stories of traumatic delays for emergency care…The Government must look on these data as a stark warning of what is to come and take the necessary meaningful action to mitigate patient harm.

And what solutions does the Government have up its sleeve to avoid another 500 avoidable deaths a week this winter in the emergency pathway? Their answer is to legislate for minimum strike levels (further alienating already burnt-out frontline staff) and point endlessly to the NHS Long Term Plan as if something that is aspirational and many years away from delivering safe staffing will save us all now. In other words, precisely nothing.

Is she up to the challenge?

Victoria Atkins has most definitely been thrown in at the deep end. Chief amongst her challenges must be positively resolving industrial disputes with doctors over pay renumeration in order to help support retention in the midst of a seemingly endless staffing crisis.  

She will need to heavily focus on the now astronomical waiting list and the delivery of emergency care which is always felt most keenly at this time of year, and must lean on her previous department (the Treasury) in the hope of potentially reversing their latest disastrous decision.

Atkins would also do well to attend to the crisis in general practice where staff numbers are similarly in significant decline. She must contend with the recent departures of senior health ministers and the necessity to form a new ministerial team after the resignations of primary care minister Neil O’Brien and secondary care minister Will Quince. The ongoing crisis in social care must also be urgently addressed as delayed discharges are a significant factor in allowing patients to access the emergency pathway.

The sad reality is that the Government does not have even the beginnings of a plan. Their tactic seems to consist of crossing their fingers and repeating media soundbites to deflect blame in the hope that the public will be persuaded this crisis is somehow the fault of striking doctors (a trick already attempted with waiting lists). We all deserve so much better.

Samantha Wathen, Press and Media Officer, Keep Our NHS Public