Review of the year 2023

Huge pressure, endless strikes, change at the top of NHS IT, and health tech targets set and hit. Look back over the year it unrolled in Highland Marketing’s Healthcare Roundup newsletter digest.

The NHS got through 2023 with pressure rising and performance against key targets falling. With a general election getting closer, think-tanks and politicians started to speculate on the long-term causes of the problems, and identified a failure to invest in facilities and IT as a key issue. Meanwhile, strikes impacted NHS finances and digital funds were raided to shore up the frontline. Despite this, NHS England was able to claim that a key target for rolling out electronic patient records had been met. Review the year, as it unrolled in our Healthcare Roundup newsletter digest.

January:

The NHS started the year with trusts declaring critical incidents and appealing on social media for staff to take up shifts. Health and social care secretary Steve Barclay blamed winter illnesses for the problems. The British Medical Association suggested he “get a grip.” NHS England issued its annual Priorities and Operational Planning Guidance (6 January) and launched a procurement for a Federated Data Platform which most observers expected US “spy firm” Palantir to win (13 January). In what became one of the year’s running stories, a wave of strikes picked up, as the NHS Confederation urged ministers to “do all you can” to end the disruption (20 January).

February:

The DHSC and NHSE issued an Urgent and Emergency Care Recovery Plan, with a renewed commitment to the development of virtual wards. NHS Digital formally ceased to exist (3 February) as followed NHSX into the NHSE transformation directorate. Then a chunk of the money allocated to “innovative digital technology” in the 2021 Budget was clawed back as finances tightened. Despite this, the government issued a medical technology strategy to boost patient care and UK business (10 February). Strikes continued in England as the devolved governments in Scotland and Wales negotiated – in the end successfully.  

March:

It emerged that NHSE is going to pay PA Consulting up to £13 million to help it to reorganise its IT, HR, and regional teams; having already set aside £100 million for redundancy payments (3 March). In further financial news, chancellor Jeremy Hunt delivered his first full Budget. He had little to say about public services, but the NHS Confederation warned this position could not last if strikes blew “a hole of up to £2 billion” in NHS plans (17 March). A pay offer was made to Agenda for Change staff (23 March) as public satisfaction with the NHS fell to record lows (30 March).

April:

Former health minister Patricia Hewitt published a review of integrated care systems commissioned by Hunt. It recommended a major reduction in central targets and “distracting” data demands. Barclay gave it a cool reception, but it was well received by NHS Confederation chief executive Matthew Taylor, who may have been hoping to influence Labour Party policy. Meanwhile, the government slashed the funds available for reforming social care and rolling out care tech (6 April). The NHS went into Easter under “extraordinary pressure” (14 April), with junior doctors holding strikes (21 April), and the Association of Directors of Adult Social Services warning the social care sector was “close to breaking point.”

After Easter, the Institute for Public Policy Research warned that rising levels of poverty and ill health were not just fuelling health and social care demand and impacting life expectancy but damaging the economy to the tune of £43 billion a year – 2% of GDP. It called for a national, 30 year “mission” to improve UK health and prosperity. Former cabinet minister David Davis, who led opposition to the “database state” and identity cards in the Cameron-era, condemned the FDP/Palantir plans. And the NHS Covid Contact Tracing app was finally switched-off (28 April).

May:

One tranche of strike action came to an end as more than a million staff on Agenda for Change contracts voted to accept a 5% pay offer. Tim Ferris, the head of the NHSE transformation directorate, announced he was going back to the US. NHSE had already set out plans for a National Improvement Board and a Digital Policy Unit to address strategic issues, such as cyber security, data and AI. Vin Diwaker, medical director for secondary care and transformation, took over (5 May). Babylon Health, once the poster-company for virtual primary care, announced a significant loss – and later went bankrupt (12 May).

As one pay dispute was settled, another started as the British Medical Association launched a ballot of consultants (19 May). With an election getting closer, Sir Keir Starmer delivered a speech on the NHS. He promised to “fix the fundamentals, renew its purpose and make it fit for the future.” He also promised a shift from “an analogue to a digital NHS” built around the NHS App, “fully digital patient records” and AI. In the same week, Barclay admitted the government’s promise to build 40 new hospitals by 2030 wouldn’t be delivered, by displacing some projects to make space for collapsing hospitals with faulty concrete (26 May).

June:

The week after Barclay’s announcement, it emerged that no fewer than 123 bids to be in a final tranche of the New Hospital Programme had been turned down (1 June). The UK Covid-19 Inquiry started to hold public evidence sessions, starting with a short film about the impact of the pandemic on people who suffered loss (9 June). The early hearings focused on how inequality and austerity had weakened public health and health services before Covid-19 hit (23 June). NHSE finally published its workforce plan. With no funding, Barclay talked up the potential of AI to make better use of the staff available (30 June).   

July:

The NHS celebrated its 75^th anniversary amid a blizzard of debate about its current state and future direction. NHSE’s new CIO, John Quinn, published “six plus one” short-term priorities for its IT, ranging from rolling-out electronic patient records to extending system control and bed management, to implementing patient portals (7 July). However, the Infrastructure and Projects Authority concluded that the frontline digitisation programme to get an EPR into every trust by March 2025 was “unachievable”; and the government knew this, since it had put the end date back a year (28 July). Consultants struck and brought the NHS to a virtual standstill.

August:

As weeks of damp and rain enveloped the country, NHSE turned its thoughts to winter. It issued its annual instruction to the health service to prepare as an update on January’s Urgent and Emergency Care Recovery Plan. Features included expanded networks of care traffic control centres and acute respiratory hubs – which were canned by the end of the year. Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, said the measures were nothing like enough and the coming winter was already looking worse than the previous one (4 August).

As if to make his point, NHSE data suggested that emergency departments had their busiest ever June and July and performance against waiting time targets deteriorated. The King’s Fund said that if the government wanted to turn things around it needed to get on top of the strike action, while NHS Providers said it also needed to fund the workforce plan. Meantime, the Royal College of Physicians suggested that NHSE’s target to have 10,000 virtual ward beds in place by September risked pulling in low-risk patients and over-medicalising them, rather than increasing capacity (11 August).

September:

The Department for Education shone a light on the use of faulty concrete in schools, inadvertently drawing attention to RAAC in hospitals (8 September). London mayor Sadiq Khan warned that climate adaptations will also have to be funded in a speech about the “incredibly worrying prospect” of 45C (113F) days “in the foreseeable future” (22 September). In his speech to his party’s conference, prime minister Rishi Sunak floated the idea of fining patients who miss appointments – an idea he raised and dropped just a year earlier. He also announced plans to phase out smoking (29 September).

October:

NHSE announced it will consult members of the public on “how the NHS uses their health data” – but not until next year (6 October). The Care Quality Commission issued a predictably gloomy assessment of the state of the NHS in its annual State of Care report. It said turbulence and the cost-of-living crisis were adding to the “gridlock” it identified last year; and warned that a two-tier system could emerge as wealthier people pay to avoid it. Having said that, it found social care is in an even worse state, with providers struggling to afford food, fuel and staff or going out of business (20 October).

Meantime, NHS productivity came under the spotlight as the Commons’ public accounts committee followed up on a National Audit Office report on the Urgent and Emergency Care Recovery Plan. The PAC noted that the NHS has more money and staff than ever before, but productivity has declined. It blamed a lack of investment in facilities, EPRs, and bed management systems. On the funding front, the King’s Fund said the NHS could be facing one of its worst-ever winters if Hunt failed to cover the £1 billion cost of the year’s strike action in the Autumn Statement (27 October).

November:

Pleas to cover the cost of the strikes fell on deaf ears at the Treasury, forcing the DHSC and NHSE to divert £800 million of winter money, waiting list initiative funding, capital and digital spending to the frontline. In return, integrated care systems were told to balance their budgets – a task that looks impossible (10 November). The Health Service Journal later reported that a further £350 million of central IT funding had gone. Despite this, NHSE pushed ahead with the hugely expensive and increasingly controversial FDP and duly awarded the contract to Palantir, working with Accenture and two other consultancies.

NHSE also claimed to have met its target for 90% of NHS rusts to have an EPR by the end of 2023 thanks to go-lives in London and Sheffield. It didn’t define EPR. When it launched, the frontline digitisation programme seemed to be aiming for HIMSS Level 5 (24 November). In further political excitement, prime minister Rishi Sunak held a reshuffle that saw most of the health team move or resign. Victoria Atkins became the fifth health and social care secretary to be appointed since Matt Hancock left in June 2021, counting Barclay twice.

December:

Atkins had an early success when the BMA and the Hospital Consultants and Specialists Association agreed to put a pay deal to their consultant members tied to measures to “modernise” their contracts and pay structures. This infuriated the Royal College of Nursing (1 December) and did nothing for junior doctors, who promptly announced their longest run of strikes ever – three days in December and six in early January. As the NHS pondered how to cope, NHSE released figures showing the number of people in hospital with norovirus and flu is rising (8 December). These days, it seems like it’s always winter in the NHS – but never Christmas.