Letter to the new UK health secretary

Letter to the new UK health secretary

Following his appointment as Secretary of State for Health and Social Care, the College wrote to Wes Streeting MP as follows:

Dear Mr Streeting,

Congratulations and introduction

I would like to congratulate you, on behalf of the Royal College of Physicians of Edinburgh (“the College”), on your appointment as Secretary of State for Health and Social Care. As you may be aware, the Royal College of Physicians of Edinburgh is one of three Colleges of Physicians in the UK. Although we are based in Edinburgh, we are very much a four-nation College – with more affiliates in England than in Scotland. As such, we take a keen interest in health policy across all countries of the UK. 

Our primary role is to help qualified physicians across the UK and internationally to pursue their careers in specialist (internal) medicine through medical examinations, education and training. We also provide resources and information to support and facilitate professional development for physicians throughout their careers. The primary purpose of all this work is to sustain and develop standards of medical care.  

You are, of course, acutely aware of the challenges facing healthcare in UK. The College is committed to working with you and your colleagues in the government – as well as with other partners, including the other physician Colleges in London and Glasgow and the Academy of Medical Royal Colleges - to address these challenges. Workforce challenges continue to dominate discussions among the medical community. The findings of the four-nation Consultant Physician Census Report for 2023/24, which we co-produced with colleagues in Glasgow and London, can be read here. 

Broadly, the census highlights what consultants are telling us on the ground – that there are too few staff to meet the current workload. This translates to suboptimal patient care, a risk of burnout and fatigue, faltering recruitment and declining retention. 

Highlights from the census include:

• There continue to be consultant physician vacancies: 59% of UK consultant physicians reported they have at least one consultant vacancy in their department;
• Consultant physicians are frequently seeing gaps in the trainee rota: 62% reported daily or weekly trainee rota gaps when on acute duty over the past year;
• Rota gaps are impacting patient care: 69% felt that consultant physician rota gaps were having a negative impact on patient care;
• Consultant physicians continue to manage significant workloads: almost a fifth (18%) said they almost never feel in control of their workload. Only 36% said they feel in control of their workload most of the time or almost always;
• Consultant physicians continue to work beyond their job plans, with over half of respondents (52%) saying their job plan does not adequately reflect all of the work that they do, compared to 48% who said it did;
• Consultant physicians feel stressed at work: 68% of UK consultant physician respondents said they were either very (14%) or somewhat stressed at work.

As a geriatrician, I was additionally concerned by the results of the four-nation British Geriatric Society workforce survey, which highlights a workforce who are frustrated and exhausted by the system that they are working in and their frustration at not being able to provide the high quality care they aspire to.

You may be interested to note that the College published its health priorities during the general election campaign – with a significant focus on public health. Based on our health priorities, we would welcome the following action from your department:

• Follow through on proposed new legislation making it an offence for anyone born on or after 1 January 2009 to be sold tobacco products;
• Introduce a sugar and salt reformulation tax to change the fiscal incentives in the food system to better support healthy diets;
• Extend the ‘sugar tax’ to other products high in sugar, including sugary fruit juices, milkshakes and coffee chain frappé drinks, which in many instances contain ‘hidden’ sugar;
• Legislate to restrict advertising on TV and online for products high in fat, salt or sugar, which encourage people to consume ‘unhealthy’ food and drink;
• Introduce minimum unit pricing on alcohol. Scotland and Wales have already introduced legislation enacting minimum unit pricing, and other parts of the UK must follow;
• Restrict the advertising and marketing of alcohol products, as recommended by the World Health Organisation.

You will note that we share your desire to increase efforts to prevent ill-health. However we would caution that the impact of many of these measures will take some years to be realised. As such, workforce must be front and centre of all policy considerations, as we continue to deal with high demand on health services.

We also share your sense that improved IT is necessary across the NHS. This would ideally join up primary and secondary care, and “health” and “social” care much more effectively than is currently the case. We would, however, caution against overzealous investment in newer, unproven IT technologies until the basic operating efficiency of NHS systems across hospitals and practices is sustainably improved. Finally, we were pleased to note your suggestion that more funding will be needed to “fix the NHS”. We wholeheartedly agree with that view. We counsel that the funding required will be significant, and that failure to increase funding in-line with increasing demand for healthcare could render the founding principles of the NHS untenable.

I hope that you find our workforce analysis and our health policy asks constructive, and I would welcome an opportunity to discuss them with you, at a date and time of your convenience...The College is extremely interested in working with you to address the challenges outlined above, and a meeting would be a good starting point in that regard.

Ends.