No Government wants the nurses to take to the streets. Especially not when they have a point. The average salary of a nurse may be just over £30,000 - higher than the national average - but if that's to work night shifts in a London or Oxford hospital with the housing market as it is, the cost of living simply doesn't add up. For too many Trusts this means high vacancy rates for permanent roles and costly agency staff in the meantime. This is a price the NHS can hardly afford to pay but as the fifth biggest employer in the world (yes you read that right) where could a multi-billion pound pay rise for two million NHS workers come from?
Firstly, there doesn't seem much of an argument for a pay rise for NHS managers. Many are paid in the hundreds of thousands with excellent benefits. There can be good reasons for these pay packets - recruiting and retaining the best talent to do difficult, important jobs - but pay inequality in the NHS can be as stark as anywhere in the corporate world, so any pay rise would have to be a smart pay rise, targeting lower paid, key roles where salary ranges are causing recruitment and retention problems, leading to higher costs in agency staff anyway. Secondly, the London weighting would have to be redesigned and extended to other high cost cities where the cost of living makes recruitment so impossible, leading to staff shortages and putting patients at risk. This would cost less and is the right thing to do.
But though a smarter approach would have inbuilt savings in agency costs and patient safety it won't come near covering the total bill. The Treasury may be able to dig deep this Parliament but what about the next one and the one after that? Even with record amounts of funding invested in the NHS - in the UK we have consistently increased health and care funding at one of the fastest rates of any OECD country over the last five years - the system still isn't sustainable in the face of an ageing population living with more chronic, complex illnesses. By adding a multi-billion pound pay rise into the equation - however morally compelling the argument for it may be - those sums become even more untenable.
This is because our hospital-centric system is becoming increasingly ill-suited for the demand it faces. Hospitals are for acute illnesses - strokes, heart surgery, car crashes - that require days or weeks in hospital. However, medical advances and changes in lifestyle mean we are now increasingly good at preventing these while rates of chronic illness, like diabetes, dementia, arthritis, have soared. Some of these conditions are associated with ageing, some with more effective medical intervention, but, whatever the cause, our health system is struggling to respond, patients are suffering and costs are spiralling.
The only solution is to innovate. We need a 21st Century NHS that is capable of meeting not only the health needs we have today but also those of future generations. The good news is that the innovations are here. As Lifesciences Minister, the ingenuity I saw in the sector was truly mind blowing, from new medicines that promise to open up a whole world of personalised medicine to AI systems to assist radiographers with the mammoth task of checking a scan every two minutes or game changing apps to help patients self-manage complex chronic conditions like diabetes or wearables to monitor elderly dementia patients' vital signs and alert carers or relatives to any changes - both of which are proven to help patients stay independent and keep them out of hospital. All of this genuinely gave me hope that if we can protect the bits of the system that are working but adopt and adapt the right mix of innovations - focussed firstly on preventing illnesses like Type 2 Diabetes, secondly, on helping patients and carers work together more easily to manage chronic illnesses like dementia, and finally, on driving through the wider availability of earlier, more accurate diagnosis and the kind of targeted treatments that lead to fewer side effects and long term disabilities. This is not only a responsive, high quality NHS but it is also a sustainable model as preventing illness, better managing chronic illness and treating acute illness in a more targeted way is also cheaper as it reduces demand immediately and over the long term.
There is only one way we have any hope of doing this, though, and that is getting our act together on health data. At the moment our health data remains largely unstructured and it is patients who suffer.
This is what the Caldecott Report was all about. It recommended 10 Data Security Standards, a number of cybersecurity measures including staff training and investment and an opt out mechanism for patients who didn't want their data passed on even in anonymised form. Dame Fiona Caldecott who wrote this report is the National Data Guardian for Health and Care Data and is in charge of ensuring responsible use of health data. However, she has no statutory powers to enforce her findings.
Before anything else then the Government must put the National Data Guardian on a statutory footing and respond to the Caldecott report - making it clear what cybersecurity improvements they will bring in and how they will implement an effective opt in/out system. Finally, they must set out how they will deliver workable data hubs of sufficient size and responsiveness to meet the innovation challenge. A patient base of two to five million - or the size of an STP - is a good starting place but they must be interoperable and futureproofed.
Hospitals and Clinical Commissioning Groups need access to the information about what services patients are using, how much they currently cost and what's not being used - without this information they cannot make good decisions about how to design the best services for the patients in their area. They cannot work out what innovations would really make the difference for their patients. They are working blind.
Furthermore, while the UK life sciences and health tech sector has made extraordinary strides in recent years, to meet the great health challenges we face as a nation - dementia, diabetes, cancers, rare diseases - medical researchers need access to anonymised data to develop new medicines and therapies to make those breakthroughs that are so tantalisingly close and crucially prove that they will make the difference for specific UK patient groups.
All of this, of course, must be done while keeping that data secure and respecting patients' right to consent - or not - to how their data can be used. Progress will only be made once the Government and the NHS have secured not just public trust in health data systems but much more importantly than that public backing for the use of health data for the public good: to innovate so we can save lives, better manage chronic illness and build a more sustainable NHS.
The stakes could not be higher. In the long term this is the only hope the NHS has of being able to meet the great health challenges facing our nation today, while managing demand and paying proper salaries to the NHS workers all of us depend on.