The number of full-time equivalent GPs fell by more than 700 over three years to March 2022, despite a pledge to deliver 6,000 more. Appearing before the inquiry, the then Secretary of State Sajid Javid admitted he was not on track to deliver them. The report describes a situation where NHS pension arrangements force senior doctors to reduce working hours as a “national scandal” and calls for swift action to remedy.

Maternity services are flagged as being under serious pressure with more than 500 midwives leaving in a single year. A year ago the Committee’s maternity safety inquiry concluded almost 2,000 more midwives were needed and almost 500 more obstetricians. The Secretary of State failed to give a deadline by when a shortfall in midwife numbers would be addressed.

Pay is a crucial factor in recruitment and retention in social care. Government analysis estimated more than 17,000 jobs in care paid below the minimum wage.

• 25% of shifts had the full number of planned registered nurses on shift.
• Three-quarters of respondents reported a shortfall of at least one registered nurse on their shift (75%, compared to 58% in 2020). The majority were working with 50-74% of the planned number of registered nurses for that shift.
• Only 28% of respondents said that the nursing skill mix (the number and educational experience of nurses working in clinical settings) was appropriate to meet the needs and dependency of patients safely and effectively. 69% of respondents said it was not appropriate.
• Only around one in five (18%) respondents agreed they had enough time to provide the level of care they would like.
• Only around half of respondents said that students held supernumerary status (52%), 39% said they did not. Supernumerary status means that education standards require that they are not to be counted in workforce numbers while learning, due to the risk to student and patients of them being counted as clinical staff.
• 62% reported that patient care was compromised on their last shift (compared to 57% in 2020 and 53% in 2017).
• Four in five respondents (81%) felt that patient care being compromised was due to not having enough registered nurses on the shift.
• 43% of respondents said that due to lack of time they had to leave necessary care undone, up from 38% in 2020, and 36% in 2017.
• One in five (21%) said they felt unable to raise their concerns.
• Even on shifts where 100% of planned registered nurses were present, around one in three (31%) respondents reported necessary care being left undone due to a lack of time.
• Half of respondents (51%) felt “demoralised”. Only 16% felt “fulfilled”.
• Almost two thirds of respondents (61%) were unable to take the breaks that they were supposed to take.
• Almost two thirds of respondents worked additional time (63%). Of these, almost eight in 10 (77%) were unpaid for these additional hours.
• 87% of Black respondents who worked within the NHS reported working unpaid additional time compared with 77% respondents from a White British background.

When I was a teenager our psychology teacher asked the class if any of us had a word or phrase that really frightened us. A big burly man in his fifties, the teacher openly shared that his dreaded words were “heart attack.” Apparently, whenever he heard someone say this phrase his heart would start pounding and he’d break out into a sweat. He was terrified of the concept.

Somehow this brought me comfort. I knew immediately that mine was “cancer.” Up until that moment I thought I was the only person in the world to be frightened merely by a word. I’d lived in mortal fear of this disease ever since 1982 when a thirteen-year-old girl in my class at school died after undergoing brutal treatment. I’d spoken to my parents about it but they’d been oddly unsympathetic and matter-of-fact.

For years cancer was my secret terror. and I went through life walking around in a daze of repressed fear, imagining it was lurking inside me waiting to break out and kill me at any moment. Twenty years later, in my mid-thirties, I came across the book ‘The Emperor of All Maladies: A Biography of Cancer’ by Siddhartha Mukherjee. I was stunned. It laid everything to do with cancer out bare, shone a light on every aspect of the disease’s history and took away all its terrifying power. For the first time in my life I could understand the condition as an illness that can be treated rather than an overwhelming cataclysm of destruction. I could say its name out loud. I could think about it in full consciousness.

There and then I decided I would plunge into this formerly forbidden territory and try to make amends for being unable to do anything for my friend at school. I would work for Macmillan, and every day say the word ‘cancer’ and not be afraid. I wanted to enable other people directly affected by the disease to be less afraid too.

It was another fifteen years before I had the opportunity. But after my children were settled in school, I finally did just that and decided to volunteer for Macmillan. I’ve now been volunteering at the Macmillan Information & Support Centre at my local district general hospital for four years, and I am part of a core team of five volunteers and two healthcare professionals with backgrounds in oncology.

We are fully occupied seeing patients at all stages of their cancer journey, and their concerned relatives and friends who are also often deeply affected. We stock leaflets about every cancer there is and take referrals for people wanting financial help, which we pass on to the relevant local council department. We also inform people about where to get practical items such as beds, wheelchairs and other mobility aids, and help for side effects from treatment such as hair loss, fatigue or breathlessness. Sometimes people just need to cry or talk things through in privacy with a sympathetic listener. Generally speaking, I feel able to answer a good percentage of the questions patients ask. I can lay my hands on literature about even the most obscure cancers and lesser-known treatments and side effects.

However, I don’t feel I’ve been trained enough, if at all, for those occasions when patients arrive in a state of high emotion. Ideally, they need to talk to a professional counsellor, but instead they have me. I do my best, but I don’t feel I have adequate techniques or knowledge to deal with these kinds of situations confidently.

Ultimately, I don’t have any answers; no one does. I can only listen sympathetically and give people the space they need to deal with their emotions. I wouldn’t feel happy to do this without my manager being in the centre at the same time, and luckily this is almost always the case.

Patients often telephone the centre with medical enquiries because they say they can’t get through anywhere else and they’ve seen our number on the internet. The official appointment and enquiry line for the Cancer Centre next door to us is invariably engaged and if patients do manage to get through it’s usually only to an answer machine. That’s often full, so they’re unable to even leave a message. In these cases, I explain that I am not medically trained, I’m “just a volunteer” so cannot directly answer their enquiry, but I’m able to take down their details and pass them on to my colleague, who will in turn pass them on to the right person to get back to them. These moments are always unsatisfying, but this is, I think, a by-product of services being overstretched and too busy, with not enough staff to handle the volume of work. And such is the repeated story throughout the NHS in 2022, although it has been like this for many years.

By volunteering I do my tiny little bit, and thankfully this is also the repeated story throughout the NHS. Without us, I don’t think the hospitals would be able to provide half as good a service to patients as they currently do. Morale and camaraderie amongst hospital staff and volunteers is an essential part of the service—it’s what makes people want to contribute, it makes us feel part of a team, part of a large organisation that will look after us (staff and volunteers equally), as well as the patients. It gives us the feeling that everyone is working together for a common good, that we’re all on the same side, and have shared issues and challenges. It helps us see that we can make a difference. Post-pandemic, this is at risk, and, if not attended to, it could result in a depletion of both — just what the NHS does not need at this crucial time.

At the Information and Support Centre where I volunteer we are lucky. The nurses, doctors, cleaners, tea ladies and healthcare workers treat the volunteers with respect, as we do them, making us feel included and seen. Our manager surprises us every Christmas with a ‘thank you’ box of gifts and a card telling us how much we’re valued, and the Voluntary Services Team ensure we are well looked after and can go to them with any queries or problems. I didn’t expect any of this when I signed up, but I must admit it makes the whole experience extra rewarding. It’s just a little added extra to show how much we’re appreciated since we don’t get paid.

If other hospitals haven’t yet put in place something to make the army of often unseen volunteers feel appreciated then this is definitely something they could look at.

Are you an NHS volunteer? We'd love to hear about your experiences, please share them in the comments

Emergency departments are full and struggling to receive ambulance patients, resulting in delays and patient harm. Hospitals are full and are struggling to get beds for the patients needing admission. Patients are stuck in the back of ambulances, on trolleys in ED corridors and increasingly in hospital beds because of the paucity of community support for discharges.

We now find ourselves in the completely unacceptable situation where the “solution” to ambulance handover problems is to put up tents or sheds in front of emergency departments...

The blindingly obvious problem here, as ever, is staffing. Neither hospitals nor the ambulance service has enough staff to cover another clinical area, let alone a tent.

Not only that, but these tents do not have the usual safety features of a hospital and while covid is still circulating extensively pose a risk of cross infection. They are a danger to patients’ health and dignity."

This will be done in four ways:

1. Demonstrating the economic value of the health workforce.

2. Investing in real, appreciative leadership from the front-line, down to central departments.

3. Dual Transformation: Empowering staff to innovate to solve problems while the big redesigns are happening.

4. Defining the rules of working in an era of high activity.

1. The Department has overseen years of decline in the NHS’s cancer and elective care waiting time performance and, even before the pandemic, did not increase capacity sufficiently to meet growing demand. Recommendation: The Department must strengthen its arrangements for holding NHSE&I to account for its performance against waiting times standards for elective and cancer care. This should include specific expectations for improving waiting time performance in 2022–23. The Department should write to the Committee alongside its Treasury Minute response to set out the specific and measurable performance indicators for elective and cancer care it has put in its 2022–23 mandate to NHSE&I.
2. At the Committee evidence session, the Department and NHSE&I appeared unwilling to make measurable commitments about what new funding for elective recovery would achieve in terms of additional NHS capacity and reduced patient waiting times. Recommendation: In implementing its elective recovery plan, NHSE&I should set out clearly: timeframes, costs and outputs of the components of the recovery plan, recovering elective care and cancer care to 2024–25; the longer-term investments and plans that are being made now to improve the resilience of elective care and cancer care beyond 2024–25; and the national performance levels expected in each year between now and 2024–25.
3. The NHS will be less able to deal with backlogs if it does not address longstanding workforce issues and ensure the existing workforce, including in urgent and emergency care and general practice, is well supported. Recommendation: In implementing its recovery plan, NHSE&I’s should publish its assessment of how the size of the NHS workforce (GPs, hospital doctors and nurses) will change over the next three years, so that there is transparency about the human resources that the NHS has available to deal with backlogs.
4. It will be very challenging for the NHS to focus sufficiently on the needs of patients when it comes to dealing with backlogs, both patients already on waiting lists and those who have avoided seeking or been unable to obtain healthcare in the pandemic. Recommendation: The Department and NHSE&I must ensure there is a strong focus on patient needs in all their recovery planning, including: measuring the success of all initiatives to encourage patients to return to the NHS for diagnosis and treatment; creating guidance and tools, and setting aside resources, for meaningful communication with patients who are waiting; and supporting NHS trusts through planning guidance and other means to prioritise patients fairly, so they are able to strike an appropriate balance between clinical urgency and absolute waiting time.
5. Waiting times for elective and cancer treatment are too dependent on where people live and there is no national plan to address this postcode lottery. Recommendation: NHSE&I should investigate the causes of variations between its 42 geographic areas and provide additional support for recovery in those that face the biggest challenges. NHSE&I should write to the Committee in December 2022 on the actions it has taken to address geographical disparities in waiting times for cancer and elective care and include a summary of any analysis it has done on differences in health outcomes for elective and cancer care in different parts of the country since the start of the pandemic.
6. For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow. Recommendation: The Department and NHSE&I must be realistic and transparent about what the NHS can achieve with the resources it has and the trade-offs that are needed to reduce waiting lists. In implementing its elective recovery plan, NHSE&I should set out clearly what patients can realistically expect in terms of waiting times for elective and cancer treatment. By the time of the next Spending Review at the latest, the Department and NHSE&I should have a fully costed plan to enable legally binding elective and cancer care performance standards to be met once more.

• infection control measures placing limits on ward space.
• reduced elective capacity.
• staffing redeployment.

For this reason, this analysis uses the pre-pandemic year of 2019/20 as the comparator, to fairly illustrate long-term trends.

As a result of the bed shortage demonstrated by this analysis, the BMA is calling for:

• an increase in core bed stock
• adequate funding to increase the workforce, ensuring that additional beds can be staffed safely.

• The total number of NHS hospital beds in England has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2019/20, while the number of patients treated has increased significantly.
• Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK has fewer acute beds relative to its population than many comparable health systems.
• Since 1987/88, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community.
• The number of hospital beds for general and acute care has fallen by 44 per cent since 1987/88; the bulk of this fall is due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital.
• Research shows that initiatives to moderate demand for hospital care often struggle to succeed. Progress depends on having sufficient capacity to provide appropriate care outside hospital, yet evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care.
• Before the Covid-19 pandemic there was widespread evidence of a growing shortage of beds. In 2019/20, overnight general and acute bed occupancy averaged 90.2 per cent, and regularly exceeded 95 per cent in winter, well above safe levels.
• It is not yet clear when and at what level hospital beds will stabilise after the pandemic.
• How hospital beds are used depends on the availability of other services, yet national data does not provide a full picture of NHS bed capacity and requirements.
• As the health and care system emerges from the pandemic, greater clarity from NHS national bodies is needed on their expectations for overall health and care bed capacity over the medium term, and the consequences of these choices.