The BMA has outlined in stark terms its areas of concern for healthcare, as an independent review of the NHS in England gathers pace.

Years of underinvestment, worsening staffing shortages and a rising tide of ill-health are among the many challenges facing the health service, the association has stated in its submission to the independent review of NHS performance in England.

The review, which was commissioned by the health secretary Wes Streeting and is being chaired by Lord Ara Darzi, is encouraging organisations across the healthcare sector to submit data and findings to understand the ‘challenges facing the healthcare system’ better.

In its submission made today, the BMA has highlighted four areas which must be prioritised by the Government in its efforts to deliver a new 10-year plan for the NHS. 

These include access to healthcare, increasing workforce capacity in primary and secondary care, improving public health and boosting NHS finance, capital and productivity.

Workforce crisis

The submission emphasises the extent to which failure to address the recruitment and retention crisis has blunted efforts to grow the workforce and cost the NHS valuable, experienced staff at a time of growing public demand for healthcare. 

It warns that policy decisions which undervalue the medical profession are ultimately to blame, and that, without action to value the unique skills and expertise doctors appropriately, workforce levels are unlikely to reach those needed for quality care. 

This includes the way in which medical associate professionals have been deployed in the NHS, and how cultures of blame, discrimination and inequality in the health service have affected staff well-being and patient safety and has made raising concerns virtually impossible.

The BMA has also warned the review that cuts to public health services in the past decade have resulted in worsening standards of health in society, increasing demand on the NHS and making access to healthcare harder still. 

Meanwhile, a lack of investment in infrastructure has contributed to maintenance backlogs of the NHS estate, limited modernisation and ultimately undermined the ‘wellbeing and safety of staff and patients’.

It says: ‘Years of underinvestment and chronic staffing shortages mean that patients are finding it more and more difficult to access critical health services when they need them.

‘The crisis in general practice is fuelled by an insufficient supply of GPs to meet demand and inadequate levels of resource being directed to primary care. By compromising continuity of care, through practices being less able to provide patients with consistent access to the same GP, opportunities to reduce hospital admissions are lost. 

‘Secondary care waiting lists remain stubbornly high and key targets for emergency and cancer care continue to be missed. These waiting lists have a profound, adverse effect on general practice as patients present repeatedly for interim management while awaiting definitive treatment. 

‘To tackle waiting lists, the Government needs to ensure longstanding issues around pensions and other disincentives are addressed for staff working extra shifts.

‘Rising numbers of doctors are leaving the NHS, and this is set to get worse without action. Policy decisions that undervalue the medical profession are ultimately to blame.

‘Without action to value doctors appropriately, workforce levels are unlikely to reach what is needed for quality care, now and in the future. While training growth, and commitments to expand recruitment, is desperately needed, training capacity to deliver this is lacking.’

The terms of reference for the review specify that organisations making submissions must confine these to a maximum of five data charts with brief supporting summary text. 

The Government has said it hopes the review will provide ministers with an ‘expert understanding’ of the performance and challenges facing the NHS in England, while also helping to ‘stimulate and support an honest conversation with the public and staff’, regarding ‘the level of improvement that is required, what is realistic and by when.’

Lord Darzi is expected to report his findings in September.