Little help for health and care services on the brink

The UK has a new government, and with it a new Secretary of State for Health and Social Care, Thérèse Coffey – the third health secretary in as many months. (Our book, Glaziers and window breakers, on the experience of former health secretaries in their own words, should be mandatory reading.) 

The context Coffey inherits is grim. Pressures on health and care services in England are extreme. In August 2022, around 28,000 people waited more than 12 hours on trolleys in emergency departments for a hospital bed – over three times more than in the whole of 2019. One in 10 patients with a serious condition, such as a stroke, waited over 90 minutes for an ambulance. And the waiting list for routine hospital treatment has now grown to 6.8 million, with around 378,000 people waiting over a year.  

Dire data on people waiting for hospital care reflect pressures across the health system – in primary care, mental health, community services, social care, public health, and wider community support.  

These issues are not new. COVID-19 created massive disruption of services. But the underlying causes of the current pressures pre-date the pandemic – including a decade of underinvestment in the NHS and wider public services that shape health and inequalities, chronic staff shortages in health and social care, limited hospital capacity, longstanding neglect of adult social care services, and more. Recent analysis from QualityWatch – a joint Nuffield Trust and Health Foundation programme providing independent scrutiny into how the quality of health and social care is changing over time – explores how COVID-19 accelerated a much longer-run trend of growing waiting times in the NHS. 

Pressures on the NHS are often used to fuel a media narrative that the health system needs fundamental ‘reform’, such as switching the NHS funding model. But international evidence suggests that no type of health care system performs systematically better than others, the existing NHS funding model provides an efficient and equitable way of raising revenue, and top-down NHS reorganisations deliver little clear benefit. The NHS is already being reorganised through the Health and Care Act 2022 – the biggest legislative overhaul of the English NHS in a decade. And there is strong public support for the core principles of the NHS, including it being free at the point of need and primarily tax-funded. The new government should avoid tinkering with NHS structures – which is a recipe for wasting time and money – and focus on the major problems facing health services instead.  

Our recent briefing summarises these problems and outlines four priorities for the new government. These include addressing chronic staff shortages in health and care, tackling unmet need, supporting and expanding the social care system, and broader policies to improve health and reduce inequalities.  

In each of these areas, a mix of policy change and investment is needed. Spending on health per person in the UK is above the OECD average but less than many western European countries, and well below countries like France and Germany. (My colleague Anita Charlesworth unpacks the latest international health spending comparisons here.) Our recent public polling with Ipsos – described in more detail by my colleague Luisa Buzelli – shows that the majority of the public think extra health care spending is needed. Ultimately, the level of public spending on health and care is a political choice, and the nation’s health should be seen as an asset worth investing in. 

But will it happen? Last week, the new government published their plan for the NHS and social care in England – a ‘plan for patients’. The plan was billed as a ‘major intervention’ to improve services. But it contained limited new measures to address the challenges facing health and care in England. The plan says government will ‘focus relentlessly on ABCD’: ambulances, backlogs, care, doctors, and dentists. But it ignores the broader task of improving the nation’s health and reducing inequalities. 

The next day, the new chancellor announced the biggest package of tax cuts for 50 years and provided no extra funding for public services. Funding provided by government in the 2021 spending review fell short of the amount needed to recover NHS services – for example, to tackle NHS backlogs – and meet demand for social care. Since then, rising inflation and NHS pay increases have eaten up a large share of planned health spending. The result is that health and care services are being asked to do more with less, which will affect what they can offer to people who rely on them. You can read more analysis of the government’s new plan for health and care services in our latest piece for the BMJ.

Hugh Alderwick (@hughalderwick) is Director of Policy at the Health Foundation.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.