Pavilion Publishing and Media Ltd
Blue Sky Offices Shoreham, 25 Cecil Pashley Way, Shoreham-by-Sea, West Sussex, BN43 5FF, UNITED KINGDOM
Tel: +44 (0)1273 434 943
Email: [email protected]
The decline of the NHS over the last decade is largely down to the failings of governments in power, according to a new report by The King’s Fund.
The report analyses the deterioration of the NHS between 2010 and 2020, and what contributed to this decline. These factors include decisions on public spending, rising demand for care, and the failure of politicians and the system in which they operate to heed the warning signs and act accordingly.
The author of the paper, former Chief Executive of The King’s Fund Chris Ham, compares this period to the previous decade (2000-2010), and says that multi-year funding increases above the long-term average and a series of reforms resulted in major improvements in NHS performance during this period.
Mr Ham says that while the current situation can feel overwhelming, the policies introduced between 2000 and 2010 show that “change is possible where the political will exists”.
To sustain and reform the NHS going forward, Mr Ham says the government (and future governments) must focus on spending decisions, moderating demand and sharing responsibility with patients and the public, as well as adopting a long-term perspective.
The decline of the NHS
The report states that constrained resources, efficiency savings, reduced capital spending, insufficient workforce planning and social care spending, a lack of action to prevent ill health, failure to meet the rising demand for care and political failure have all contributed to the deterioration of the NHS.
The report highlights that the Covid-19 pandemic cannot be blamed for the deterioration of the NHS, as analyses show that waiting times for cancer care, planned routine hospital treatment and A&E care have been steadily rising since 2011 (Figure 1).
Perhaps the most significant contributing factor to the NHS’ decline appears to be a lack of funding, and international analysis shows that UK health spending would have been £40 billion higher every year between 2010 and 2019 if it had matched the EU average. This has led the NHS to have much lower healthcare capacity than other similar countries, as seen in the number of hospital beds, doctors and nurses, and medical equipment.
While spending on hospital care has grown over the last two decades, this has not been matched in primary care and community services, despite policy commitments to shift care and resources away from hospitals and into the community.
Mr Ham states that “the decline in NHS performance was not only predictable, it was actually predicted” in 2014. “Decline started gradually, but by the middle of the decade, the adverse impacts on patients and staff were plain to see … The chorus of voices calling on the government to act reached a crescendo,” he writes.
Mr Ham says successive governments have had various opportunities to change how the NHS is run, but they have all failed to adjust funding levels to appropriate levels and implement policies designed to address these challenges.
Opposition parties are also at fault, Mr Ham says, with none of the parties offering policies on a scale commensurate with the challenges that had emerged in the NHS and social care. He criticises the Labour Party for failing to commit to “funding increases on the scale needed to tackle current pressures”, and he notes an excerpt from Sir Keir Starmer’s 2023 new year speech in which he said: “Investment is required… But we won’t be able to spend our way out of their [the Conservative government’s] mess”.
Where next?
The report lays out various measures future governments should take to reform and restore the NHS to its optimum level of service.
A significant focus is increasing funding levels so that they are in line with the long-term average, with public health given priority.
Social care services should also be a particular focus for the government, the report says, with funding gaps filled and a workforce plan created to ensure there are adequate levels of staff to meet the rising demand for care.
Equal priority must also be given to primary care and community services, so that healthcare professionals are able to anticipate people’s needs, promote independence and offer alternatives to hospitals.
Patients and the public should also be seen as active agents in their care, with responsibility to preserve their own health as well as being aware of their rights. This will help shift the focus from treating diseases to prevention and early intervention to tackle the wider determinants of health and reduce inequalities.
“The future will be shaped by decisions on these issues and on the ability to moderate demand for care and support, to invest more in primary care and community services, and to recognise the role of patients and the public in improving health and care. The next government must adopt a long-term perspective to avoid repeating the mistakes of the past decade. The improvements that occurred between 2000 and 2010 show that change is possible where the political will exists,” Mr Ham concludes.