Election 2024 – what comes next for the NHS?
As predicted, we have a huge Labour majority government with a mandate to make lasting changes to the country – and with the NHS being at the top of their priority list. ?
It was a striking feature of the election campaign that despite it being joint top of the list of concerns for the public, with record high waiting lists and the lowest levels of public satisfaction we have seen, the #NHS did not featured in the campaign anywhere near as much as it should have. That leaves plenty of unanswered questions that will now come to the fore.
Why was the NHS largely absent in the campaign?
Firstly, what explains this lack of focus on the NHS? I think two things. Firstly, the Conservative Party understandably did not want to make this election about the NHS given where performance stands today compared to what the Coalition Government inherited in 2010. An unprecedented pandemic, industrial action and other factors have obviously contributed to the decline, but they don’t explain it all.
Secondly, and for very different reasons, the Labour Party knew that they would be encountering very different economic conditions to the ones they faced in the early 2000s when they delivered 6-7% annual real terms increases in NHS spending. Fast forward to 2024 and the outlook for the public finances looks dire. That has naturally restricted what Labour were able to commit to in their manifesto.
A bulging in-tray on the NHS
So, what happens next for the NHS and care? While some will forgive Labour for skating over their intentions in an election campaign, that patience won’t last long and they will inherit an in-tray bulging with problems:
?? A record high waiting list for elective care of nearly 7.6m.
?? A long running and damaging industrial dispute with junior doctors, and with other NHS staff looking ahead to the outcome of the pay review body process before deciding whether to ballot for strike action again.
?? A revolt of GPs over contract changes that could see huge disruption to primary care to come.
?? ?Estimates of a ￡3 billion gap in funding between what is available and what local health and care systems are being asked to deliver in 2024/25. This is before any potential additional costs of new pay awards for junior doctors and other NHS staff are factored in.
?? ?A ￡12bn backlog in capital and maintenance, which has resulted in crumbling estate and outdated technology – all of which continues to impede efforts to improve productivity.
?? Big questions on how to fund and deliver the much supported NHS Long Term Workforce Plan.
?? A social care system in crisis, with sticking plaster reforms over decades having left the service in disarray.
?? And many more challenges, including concerns over the safety of maternity and other services, delays in A&E and with ambulance handovers.
Voters will expect the Government to start to get an early grip on these challenges, no matter how unfair that may feel. While the reality is that these issues are not amenable to quick solutions and will take years to turn round, honeymoons for new governments don’t often last long.
And despite Labour having a huge majority, the size of their vote share, the number of seats with wafer-thin majorities and the low personal poll ratings for Keir Starmer, mean it wouldn’t be a surprise if frustrations set in early. That will especially be the case if the government doesn’t start to turn round performance before the winter sets in.
Our NHS Confederation animation provides a useful primer on these challenges: https://youtu.be/QCyWEUD-F_4
A twin-track focus on the short and long term
Given the size of the in-tray, the Government are right to frame this as a 5-10 year mission. A twin-track focus on stabilising the NHS in the short term, while making the bold changes needed to place the NHS on a more sustainable footing over the long term, will be needed.
The biggest two immediate challenges will be bringing an end to the damaging industrial dispute and solving the unfolding financial crisis that is starting to grip the system.
??? On the money, the Nuffield Trust Trust has estimated that Labour’s plans for the NHS would amount to a 1.1% real terms annual funding increase. By comparison, that’s less than the 1.4% annual increases we saw in the austerity years between 2010-2014. And, of course, waiting times were in a far different place back then. As outlined above, estimates suggest there is around a ￡3 billion gap in funding that has opened up this year. All of this will have to be considered as part of any emergency budget this Autumn – failure to do so could see the new government presiding over a very challenging first winter in charge of the NHS.
Despite the challenges, there are things to be optimistic about. The government plan to adopt a mission-based approach, with a more joined-up strategy across government to addressing the fundamental barriers affecting the health and wellbeing of the nation. They are also expected to lead a wide-ranging engagement exercise before launching a new 10-year plan for the NHS in summer 2025. All of which could provide new energy and focus on addressing the fundamental challenges ahead.
?? ???As part of this, the government has the opportunity to finally address long-standing issues that have been ducked by governments of all stripes for decades. Social care must be top of that list. We know the reasons why it didn’t feature during this campaign – think of Labour’s ‘death tax’ or the Conservative’s ‘dementia tax’, which have derailed previous campaigns. But few will forgive a new government, especially one with a big majority, if they don’t take early steps to start to address this. Clearly, it will take years but an early statement of the government’s intent will be needed.
This will be a 5-10 year turnaround, with many of the challenges not amenable to quick fixes.
But history tells us that it won’t be long before the public forget about the outgoing government’s role in causing and/or not solving these problems and when they instead start to hold new ministers to account for fixing them.
Early progress on the NHS to stop things from getting worse, while restoring public confidence that services will be recovered in the medium term, will be critical to the government’s ambitions. ?
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7 个月It would be great for them to invest in Single Handed Care to maximise capacity across the whole system. Layla McCay this has been demonstrated to be very effective in different areas. Such as Medway Kent led by Diane Lane and in Southampton led by Hannah Foxley. PS Great interview on TV ??
Optimist and problem solver. Managing Director - Medacy Ltd | Independent Prescribing Pharmacist @ Medacy Ltd | Non-Medical Prescriber
7 个月Daniel Reynolds . No increase in income tax, NI and VAT promised. Could we see a NHS and Care Tax do you think?