Slowly but surely, health policy choices in England are becoming dominated by the general election which will be underway by the end of next year. The government are looking with increasing urgency to fulfil their handful of key pledges to rebuild trust, while the opposition weighs in regularly with new commitments and interventions, trying to credibly signal that it could lead a sudden recovery.
There is a good reason for this. Public satisfaction with the NHS has plummeted. Polling shows this issue vying with the worst cost-of-living crisis in decades as the defining factor on which voters will decide who controls the country. The crisis they see, and changes in technology, staffing and disease, mean that the winning government will arrive at a genuinely critical decision point for the most important elements of the systems that provide care.
It is the public who will decide, but we want to do what we can to ensure that the national debate based on which they choose matches the scale of the problem, is based on accurate facts about what is wrong, and a fair assessment of what will work to solve it. We are delighted that the Nuffield Foundation have awarded us a grant to bring evidence to bear on health and care during the next election. With their help, we are starting now.
We have identified five key fields where we believe decisions following this election will be vital. For each one, we will produce a set of clear, evidence-based tests that a future government would need to meet to secure stability and improvement for people who need services. During the election, we will mark commitments and pledges against them. We hope these can set out clearly how parties can adopt long-term, honest policies to improve care – and enable them to take some credit if they do.
Behind only the difficulty in accessing services themselves, staffing was the reason most cited for public dissatisfaction with both health and social care in the most recent British Social Attitudes Survey. The workforce has always been indispensable to every moment of care provided. Burnout rates, people quitting, strikes and shortages in different areas show serious problems. We can expect both main political parties to continue looking at the pledges and announcements for expanding popular staff groups which have been a feature of recent years. But if the next five years do not see an improvement in the ability of planning to evolve and stop new areas of shortages, in the rate of existing staff leaving, or in their wellbeing, then the resulting problems are likely to undermine everything else that a new government attempts.
General practice is the crucial point of access and direction for patients in the NHS. It is struggling with a flatlining workforce, the ease of being seen declining on all fronts, and a less reported drop in people being able to see the same doctor each time. The next government will inherit most of these problems, but also powerful tools. An explosion in digital and telephone use and capabilities carries many risks but will make it more possible to match patients with the right kind of care, while next year’s new contract could reshape the GP practice as the public has grown used to it for decades.
After decades of neglect, social care has become a more and more prominent campaigning theme in recent elections, forced on parties as public perceptions harden from confusion into firm disapproval. With access difficult and many costs left to fall on individuals, the position in the real world is unpleasant and difficult for many people who find themselves having to seek care for themselves or their families. The current government will find itself in the awkward position of having failed to deliver its manifesto commitments on funding reform within the parliamentary term. Labour, meanwhile, has yet to endorse or confirm a specific policy of reform at all. We cannot afford more years of drift, and the public should demand comprehensive improvements.
We have chronicled over the years how the NHS in England has repeatedly received budgets that leave it over-running each month to try to meet its commitments in the absence of miraculous efficiency gains. Money for transformation, buildings and public health has been siphoned off to fill the predictable gap, at every level from the Chancellor of the Exchequer to local health leaders, meaning efficiency and good allocation of resources often suffer. The service cannot thrive under another five years of this approach, but political parties face very difficult choices in a context where public finances are strained, living standards are declining, and working out how to truly improve efficiency is always more elusive than is hoped for.
Access to treatment and diagnosis
Lastly, but most prominent of all in the public eye, is the question of waiting times, and access more widely to treatment and diagnostic services. There is no point in having excellent, equitable public health care that nobody can actually receive when they need it. But measures have been broadly worsening for years across the board. No party wants to preside over this, but increasing the volume of treatment is not easy or cheap. The temptation to promise big new targets with no especially clear way to deliver it will tug at them all during a general election. We hope to draw on our ongoing research and monitoring to make evidence-based suggestions for the coming years.
Just as important as debating the policies that really matter is ensuring that the facts are accurate and available. Much of this is a job for journalists, Full Fact, and other experts once claims and denunciations start to fly back and forth during an election campaign. We will regularly update our staffing tracker and our QualityWatch monitoring funded by the Health Foundation, and we will add a new finances tracker which provides fully updated analysis of the key indicators politicians, journalists and voters need to watch to understand the level of spending and where it goes.
The issues facing health and social care are difficult, but they can be overcome – and the public are unlikely to accept anything less. We hope that by spreading accurate information and pulling together the evidence about what works in the long term, we can help the next government to start with the benefit of having made promises that measure up to the problems.
Dayan M (2023) “The next general election will be critical for five areas of health and social care”, Nuffield Trust blog