What health and care need from the next government: #4 – Improving access to treatment

With a general election approaching, the Nuffield Trust's briefing series challenges the NHS and social care manifesto commitments of UK political parties ahead of the electorate heading to the polls. The fourth in our series looks at waiting times for health care – the biggest cause for public dissatisfaction with the NHS and a central battleground of this election. We identify seven tests that must be met which should be put to politicians as they battle to convince the public they have the answers.

The NHS and social care in England are struggling. A combination of the sudden shocks from the Covid-19 pandemic and high inflation, and the longer-term pressures of poor workforce planning, morale problems, failure to deliver promised efficiency savings, and decades of delay to social care reform are all taking their toll. Strain and dysfunction are deeply rooted and will not immediately improve, and the public sees this clearly: satisfaction with both services is at historic lows. Credible long-term plans to improve this situation are vital for any political leader who wants to gain the support of the British people.

Our general election briefings, produced with funding from the Nuffield Foundation, look at key issues where we believe a government taking or returning to office must act in order to meaningfully improve health and care. The fourth in our series looks at improving access to treatment. 

Waiting times for health care are the single biggest cause for public dissatisfaction with the NHS, according to the British Social Attitudes survey. They are rightly a central battleground in the 2024 general election: delays of months or years in getting treatment which grew over many years before Covid-19 struck, and then worsened alarmingly, strike at the sense of safety people were once proud to feel because they knew the health service was there for them.

Every political party has its own slogans, claims and targets. But when the election is over, the next government will need to select its policies with immense care, learning from long histories of success and failure to deliver and demonstrate the improvement that is needed. We identify seven tests that must be met, and which should be put to politicians as they battle to convince the public that they have the answers.

Test 1: There needs to be a limited number of targets and pledges, based on how much care the NHS can actually provide

The NHS in England has never delivered all eleven of the targets listed as pledges to patients in its Constitution handbook at once. Even going back to their predecessors it is more than eleven years since it met all those that existed at the time. Having targets that cannot be met is distracting, demoralising, and encourages unhelpful behaviours for moving patients on through the system. The next government must have commitments that are backed up by a clear calculation of how much the NHS can actually deliver based on finance and efficiency.

Test 2: Improve people’s access to all NHS services, not just hospitals

There have been longstanding promises across parties and governments to deliver more care outside hospital, but this has not translated into improving access and capacity. Spending has shifted away from community services like rehabilitation and children’s services, and areas of mental health like autism and inpatient care remain overlooked. Waiting times and access are often not even measured. The next government must make these more of a priority.

Test 3: Invest in buildings and equipment

Buildings and equipment in the NHS are in a poor state and limit what it can offer patients, because not enough of the budget has been dedicated to long-term investment over many years. Funding has been repeatedly raided to plug day-to-day deficits. Available data suggests that the UK has unusually few diagnostic scanners compared to other developed countries. The budget raids must stop, and England should spend as much on health care capital as comparable countries do.

Test 4: Set up long-term programmes for improvement over multiple years and don’t raid them

Initiatives to improve access to care, or improve care generally, work best when they are sustained for the long term. The next government should cut down on small, specific, short-term financial pots for improvement, which make it difficult for the NHS or social care to make big or permanent changes. Fewer, bigger initiatives that do not get raided for cash would be an improvement.

Test 5: Tackle the way that planned treatment favours the fortunate

There is a systematic inequality where people in poorer areas get worse access to planned care than richer counterparts – for example, the most deprived tenth receive 20% fewer hip replacements than the English average. The next government should set a clear target to reduce the gap in planned care between rich and poor.

Test 6: Don’t fixate on closing the gap between ‘the best and the rest’

The next government should not assume that it is easy to improve efficiency and waiting times by closing the gap between ‘the best and the rest’. Making different areas do the same thing has often failed, best practice does not spread easily, and blanket requirements for every trust
or area in the NHS will be irrelevant to both those who do much better and those who do much worse.

Test 7: Improve data collection to understand what works and what is fair

Limited data mean it is difficult to tell whether many initiatives to improve access are actually working. Community services data is limited, coding of ethnic groups is not reliable, and information is not fully connected across services. It is increasingly difficult to compare English NHS performance to Scotland, Wales, Northern Ireland, or other countries. These gaps must be addressed.

Suggested citation

Dayan M, Bagri S and Morris J (2024) What health and care need from the next government: #4  – Improving access to treatment