The British government is hard at work on a 10-year plan to revamp health services, though it’s still a way off from being finalized. Alongside this, a multi-year spending review is also in the pipeline to determine funding guidelines. Labour, however, is already clear on the three main pillars of its proposed NHS reforms: shifting focus from treatment to prevention, moving healthcare from hospitals to community settings, and embracing digital technology over analogue methods.
Since health policy is devolved, these plans will directly affect only England. However, the entire UK will inevitably feel the ripple effects, given that the largest health system’s trajectory will likely set the stage for others. As Labour gears up for its first full year in government in 2025, after a long hiatus since 2009, achieving tangible results in the NHS seems critical.
So, what’s the roadmap to success? The NHS app, boasting 34 million users, allows people to book appointments, order prescriptions, and access test results online. This could potentially liberate healthcare staff to concentrate on other essential tasks, aiding in a much-needed 2% productivity increase supported by a £22.6 billion funding boost from October’s budget. However, it’s crucial to ensure digital tools don’t widen the gap for those less tech-savvy. Maintaining traditional means of accessing care is essential to mitigate health disparities.
Efforts to restore the 18-week treatment target reflect a mediation between the drive for strict, overarching goals and a more community-focused approach. The goal is for 92% of patients to receive treatment within this timeframe by the end of the current parliament, a challenging feat amidst workforce shortages and industrial unrest. The waiting list has already ballooned to over 7.5 million cases in England alone, with even more delays in Northern Ireland, Scotland, and Wales.
From a political standpoint, it’s easy to see why the government needs to present concrete solutions to voters. However, doubts linger about whether it’s feasible to slash waiting lists while also overhauling the health system towards preventive public care. Experts are skeptical.
While health has generally done well in budget allocations since Labour’s return, and is expected to continue benefiting, it’s unlikely that NHS funding will soar like it did during Labour’s previous tenure, which saw a 5.5% annual rise. This means rapid improvements, like boosting staff overtime, aren’t on the horizon. Public awareness of the crisis’s severity might afford ministers some breathing room, a strategic calculation Health Secretary Wes Streeting seems to have made, labeling the system as “broken.”
Despite the challenges—particularly the aging population with chronic conditions—there’s at least widespread agreement on the structural approach. The move towards integrated care is being implemented through 42 regional NHS entities working closely with local councils and the voluntary sector to boost community health.
While the concept appears straightforward, as Lord Darzi highlighted in his recent ministerial review, there’s already significant variation in how these integrated care boards (ICBs) are interpreting their roles—especially in addressing broader social health determinants like poor housing.
The risk of overextended responsibilities looms large, potentially setting ICBs up for failure as mini welfare states. Yet, a bigger risk might be the government’s reluctance to relinquish control. The inclination to manage performance from the center can seem politically savvy for leaders wary of public judgment, but goes against empowering local boards. Setting an 18-week treatment target alongside performance rankings for hospitals could distract from building preventive healthcare services.
The trajectory of this centralization trend might shift following the government’s ongoing NHS evaluation. Mental healthcare could likely see improvements due to heightened public concern, but integrated care might not feature prominently in consultations, partly due to its vague nature. The 10-year plan needs to clarify where community health services will find their home and who will lead them—be it GPs, health visitors, district nurses, or schools. Strong leadership, open culture, and the principles guiding private sector involvement must also be outlined. The burgeoning private-equity presence in social care warrants caution.
Former Health Secretary Patricia Hewitt recently suggested that local boards should adhere to only about 10 national goals, recommending a 1% annual increase in prevention-focused spending. The strategy’s direction may heavily depend on whether Mr. Streeting favors advice from Alan Milburn, a past health secretary under Tony Blair, or Ms. Hewitt, now leading an ICB.
Decentralization demands bravery. When local entities decide on their own priorities, maintaining consistent standards over innovative support can pose a threat. What one sees as local empowerment, another views as inconsistent service provision. Joint commissioning by NHS and local councils introduces technical hurdles that require direct resolution.
The fear is that this freedom, along with the integration agenda, contradicts the British state’s inherent centralization. But Mr. Streeting shouldn’t let such biases, or nostalgia for New Labour’s strategies, skew his decisions. If the NHS is as broken as claimed, then finding effective solutions should be paramount.
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