Last Word


A clear strategy for change is needed for health and social care

Nigel Edwards, CEO at the Nuffield Trust, argues that it would be a lost opportunity if the next government does not seek to put both health and social care funding on a more sustainable footing.

Just over two years ago the 2015 general election loomed, and all parties scrambled to pledge upfront funding increases for the NHS. Fast-forward two years, and we find ourselves facing a general election under wholly different circumstances. The UK’s exit from the EU looks set to become the defining feature of the next decade of public policy, squeezing out time, money and talent desperately needed for the development and implementation of domestic policy. And while there is broad consensus that NHS and social care funding needs a fix, the impact of Brexit both on the economy and future workforce now presents an even more daunting challenge. 

Yet it would be a tremendous lost opportunity if the next government does not seek to put both health and social care funding on a more sustainable footing, outline a clear intention to address the looming workforce problems in both sectors, and give government the space to provide the financial and legislative support the NHS needs to transform services. 

There is genuine concern within the NHS that the next three years will be almost impossible to deliver on the current funding settlement without concerning implications for the quality and availability of care. In the medium term, while drives to integrate health and social care and transform health services are welcome, they will take time to deliver and will not generate savings on the scale politicians might wish for. In the longer term, evidence suggests that while a centrally-funded, free-at-the-point-of-use healthcare system is sustainable, this will require increases in the NHS budget that are significantly higher than those it has had since 2010, and indeed closer to the historical average of 4% a year. 

The next government should allow itself the flexibility to respond to the changing landscape and set out how it would fund a free-at-the-point-of-use NHS and sustainable social care system in the long term. Some clarity about how the next government will find the money if services turn out to need even more funds than anticipated would provide credibility and certainty for the taxpayer. 

The funding problems facing health and social care have the potential to be swamped by an even bigger challenge that will present itself to any new government soon into their period in office: the crunch facing the health and social care workforce. Staff shortages, dwindling morale and the looming impact of Brexit on a sector already dependent on overseas workers promise to make the next decade extremely challenging indeed. The new government will need to support initiatives to address the impact of these pressures. Accepting that nurses may need to stay listed as a shortage occupation, ensuring a joined-up approach across government departments to the recruitment of overseas workers, addressing staff shortages, and supporting workforce development would be a good start.  

As well as funding and workforce issues, a new government will inherit an NHS in the midst of a major change programme. The Five Year Forward View offers the right vision for the health service by shifting care closer to people’s homes, but is unlikely to be realised without upfront investment in community services alongside hospital care and changes to the legal status of some NHS bodies. 

The sustainability and transformation plan (STP) process has undeniably had a rocky start. But it has helped local organisations forge new relationships and set in train plans for reforming care that are long overdue. Instead of risking a further distracting reorganisation of the NHS, any future government should go with the grain of these reforms and support local areas in changing the way care is delivered. This will mean the new government supporting bids for capital funding where required, leaving open the option for legislative changes to formalise STP structures and, in time, making changes to ensure that the 2012 Act does not stand in the way of collaboration. 

It is clear that both health and social care need a thorough and long-term approach. The next government must provide a clear strategy for change whilst, at the same time, delivering the high-quality publicly-funded healthcare and access to social care that the public expect. Not tackling this has the potential to cause serious problems over the course of the next Parliament and beyond.

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