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A big cash injection is the lifeline the NHS desperately needs

Over the next five years, the cost of maintaining the NHS will inevitably grow with demand. The next government must be willing to spend more to improve it.

June 20 2024, 15.04pm

The challenges facing the NHS seem endless: missed cancer targets, long GP waits, the biggest-ever elective backlog, widespread dental deserts and crumbling hospital buildings. And these are just today’s problems. Our population is ageing fast and getting sicker all the time. We need an NHS that not only tackles everyday emergencies but can treat a growing elderly population safely and with dignity. 

Almost all of us were born in an NHS hospital. We rely on the service to keep us healthy and to fix us when we’re broken. So how can we make sure it will be there for us in the future?

First, the greatest hidden pressure must be taken off emergency services.

The Royal College of Emergency Medicine has linked tens of thousands of excess deaths to long waits in A&E over the last two years. More than 23,000 in 2022 and around 14,000 last year. Although there have been improvements in wait times, the sector is still under enormous strain.

It's often assumed that more ambulances, emergency clinicians and bigger A&Es are the way to fix this crisis. However, the root of this crisis lies in a lack of social care capacity.

Many people need ongoing care after a spell in hospital. But if a care package isn’t available, a vulnerable patient may end up waiting in hospital for days, even weeks, until it is. This reduces the number of acute beds available to new admissions, slowing patient flow from A&E. Emergency departments become overcrowded. Patients wait for hours on trolleys. Some are triaged inside the ambulance they arrived in. And while ambulance teams are stuck at hospitals, they can’t answer new calls. 

Hospitals are scaling up their community-based care and trying out new care models to improve flow. There are green shoots of success, yet there’s only so much they can do. 

To fix the emergency care crisis, we need to rapidly increase social care capacity and create a detailed long-term workforce plan to sustain it. Our population is getting older and sicker, and the importance of these services will only grow in the years to come.

The Labour Party wants to introduce an NHS-style National Care Service, which could provide much-needed consistency across a sector propped up by the goodwill of unpaid carers. But what this kind of service would actually look like, and how closely it would resemble the NHS in more than name alone, remains to be seen.

Secondly, the NHS needs more staff, and they must be paid better.

Tugging at every worn seam in the NHS is a workforce stretched to its limits. There aren’t enough staff to review imaging results, treat heart disease, assess people for ADHD, or see them for toothache. There often aren’t enough staff to safely care for patients at all. The workforce is overburdened, unhappy, and underpaid. 

We need a healthier pipeline of domestic workers to stop trusts using so many expensive agency workers and hiring nurses from countries that can’t spare their staff. That means increasing training posts for doctors, nurses and other clinicians, and making sure we’re giving enough doctors the tools to be radiologists, geriatricians and cardiologists.

It also means making the NHS a more attractive place to work. After more than a year of industrial action, the government needs to agree on a pay deal with junior doctors. Strikes affect staff morale—particularly when action feels like it’s going nowhere—and they’re expensive for hospitals. Fairly closing this chapter will give some breathing room to trusts and their staff.

With staffing already the biggest area of spend for the NHS, shoring up the workforce will mean spending more. Right now, many hospitals are in the mind-boggling position of being desperate to recruit while searching for ways to reduce their headcount to meet extremely tight post-Covid budgets.

After years of sluggish economic growth and stagnant wages, leaders can’t rely on brimming tax coffers. Immediate investment will need to come from borrowing, tax hikes or cuts elsewhere in the budget.

All three parties have been non-commital about the cost of their health plans and how they’ll fund them. The Nuffield Trust estimates each party’s plans would result in real-terms spending growth on health of 0.9% for the Conservatives, 1.1% for Labour and 1.5% for the Liberal Democrats.

If accurate, this is pitiful, sub-austerity-era stuff. The equivalent growth in spending was 1.4% a year from 2011 to 2015. The cost of simply maintaining the NHS will inevitably grow with demand. We need to be willing to spend more to improve it.

Finally, the next government should address the social determinants of health, not just as a matter of principle, but because it will also help control health spending.

Poverty, housing and ethnicity play a huge role in health outcomes in the UK. Those living in the poorest places die a decade before their wealthy peers. Alcohol kills more than three times as many men in the poorest places areas. Black and Asian women are considerably more likely to die in childbirth than white women.

We’ve known about the health impacts of an unequal society for decades. And in the UK, inequalities are deepening. Investments in sectors like housing and education are indirect investments in health.

Local population health management schemes should be a key part of any meaningful public health plan. Some excellent pilots have seen multi-agency teams address poor housing, obesity, loneliness and nutrition alongside specific medical interventions. And wider public health schemes help reduce smoking. This work should be front and centre for any health system. Health is just one facet of our complex lives. We shouldn’t treat it in a silo. A healthy lifestyle should be just as accessible as healthcare.

To tackle inequality, we need to make meaningful efforts to understand and address the racial disparities in health outcomes. To make sure every clinician knows what cyanosis or jaundice looks like in a Black baby. To provide devices that can measure oxygen accurately on darker skin. We need to ensure staff always listen to patients, no matter what they look like.

If we want to fix the NHS, we need to fix our society. We can’t stop people getting older (at least not yet), but we can stop them from getting sick before their time. Millions of young people are in good health today, irrespective of their background. How many will still be 20 years from now?

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