It’s finally spring, a time of year that is all about new beginnings. Most legal COVID-19 restrictions have now ended. Cases are high but the national approach to managing the pandemic is firmly moving to a new phase.  

Beyond COVID-19 this is a time of major change for the NHS. The Health and Care Bill is in the final stages of debate in Parliament, on track for the new integrated care systems (ICSs) to begin work as legal entities across the NHS in England from June. April is also when the new Health and Care Levy is implemented, increasing employers and employees’ National Insurance contributions. And while the Chancellor’s Spring Statement didn’t include any new funding for health and social care, rising inflation will have implications for budgets and for those delivering care, as we highlight in our new analysis

Integrating services 

The new ICSs have a daunting agenda. It’s now 20 years since National Insurance was last raised to fund improvements in health care on the back of the Wanless Review. The Wanless Review laid the ground for additional funding in return for a health service that delivered improved population health by putting patients and communities at the heart of care. Improved value for money would come from investing in new technologies (notably digital), engaging the workforce and better integrating care. 20 years on, ICSs are tasked with making that vision a reality. 

Even before COVID-19, the challenges facing ICSs were significant. The REAL Centre publication in 2020 showed that despite the intent to better integrate care, over the last two decades an increasing share of care has been delivered in hospitals.  

In England, the most recent large-scale integrated care programme was the 2015 new care model vanguards. Last autumn the Improvement Analytics Unit (IAU) pulled together findings from four long-term evaluations of the vanguards’ impact on emergency hospital use. This concluded that it’s unrealistic to expect integrated care programmes to reduce emergency hospital use in the short term. They may be able to reduce emergency hospital care in the longer term, but this took up to 5–6 years. 

In early March the Secretary of State gave a keynote speech on the future of the NHS saying, ‘Business as usual won’t fix winter pressures or the COVID backlog. Doing nothing risks locking us into a decade of decline. Reform is an essential pre-requisite for recovery.’ 

He made clear that he doesn’t see further spending as the answer. Rather he emphasised the need for reform. In mid-March, the government then announced that the efficiency ‘ask’ of the NHS is being increased from 1.1% a year to 2.2% a year. My colleague Stephen Rocks explains here why creating such an unachievable target may not be all that helpful

ICSs are going to need to think differently. There are no easy off the shelf models to achieve the scale of ambition required. How do we turn this from mission impossible to something closer to mission possible?  

Improving leadership and driving productivity 

The findings from our new report suggest that if managers are to be equipped to meet these challenges the forthcoming Messenger review needs to focus on better support to providers and systems to tackle variation in management practice and – against the populist grain – ensure the role of managers and leaders is better understood and valued.  

Technology will be at the heart of efforts to improve the quality and efficiency of care over the coming years. Primary care is at the forefront of the debate about the role of digital technology in the NHS. A new briefing from the IAU examined data from 146 GP practices using the askmyGP online consultation system. The increasing use of online consultation systems has raised concerns about increased inequalities in access to care. However, the analysis shows that patients often choose remote over face-to-face consultations and that GP practices can mitigate the risk of digital exclusion by ensuring access to both options.  

As the NHS sharpens its focus on efficiency and productivity, our report on agility highlights some of the service improvement approaches that offer opportunities to improve productivity. Skill mix change, patient activation, improving flow and the use of technology are all important.  

The challenge of rising inflation 

As we highlight in our new analysis of the Spring Statement, the task of clearing the backlog and improving services has been made all the more difficult given the economic outlook and rising inflation.  

One of the key issues that will determine how far the NHS can improve care and deliver value for money is workforce. The Chancellor’s Spring Statement, and the accompanying new economic forecast, show that with annual CPIH inflation at 5.5% in February 2022, hospital and community sector staff are due to face a real-terms basic pay cut of around £850 on average, given the 3% pay award made in 2021/22. There will be considerable pressure to increase earnings to help staff meet cost-of-living pressures and manage potential recruitment and retention problems, but without additional funding this adds to NHS budgetary pressures.  

Vacancies are rising again and are back above pre-pandemic levels. The Health and Care Bill provides a major opportunity for the government to create a better system for workforce planning, but the bill currently falls far short of the action needed. Over 100 organisations, including the Health Foundation, have supported an amendment to require the Secretary of State to publish independently verified assessments of current and future workforce numbers every 2 years. This would strengthen long-term spending decisions about workforce planning, regional shortages and skill mix based on evolving trends.  It wouldn’t solve this year’s workforce problems but would be a key learning from the pandemic – better planning is critical.  

Embedding learning 

And finally, learning lessons from our experiences of COVID-19 is vital if we want to bring about meaningful change. The announcement of a statutory public inquiry into the handling of the pandemic is welcome and necessary. But the Hallett inquiry faces a daunting task that will involve difficult decisions about priorities. We’ve laid out our thoughts on what the inquiry’s terms of reference should be in this long read. 

COVID-19 has been one of the biggest shocks the health and care system and wider society have faced. The Hallett inquiry must identify the lessons learned from the pandemic response and create the impetus for changes needed to be better prepared for another human, social and economic crisis of this scale.  


Anita Charlesworth (@AnitaCTHF) is the Director of Research and the REAL Centre at the Health Foundation. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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