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The NHS will turn 75 in July, but it is reaching this milestone in poor health. In March 2023, the waiting list for routine hospital treatment reached 7.3 million – the highest since records began – with around 360,000 people waiting more than a year. Pressures on emergency departments have eased since winter, but remain grim: 27,000 people waited over 12 hours on trolleys in emergency departments for a hospital bed in April – 60 times more than in the same month in 2019. People are suffering as a result, and public satisfaction with the NHS is at an all-time low.

Cue familiar debate about the NHS’s longevity. Will the NHS make it to 100? Beyond? And what’s needed to keep it running? Labour says the NHS must ‘reform or die’ – and is calling for more care in the community, a shift in focus to prevention and new technology to ensure the NHS’s survival. Rishi Sunak’s government is squarely focused on tackling long waiting lists for care. But Conservative MPs are calling for reform too, including considering new funding sources for the NHS, like user charges. The next three episodes of the Health Foundation podcast will set out the big questions facing the NHS at 75 and what the future might hold – listen to the first episode here.

Meantime, the social care system is turning 75 too. Except the public won’t celebrate (much) and endless column inches won’t be written about it. In 1948, the NHS was set up as a comprehensive service, free at the point of use, while the National Assistance Act left social care both means-tested and needs-tested – a system with origins in the Poor Laws of 1601. Today, social care in England is on its knees and many people go without the care they need. 1 in 5 care workers live in poverty.

As we head towards the general election, debate about the future of the NHS will grow louder. But rhetoric about ‘reform’ can be a distraction from the real problems facing the health system – including a decade of underinvestment in the NHS and wider public services, chronic staff gaps, neglect of social care, widening inequalities and more. Ideas for reform are too often ‘zombies’ – policy ideas that keep coming back no matter how often they get knocked down by the evidence.

At the Health Foundation, a big part of our role is to inject evidence and analysis into debates about NHS and social care reform. Here’s a flavour of the work we’re doing on health and social care policy in 2023, and examples of upcoming research and analysis.

Health system performance

In February, we published the latest findings from our programme of research with Ipsos into public perceptions of health and care in the UK. Concern about the state of the health system is high – and most people think the standard of care provided by the NHS will get worse over the next 12 months. But support for the founding principles of the NHS – that it’s comprehensive, free at the point of use, and funded through taxation – remains rock solid. Our most recent public polling will be published around the NHS’s birthday. We’ll also be publishing new analysis on changes in the length of time patients stay in hospital and hospital admissions, as well as how the NHS performs compares to health systems in other countries. Our QualityWatch programme with the Nuffield Trust will continue to provide ongoing analysis on the quality of health and social care in England and how it’s changing over time.

NHS reform

Another chunk of work looks at national policy approaches to improving the NHS in England. The latest NHS reforms established 42 integrated care systems (ICSs) – area-based partnerships bringing together the NHS, social care, public health and others – to plan and coordinate services. We’ll look at approaches ICSs are taking to reduce health inequalities and contribute to social and economic development. We’ll also look at how policy on the NHS in England compares to other countries – including starting new research with the OECD analysing links between health system policies and performance internationally. We’ll continue to assess new policy announcements as they arrive (here’s our take on Patricia Hewitt’s recent ICS review) and identify policy priorities ahead of the general election.

Social care

We’ll be working on social care policy too. We’ll soon be publishing the REAL Centre’s latest analysis of the social care funding gap in England – including estimates of the spending needed by government to meet growing demand for care, improve access to services and pay more for care. The analysis takes a long-term perspective, estimating costs under different scenarios to 2032/33. We’ll also be focusing on staff pay. Our recent analysis showed that care workers in the UK are among the lowest paid in society, and experience shocking levels of poverty and deprivation. New analysis with the Nuffield Trust will analyse policy options to improve pay and how they might work in practice.

Primary care

We’ll also look in detail at primary care and how policymakers can best support it. General practice in England is under extreme strain – as our recent international survey showed – and people are finding it harder to book GP appointments. A new programme of research with THIS Institute is looking at what policymakers should do about it – including options for improving access to general practice, and patient and staff views on which of these should be prioritised. Our general practice data tracker will continue to monitor the latest trends on staff and appointments in general practice. And a mix of other work will look at how primary care is changing – including analysis on skill-mix, remote consultations and the impact of policies on GPs in more deprived areas.

Health care supply and demand

Our work will also focus on providing long-term projections of health and social care demand in England, led by the Health Foundation’s REAL Centre. This includes our collection of research on funding and staffing in the NHS and social care – and estimates of how these will need to change in future to keep up with changing population needs. In June, we’ll be publishing a major new report looking at the current burden of illness in England, how this might change from now to 2040 and what this could mean for demand for health services and spending. We’ll also publish analyses on the health and care workforce – including new work on international recruitment. 

Across these areas, our work will continue to offer an independent view on how the health system is performing, and use evidence and analysis to identify priorities for policy. You can read more about our plans in our new strategy for 2023–25


Hugh Alderwick (@hughalderwick) is Director of Policy 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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