NHS at 75: What next?

As the NHS turns 75 this week, politicians will use the moment to underline their loyalty to the service and how they would improve it – before their attention moves onto their manifestos ahead of the general election. Rishi Sunak has already set out the five ‘people’s priorities’ for voters to judge his premiership, including cutting the NHS waiting list. Keir Starmer recently launched Labour’s NHS ’mission’ to tackle the biggest killers and improve healthy life expectancy. But are these what the NHS actually needs? 

The immediate big issues to fix are clear with more than 7 million patients on waiting lists, people rightly frustrated about not being able to see their GP and chronic staff shortages right across the NHS. While the publication of the NHS long term workforce plan and the headline commitment to train more doctors, nurses and other medical staff is a huge step forward, making it work in practice will depend on broader action and investment from future governments, as well as this one. 

Looking a bit further ahead, the challenges on the horizon for the NHS, as for other health systems around the world, are as formidable as they are well rehearsed. An ageing population with greater care needs, a shrinking labour market and a global shortage of health workers, and the ongoing legacy of the pandemic. This against the wider context of ongoing pressure on public finances, exacerbated by low economic growth and productivity. 

Governments are elected on bold defining visions, not promises of multiple technocratic fixes, and rightly dislike shelling out investment without reform to match. Following the failure of various top-down changes to the NHS over the last few decades, the current appetite for further sweeping reforms is close to zero (faith now rests with the power of collaboration in the form of 42 integrated care systems).  

Targeted fixes have had more success. However, even with significant investment in the NHS, it’s difficult to see how the targeted-iterative-fix approach will alone deliver even a fraction of the change needed given the challenges ahead. The focus of reform needs to shift to a completely different lens – directly improving frontline care.  

With this in mind, the parties should prioritise four key themes as they develop their manifestos. 

1. Making the most of scientific and technological developments 

With so many scientific and technological developments already here and more crowding on the horizon, not least within artificial intelligence and genomics, the biggest challenge lies in how the NHS makes the most of these opportunities.  

In the short term, the focus could be on largely non-clinical technologies that lighten the considerable burden of administrative drudge and give staff more time to care. And while public and private investment is flowing for early-stage clinical innovation, it isn’t yet there to skill up NHS staff to test and implement new innovations effectively and fast enough. For the UK’s largest employer, spending over £150bn every year, this is startling. The NHS needs much bigger and bolder demonstrations of the most promising new technologies that have potential to shift care out of hospitals and support care in the community. This needs to be backed by investment in skilling up staff and patients, and increased capital spending on IT and digital infrastructure, crumbling buildings and outdated equipment, after a lost decade during which investment has lagged behind other countries. 

Look out for our final NHS at 75 podcast episode launching later this month, which will explore the promise of new technology and what it means for the NHS and its workforce. 

2. Harnessing how tech can support more active management of health 

Linked to this is the need to take advantage of the public’s increased use of everyday technology. With smart phones and wearable tech now the near-norm, more of the population are using technology that gives them a personalised prediction of health risks. This could prompt large numbers of people to take a more active role to manage their health and future risks of ill health. The demand could be huge, fuelled and met by commercial and other organisations, and the NHS must urgently figure out how to respond.  

3. Understanding and investing in health as an asset 

The third theme is better understanding of health as crucial to the economic prosperity and resilience of the nation. This will help unlock future investment in health. Current trends – which show ill health as a major reason for 2.5 million working age people being economically inactive – should set alarm bells ringing. Rather than simply patching up the NHS, an ambitious, long-term goal is needed that puts improving the nation’s health on a par with delivering economic growth and tackling climate change as the three great challenges of the age. The economic payback, as well as the health benefits, will be significant. As my colleague Jo Bibby says in her latest blog, the NHS was never meant to go it alone. We need to invest in a broader system of support, understanding the impact it will have on health and prosperity.  

4. Stepping up and showing bold political leadership 

It’s a cliché but whoever wins the next general election must demonstrate the political leadership needed to make bolder choices to reform the NHS and social care. Politics is, after all, the art of the possible. Reforms can be delivered if leaders can harness the commitment of staff and the public, whose support for the NHS model remains unwavering (as demonstrated through our latest polling with Ipsos).  

Politicians should start by owning and acknowledging the gravity of the NHS crisis, which has been more than a decade in the making and will need a 10-year plan to address it. This would give demoralised and exhausted staff hope for the future and help switch on the discretionary effort that the service has always depended on. After years of delay, the next government must also finally grasp the nettle by reforming England’s hopelessly inadequate social care system. The sheer numbers of retiring baby boomers over the next 20 years will only make this challenge even more acute. 

Are political leaders up to the task? Time will tell. Have a listen to our latest podcast episode with former health ministers Alan Milburn and Stephen Dorrell on this question and getting the NHS to its 100th anniversary. 

Jennifer Dixon (@JenniferTHF) is Chief Executive of 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.