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Rt Hon Rishi Sunak MP 
Prime Minister
10 Downing Street
London SW1A 2AA

Rt Hon Sir Keir Starmer MP
Leader of His Majesty’s Official Opposition
House of Commons
London SW1A 0AA

Rt Hon Sir Edward Davey MP
Leader of the Liberal Democrats
House of Commons
London S1A 0AA

5 July 2023 

Dear Mr Sunak, Sir Keir and Sir Ed,

75 years after its creation, the National Health Service is in critical condition. Pressures on services are extreme and public satisfaction is at its lowest since it first began to be tracked 40 years ago. Despite this, public support for the NHS as an institution is rock solid – it still tops surveys about what makes people most proud to be British, and the public are unwavering in their support for its founding principles: free at the point of use, comprehensive and available to all.

As leaders of three leading independent health and care research institutes, we urge you to make the next election a decisive break point by ending years of short-termism in NHS policy-making. Recovering NHS services and reducing waiting times for treatment should be a key priority for any government. However, our work shows that promising unachievable, unrealistically fast improvements without a long-term plan to address the underlying causes of the current crisis is a strategy doomed to failure. The path back to a stronger health service is through long-term policies that support innovation, boost productivity and provide the resources, capacity and technology it needs over multiple years.

The NHS has endured a decade of under-investment compared to the historic average, and capital spending has been well below comparable countries. As a result, the health service has insufficient resources to do its job: fewer hospital beds than almost all similar countries, outdated equipment, dilapidated buildings and failing IT. Despite long-term objectives to reduce reliance on acute hospitals and move care closer to people’s homes, spending continues to flow in the opposite direction. Long-term thinking is essential to meet the challenges ahead – from responding to changing health needs to harnessing AI and new technology.

Last week’s publication of the NHS long term workforce plan signals a welcome cross-party consensus on the need for a long-term approach to health service staffing. The plan now needs a sustained cross-party commitment to updating forecasts and providing the resources it needs to succeed. However, ambitious steps to increase the number of staff through training, apprenticeships and international recruitment risk being frittered away if trainees continue to drop out and poor morale and sickness continue to drive staff to leave the service and retire early. A failure to act to retain existing staff would be fatal to the NHS and the health of the nation – again, this needs sustained action over the long-term to make the NHS a better place to work.

Serious reform of adult social care has been shamefully neglected by successive governments. Changing this is critical for the people, families and carers who rely on social care services and would also make a major contribution to reducing pressures on the NHS. A long funding squeeze has led to chronic staff shortages, high levels of unmet need and providers struggling to deliver high quality care. To overcome these challenges, new funding should be carefully deployed as part of a reform package that improves access to high quality care, prioritises better pay and conditions for staff, and gives people far greater protection against social care costs. The next government must succeed where its predecessors have failed by forging a long-term consensus on social care reform.

Long-term political action is also needed to address the fraying health of the UK population. The NHS was not set up to go it alone. Protecting and improving people’s health depends on a wider system of services and support that includes local government and social security. Yet people are falling between the cracks of public services and the NHS is often left to pick up the pieces.

Life expectancy has stalled and compares poorly with other countries. A recent study showed that the UK had the second lowest life expectancy among 19 countries analysed, with only the United States faring worse. Inequalities in health are deep and growing – people in the most deprived areas of England can expect to spend almost two decades less living in good health than those in the wealthiest areas. The challenging economic climate and the NHS crisis are interlinked – a healthy economy needs a healthy population, yet ONS figures show that the number of people absent from the workforce due to long-term sickness has continued to climb since the pandemic.

Our health should be treated as an asset to be invested in. The next Prime Minister should commit to a multi-year, cross-government strategy over the course of the next parliament to improve the underlying social and economic conditions that shape the health of the nation – like people’s income, education, jobs, housing and food.

For the public, the NHS remains the jewel in the country’s crown, even if it is losing its shine. The next government will face a choice between providing the investment and reform needed to preserve the NHS for future generations or continuing with short-termism and managed decline that gradually erodes the guarantee of safety in place of fear it was designed to create. Persisting with the current addiction to short-termism and eye-catching initiatives will risk the health service being unable to adapt to the huge challenges ahead and reach its centenary. It is time to move away from quick fixes and over-promising what the NHS can deliver and give it the tools it needs to succeed.

Yours sincerely,

Richard Murray
Chief Executive
The King’s Fund

Nigel Edwards
Chief Executive
The Nuffield Trust   

Dr Jennifer Dixon
Chief Executive
The Health Foundation

Media contact

For further information or to arrange an interview, please contact Gemma Umali, Senior Press and Public Affairs Manager: g.umali@kingsfund.org.uk or 07584 146035. Our joint press release is available on The King's Fund website. 

About the three organisations

  • The King’s Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all.
  • The Nuffield Trust is an independent health think tank. It aims to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
  • The Health Foundation is an independent charitable organisation working to build a healthier UK. More about us.

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