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Tuesday 18 June 2024

When the talking’s done, who will deliver what the NHS needs?

By Rhys McKenzie & Craig Ryan

ELECTION 2024: We look at what the experts say about six key challenges facing the NHS: waiting lists, workforce, social care, reform, buildings and technology. Do Labour or the Conservatives have the policies to meet them?

Paint splash election graphic in party colours


What the experts say

The Nuffield Trust says politicians promising to bring down waiting lists need to set out clearly how they will achieve it. Trying to make staff work “harder, smarter and more efficiently” is “hugely complex” and will take time especially when staff are “burnt out, unwell and, increasingly, leaving”.

The King’s Fund says improving access to out-of-hospital care is crucial to bringing down waiting lists in the long term. This requires a “radical focusing towards primary and community settings”, targeting future investment on community services and “meaningful reform of social care”. The Nuffield Trust adds that existing party proposals in this area are too “small scale” after “years of funding flowing away from community services”.

What the parties offer

The Conservatives have promised to “free up” to 20 million GP appointments by expanding the Pharmacy First scheme, which allows patients to access more treatments from pharmacies without seeing a GP. The party has also pledged to “build or modernise” 250 GP surgeries and set up 50 new community diagnostic centres. These proposals would cost £1.2 billion a year, the Tories say, and will be funded by cutting a further 5,500 NHS management jobs.

Labour have pledged to deliver an additional 40,000 hospital and clinic appointments a week, by asking staff to work overtime on evenings and weekends and using spare capacity in the private sector. The party also promises to double the number of MRI and CT scanners and to meet the target of 92% of patients starting treatment within 18 weeks within five years. Labour says these policies will cost £1.3 billion in the first year, to be funded by abolishing non-dom tax status. RM


What the experts say

The neglect of social care has been “a terrible failing of British public policy”, says the Nuffield Trust. “Both government and opposition… fear that taking action will bring more blame than credit because of low awareness among voters, and tight finances.” The think tank has called for a “credible funding system” through general taxation to “spread the risk of high costs across the whole population”, as well as a workforce plan for care staff and measures to stabilise the care market — including “fair” fees for private providers.

The King’s Fund says over half of older people are not receiving the care they need. It has called for big increases in social care funding to stabilise the sector, recruit and retain more staff and meet growing demand. With one in six services falling below CQC standards, it also wants reforms to regulation to drive improvement in service delivery.

What the parties offer

Not much if you want detail. The Conservatives’ 2019 pledge to “fix” social care has unravelled, with the social care levy scrapped in 2022 and plans to cap social care costs kicked into the long grass. But the government has increased funding for adult social care by £7.5 billion over the last three years and the Conservatives now promise to improve service delivery by digitising care records and to invest in technology to support independent living.

Labour offers a ten-year plan to “build towards” a comprehensive National Care Service, “locally delivered but underpinned by high national standards”, with the emphasis on supporting people at home and giving them more control over their care. The party’s also promises a workforce plan for social care with better working conditions and a fair pay agreement negotiated across the sector — including with private providers. Details remain sketchy and and, like many of Labour’s promises, funding will depend on economic growth over the next parliament. CR


What the experts say

Experts agree that tackling staff shortages in the NHS must be a top priority and that much more work needs to be done to make the NHS Workforce Plan a reality. The Nuffield Trust has made this its number one priority for the next government, alongside the King’s Fund, which says making careers in the NHS and social care more attractive will help to “fix” services.

NHS Providers and the NHS Confederation have both pressed the parties to commit to ‘fully fund’ the Workforce Plan, and called for an equivalent plan for social care to tackle the workforce crisis there.

What the parties offer

At the time of writing (18 June) neither main party has made any pledges likely to have a significant impact on NHS workforce shortages. Labour have promised 7,500 more medical training places and 10,000 more nursing and midwifery clinical placements each year. They have also pledged to train 700 more district nurses and 5,000 more health visitors to support care in the community, and to recruit 8,500 more mental health professionals. These pledges are over and above the plans set out in the Government’s Workforce Plan.

So far, the Conservatives are sticking to the NHS Long Term Workforce Plan as published last summer. This aims to recruit 60,000 more doctors, 170,000 more nurses and 71,000 more allied health professionals by 2036-37. This will be achieved by increasing medical school places and expanding apprenticeships, the government says. RM


What the experts say

Experts are united in saying there should be no further top-down restructuring of the NHS during the next parliament. Avoiding this is the top priority for NHS managers, according to the NHS Confed, while Nuffield Trust chief Thea Stein has told managers to pin any such pledges from politicians to their noticeboards.

Experts also warn against further cuts to the management workforce. The Health Foundation says research shows that managers have a positive impact on efficiency, financial outcomes and quality of care. The King’s Fund warns that the NHS “already has a lower ratio of managers compared to other industries” and that managers are needed to ensure clinicians can focus on delivering care, rather than filling the gap left by under-management.

What the parties offer

So far, neither Labour nor the Conservatives have unveiled plans for any major re-organisation, and both look set to work within the existing NHS structures.

However, the Conservatives have announced plans to cut 5,500 managerial posts in NHS organisations ‘not providing frontline patient care’ in order to fund an expansion in community services. This could see a further downsizing of ICBs and arms-length-bodies like NHS England. RM


What the experts say

Experts worry that the record £12 billion maintenance backlog for the NHS estate in England is increasingly skewed towards “high risk” and “significant risk” projects, which now make up more than half the total. Even if the entire NHS capital budget were spent on the estate this year, it would barely cover the backlog, leaving nothing for new problems or investment in technology and equipment.

Nuffield Trust chief executive Thea Stein advises treating extravagant promises about new buildings and tech with caution. Instead, politicians should promise to “invest sustainably, predictably, relentlessly and for the long term in capital”, she says. The Nuffield Trust has called for a “once-in-a-generation capital settlement”, including investment in “modernising crumbling buildings” as well as in technology and replacing outdated equipment.

What the parties offer

Neither party has set out specific plans to tackle the maintenance backlog. The Conservatives have insisted they will honour their 2019 pledge to build “40 new hospitals” by 2030, although many projects under the New Hospitals Programme are beset by delays and some are little more than refurbishments of existing buildings. The government has increased NHS capital spending significantly but has targeted investment on new technology and modernising medical equipment.

Labour says “we can’t go on with a crumbling NHS estate”, promising new investment but without any specific spending pledges. The party’s manifesto says Labour will “deliver” the New Hospitals Programme and carry out a comprehensive review of NHS capital spending, with priority given to projects that will cut waiting lists. Labour will also encourage ICBs to co-locate services and establish a new network of Neighbourhood Health Centres to bring together local health and care services under one roof. CR


What the experts say

The Nuffield Trust says what technology we invest in, how it’s deployed and how the NHS uses the time saved are just as important as how much money we spend on it. Experts suggest the investment need lies more with day-to-day tech — the clapped out computers and wonky software in GP surgeries and hospital wards – than with high-end stuff like AI systems, for which research money and private capital can more easily be mobilised.

Investment also needs to be sustained, targeted and not overly focused on shiny new kit, says the King’s Fund. “It’s not just the widgets that enable transformation but also staff time and skills, and having the right culture and capacity to change processes,” says the Fund’s digital technology expert Pritesh Mistry. It’s also important, he adds, that money for tech is not raided to plug gaps in current spending as has often happened in the past.

What the parties say

There’s little difference between the two main parties on this issue. The Conservatives point to the £3.4 billion of new investment already announced in the March budget, which the chancellor said would modernise all the outdated NHS IT systems “so they’re as good as the best in the world”, as well as paying for digitising operating theatres, upgrading MRI scanners, extending the use of AI systems and developing a new apps for patients and NHS staff. The party also promises to accelerate the roll-out of 160 Community Diagnostic Centres, due to be completed next year.

Labour promises to double the number CT and MRI scanners within five years, develop the NHS app “to end the 8am scramble for GP appointments”, and develop a new streamlined NHS procurement process to encourage the adoption and spread of new technologies. Shadow health secretary Wes Streeting is also promising a new network of “Neighbourhood Health Centres” integrating health and care services and equipped with modern technology including digital health records and tele-health services. CR

  • Craig Ryan is editor of Healthcare Manager and Rhys McKenzie is MiP’s communications officer.

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