On Tuesday, the Queen’s speech will offer a preview of the government’s plans for the health service’s recovery from the pandemic. An NHS bill is expected to give back to the secretary of state powers to direct the service in England that were delegated under previous reforms. Clinical commissioning groups will be merged into a smaller number of new bodies to be known as integrated care systems, with a new responsibility to work with councils on social care. NHS England’s boss, Sir Simon Stevens, is stepping down.
Exactly what these changes will mean on the ground remains to be seen. But they will not heal the wounds inflicted by the pandemic on an already under-resourced service. The Johnson government’s record on public service reform is short and unimpressive. The two Conservative prime ministers before him did far too little to address the long-term health challenges facing the country, notably the increasing demands of an ageing population and the toll of chronic and mental illnesses. The failure to legislate for a new funding model for social care must be counted, along with the lack of affordable housing, among the biggest social policy failures of the past 10 years.
The pandemic exposed existing gaps and problems brutally, and created a raft of new ones. The reasons for the UK’s extremely high Covid death toll require further study. But an important report issued last week by the LSE-Lancet Commission on the Future of the NHS pointed to underfunding, particularly of social care and public health, as growing problems. It highlighted low health and care spending in the UK compared with many other countries (Germany, France, the US and Japan) and recommended that it should increase by more than £100bn annually by 2030-31 (from £185bn to £288bn).
The danger is that unless the government addresses structural weaknesses, including chronic workforce shortages, the gaps in provision will grow wider and deeper. The refusal to conduct detailed workforce planning along with modelling of demand, and to treat training and recruitment of staff as a national strategic priority, is a dereliction of duty. With waiting list numbers rising rapidly as demand that was suppressed during the pandemic returns, the outlook is grim to say the least. The Health Foundation thinktank has predicted that the number of people waiting for operations or other hospital treatment could reach 10 million by 2024.
As ever, those who wish to preserve the NHS and the egalitarian ethos it represents in perpetuity are concerned by the threat of privatisation. And with good reason: the recent sale of 58 GP practices covering half a million patients to the US health insurance group Centene is one example of how profit-seeking corporations are advancing with minimal accountability. The privileged access to government offered to businesspeople including Lex Greensill during the pandemic, and the scandalous failures of PPE procurement, have heightened concerns about the government’s commitment to transparency. How to halt such deals, or at least limit them, is among the most urgent questions for the government’s critics, including Labour.
But the biggest threat, according to the former NHS England boss Sir David Nicholson, is that the service will find itself unable to meet demand, including for urgent cancer and heart surgery. If the Treasury can be persuaded to boost budgets, perhaps some alteration of commissioning structures could be managed alongside the clinical catching up that is so desperately needed. It is hard to see how ordering a reorganisation, while ignoring calls for increased funding and a plan for social care, could be anything other than a reckless distraction.