The NHS needs a comprehensive plan for recovery

Long term solution

Confronting these challenges will need a long term solution made up of four key elements. Firstly, although the visibility of the waiting list draws attention to the acute sector, solutions need to be about more than acute care. In general practice, despite the increases in activity, the number of GPs and practice nurses is not rising (measured by whole time equivalents) even if some progress is being made on the recruitment of other professions into primary care.7 Anecdotal reports of rising demand for mental health services are consistent with the effect of prolonged lockdowns and interruptions in care.8 This is a system-wide challenge and needs a system-wide response.

Secondly, we need long term planning. Some of the key resources—such as operating theatres and medical imaging scanners—don’t get built overnight. Most critically of all, workforce shortages are so deep that they cannot be overcome quickly, and the service desperately needs a workforce plan that provides some relief to staff already exhausted by the past year while also setting out longer term staffing commitments and how they will be met.9

Thirdly, the plans will need funding. The government had set out spending totals for the NHS through this parliament, but these were all agreed before the pandemic and excluded essential budgets such as training, public health, and capital spending. To the pre-existing priorities from the NHS long term plan—many of which remain valid—we must now add dealing with growing backlogs of care, long covid, and an ongoing pandemic. Leaked estimates suggest that between £2bn and £10bn (€2bn-€12bn; $3bn-$14bn) a year will be required to reduce elective waiting lists back to acceptable levels10—the wide range underlines uncertainties over future trends in demand, not least from all the patients who should have been referred in 2020 but were not.

Fourthly, a proper conversation with the public is required. The NHS and the public will not be well served by overly optimistic commitments on recovery that cannot be delivered. This will mean living through a period when patients’ overall expectations are not going to be met and making some tough prioritisation decisions until capacity and productivity recover.

Despite the tragedy of the pandemic, the health and care system enters this new era having learnt some valuable lessons from the response to covid-19. The digital experience has shown the NHS capable of largescale change at pace. The stronger relationships forged with both local government and parts of the voluntary sector also offer the chance to provide a more integrated service that should be better at tackling the longstanding inequalities that often need a system-wide approach.

If it all sounds too daunting, remember this has been done before. After years of decline, the NHS Plan in 2000 kicked off a decade of improving access and consistent and rapid increases in staff numbers—backed of course by a proper workforce plan and improving outcomes. If the government provides the resources, history shows the NHS can deliver.