Intended for healthcare professionals

Editorials

Health policy priorities for the next prime minister

BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1726 (Published 13 July 2022) Cite this as: BMJ 2022;378:o1726
  1. Hugh Alderwick, director of policy
  1. Health Foundation
  1. Hugh.Alderwick{at}health.org.uk

Avoid zombie policies and invest in growing the workforce and reducing inequalities

The UK will soon have a new prime minister. Boris Johnson stepped down as Conservative party leader on 7 July 2022, after a week of mass government resignations removed his already diminished political authority. Johnson intends to stay on as prime minister until a new leader is elected by September. Eleven MPs put themselves forward for the job, but their number is dwindling.

Meanwhile, England also has a new secretary of state for health and social care. Sajid Javid, who became health secretary just over a year ago, resigned on 5 July 2022—the NHS’s 74th birthday—and briefly joined the race to be the new Conservative party leader. Steve Barclay—previously chief of staff at Downing Street—has replaced him in Johnson’s caretaker government. Barclay has a reputation as a hawk on health spending1 and a sceptic of NHS bureaucracy.2

The context for whoever emerges as the next prime minister is grim. Pressures on health services are extreme, with the waiting list for routine hospital treatment at 6.5 million and counting.3 Public satisfaction with the NHS fell 17 percentage points between 2020 and 2021, falling to its lowest level since the 1990s.4 Covid-19 hospital admissions are back on the rise.5 And government risks colliding with NHS workers later this summer over pay.6

The health system is also in flux. The English NHS is being reorganised under the Health and Social Care Act 2022—the biggest legislative overhaul of the NHS in a decade. Right wing commentators are attacking the system and calling for more fundamental (though typically unspecified) “reform.”789 Zombie policy ideas—like switching the NHS funding model—continue to rear their heads.101112 Yet top down NHS reorganisations deliver little benefit,13 and international evidence points to no perfect model.14 The new prime minister must avoid tinkering with NHS structures and focus on the real problems facing health services instead.

Workforce shortages are top of the list. Staff gaps stand at around 110 000 in NHS trusts and 100 000 in adult social care.15 Shortages of fully qualified general practitioners are estimated at 4200 and without change in policy could grow to 10 700 by 2030-31—over 1 in 4 of projected GP posts.16 Staff gaps affect quality of care,1718 and tackling them is a top priority for the public.19 National NHS bodies have been asked by government to produce a plan for how to recruit and retain the workforce needed in the future. But this will do little good without the long term investment needed to make it happen.20 Failure to fairly reward staff—for example, if government sticks with its plan for 3% NHS pay increases21—might make shortages worse.

Tackling unmet need is another priority. The record high hospital waiting list in England could grow to somewhere between 7 and 11 million by 2023.22 Progress has been made on reducing numbers of people waiting over two years for treatment, but around 320 000 people have waited more than a year.3 Some patients also face challenges accessing primary care and community services.18 Growing staff numbers would improve access. But wider policy changes are also needed, such as investing in improving NHS infrastructure2324 and testing service changes that could boost productivity.

A new prime minister must do better than the last one on adult social care. Johnson’s government introduced reforms to cap individuals’ care costs over their lifetime, but last minute changes made the policy less fair and generous for people with lower levels of wealth.25 Meanwhile, the social care system is on its knees. Many people go without the care they need, terms and conditions for staff are poor, and reliance on unpaid carers is high.26 Covid-19 made things worse.2728 A mix of reform and investment is needed to improve and expand the broken system. Yet government spending is barely enough to meet growing demand for care.15

Reducing health inequalities should be an overarching priority. Unfair differences in health between more and less deprived areas are vast and growing.2930 Covid-19 deaths have been higher among ethnic minority groups.31 Johnson’s government produced grand political rhetoric on “levelling up” but failed to match it with the policy changes or investment needed to tackle structural social and economic drivers of health inequalities.3233 Cross government action is needed—for example, to improve living conditions and strengthen social security. Progress in each of these areas would also help the UK respond to future waves of covid-19.

But will it happen? A dominant feature of the Conservative leadership campaign so far has been competing pledges to cut taxes.34 Sajid Javid, for example, promised to reverse national insurance increases—introduced while he was health secretary to boost NHS and social care spending—while cutting income tax and scrapping planned increases in corporation tax. Yet improving health services over the next decade—for example, to expand the NHS workforce or strengthen public health—will require additional public spending. UK tax levels are not high by international standards.3536 Conservative leadership hopefuls should be honest about the consequences of future tax cuts and what they mean for public services.

Footnotes

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: none.

References