Intended for healthcare professionals


New government’s plan for health and social care in England

BMJ 2022; 378 doi: (Published 28 September 2022) Cite this as: BMJ 2022;378:o2332
  1. Hugh Alderwick, director of policy
  1. Health Foundation, London, UK
  1. Hugh.Alderwick{at}

Thin gruel for a health system that needs much more from its politicians

The new government has set out its plans for the NHS and social care in England—a “plan for patients.”1 The experience for too many patients in the NHS right now is grim. In August 2022, around 28 000 people waited more than 12 hours on trolleys in emergency departments for a hospital bed—over three times more than in the whole of 2019.2 The plan was billed as a “major intervention” to improve services.3 But the reality contained limited new measures and will do little for patients.

The plan introduces an “expectation” that people will be able to get an appointment with their general practice within two weeks, and that patients with urgent needs will be seen on the same day. Public satisfaction with general practice is falling,4 and more people are struggling to make appointments.5 But most patients (85% in July 2022) already get an appointment within two weeks of booking—almost half (44%) on the same day.6 People value speed of access but also convenience of appointments and continuity with their GP, and make different trade-offs between them.7 A new target risks unintended consequences8—not least adding more pressure on overstretched GPs. And it does nothing to address the reality that there aren’t enough GPs. Shortages of fully qualified GPs in England are estimated at 4200 and could grow to around one in four of projected GP posts by 2030-31.9

Support for social care was limited. The sector will have £500m available to support discharge of patients from hospital over winter, “to free up beds for patients who need them.” The money should help in the short term—and a similar scheme ran earlier in the pandemic.10 But social care is about far more than reducing pressure on hospitals. People need support to live independently, participate in the community, and go about their lives. Yet decades of political neglect mean the system is a threadbare safety net. Unmet need is high, staff pay is poor, and unpaid carers plug the gaps.11

The plan commits government to implementing recent reforms to cap individuals’ care costs over their lifetime. But these changes provide limited protection for people with lower wealth12 and do nothing to fix the ongoing crisis engulfing the system. Current policy means this crisis will continue.

Missing items

Chronic staff shortages are an existential threat to the future of the health system. Staff gaps are currently estimated at 132 000 in NHS trusts and 165 000 in social care.1314 The plan includes some pragmatic measures to boost staff numbers in the short term, such as revising the NHS pension scheme and pledging more international recruitment. But—incredibly—government still has no long term plan for recruiting and retaining the workforce needed to deliver services in the future. The plan states government “will design and deliver our long term workforce plan.” But how long will it take? The same promise has been made and broken for several years. Meantime, services are suffering and the public is noticing: staff shortages are one of the main reasons for public dissatisfaction with the NHS,15 and boosting staff numbers is among the public’s top priorities for the health system.16

Action on improving health and reducing health inequalities is lacking. The plan says government will “focus relentlessly on ABCD”: ambulances, backlogs, care, and doctors and dentists. But this ignores the broader task of improving the nation’s health, not just its health services. Gains in life expectancy are stalling and gaps in health between richer and poorer areas widening.1718 Tackling these issues depends on coordinated policy measures to improve social and economic conditions shaping health.19 It also means providing sufficient funding for local government, which has a central role in improving health but has seen its budget cut substantially over the past decade, with funding falling furthest in more deprived areas.2021 Yet the future of the “health disparities” white paper—planned under Johnson’s government—is uncertain, and anti-obesity policies risk being scrapped.22

And where’s the money? The chancellor has just announced the biggest package of tax cuts for 50 years—including scrapping the health and care levy, introduced to help fund the NHS and social care—and provided no extra funding for public services. Even before rising inflation, government’s spending plans fell short of the amount needed to recover NHS services and meet demand for social care.23 Since then, higher prices and pay increases have eaten up a share of planned spending.2425 The result is that health services are being asked to do more with less, which will limit what the NHS can offer patients. There is also a risk that the new tax cuts, which disproportionally benefit the richest in society, may be followed by future public spending cuts to help pay for them.26

The new government is in danger of losing touch with reality. The health system is under extreme strain, and investment is needed to recover services. The public strongly supports the NHS and backs extra spending.16 Yet—so far—government has prioritised tax cuts for the wealthy instead.