Intended for healthcare professionals


Primary and social care funding must increase if the NHS is to recover

BMJ 2023; 382 doi: (Published 21 August 2023) Cite this as: BMJ 2023;382:p1916
  1. David Haslam, writer and healthcare policy consultant1,
  2. David Pendleton, professor in leadership2
  1. 1Kaleidoscope Health and Care, London
  2. 2Henley Business School, UK

Redirecting investment towards primary and social care would help recovery across the NHS, especially in secondary care, say David Haslam and David Pendleton

The NHS needs better funding.

Almost every analysis of the current crisis indicates that the UK’s healthcare funding—relative to our peers in other high income nations—has resulted in fewer healthcare professionals per head of population, poor quality infrastructure, and scarcity of essential equipment, particularly magnetic resonance imaging scanners.123 Even the current chancellor of the exchequer Jeremy Hunt, while chair of the Health Select Committee, wrote “surely we need to find a longer term, more strategic approach to funding our health and social care system.”4 It is critical that investment isn’t directed only at the short term crisis, however politically attractive this might be.

Would an injection of funds ensure sustainability for the UK healthcare system—or merely provide temporary respite before another inevitable crisis? Short term planning bedevils many political challenges including climate change, social care, and the long term health of the NHS. We need change and the more radical the change the bigger the difference. The change needed is not an across-the-board uplift in funding to unsustainable levels but a rebalancing of investment across the entire healthcare system.

Between 2010 and 2019 around £40bn was withheld from NHS investment in the pursuit of austerity.5 Reinvesting this missing funding in secondary care could begin to tackle the shameful state of NHS waiting lists and bring the deteriorating infrastructure up to scratch. While it would be popular, and even if such a massive sum could be found, it would not, however, solve the longer term challenges by itself.

Instead, we must advocate for rebalancing the system. To do this, a disproportionate amount of investment in primary care and social care is essential. The hospital sector is always the most politically visible part of healthcare, but hospitals depend on effective primary and social care—and in particular an appropriately skilled and adequate workforce—to keep them functioning at maximum efficiency.6

Primary care provides early detection and treatment, support, education, preventive actions, and helps to avoid potential overmedicalisation, all of which can relieve the need for much of the work that is currently carried out in hospitals, provided additional work is appropriately supported. Evidence shows that a strong foundation of primary care yields better health outcomes overall, greater equity in healthcare access and outcomes, and lower per capita health costs.7

High quality social care in the community supports those with longer term needs and ensures that patients can be appropriately discharged without delay from hospitals—an equally important aspect of any rebalancing of the system. Improved access to publicly funded social care through investment and additional reform would help prevent more frail older people from deteriorating and help them maintain their independence.8

A rebalanced system has the potential to be sustainable but needs significant investment and bold leadership. Increased immediate funding to help the acute problems will buy some breathing room, including better pay deals from the government to improve recruitment and retention and provide safe staffing levels. But we must fix the broader problem of staff retention lest we find that the ambitious recruitment built into the workforce plan is merely pouring additional resources into a leaky receptacle. Improving working conditions and tackling the considerable time that clinicians spend on non-clinical processes and paperwork must be part of the change. New technology can liberate significant time for more direct patient care from those already employed in the NHS. These recommendations can make a difference in the short term before the planned expansion of training places can produce more clinicians in the long term.9

It is important to be realistic about ongoing funding. No politician will authorise a blank cheque on an ongoing basis. This temporary, short term, but costly reset will enable the revival of prevention, the delivery of enabling technology, and the recovery of the primary and social care sector. It would allow an opportunity to tackle overtreatment, overmedicalisation, reinvigorate continuity of care, and clarify what we expect the NHS to provide.


  • Conflicts of interest: None.