The King’s Fund; April 2023
The story of decline
• Multi-year funding increases above the long-term average and a series of reforms resulted in major improvements in NHS performance between 2000 and 2010.
• Performance has declined since 2010 as a result of much lower funding increases, limited funds for capital investment, and neglect of workforce planning.
• Although NHS performance held up well on most indicators in the early years of the 2010s, deficits in NHS trusts became widespread by 2014 and the NHS failed to hit key waiting time targets in 2014 and the following years.
• Performance continued to decline for the rest of the decade, with the NHS and social care both showing signs of growing stress across all services, including mental health, learning disability services, primary care and community services.
• Constraints on social care spending resulted in fewer people receiving publicly funded social care and a repeated cycle of governments promising to reform social care but failing to do so.
• Long-term improvements in population health either stalled or went into reverse after 2010, and successive governments were reluctant to use their regulatory and fiscal powers to tackle the wider determinants of health.
• Cuts in the public health grant to local authorities hindered work to improve population health.
• Increases in NHS activity and funding since 2000 have been much greater in hospitals than other services and this has hindered ambitions to deliver more care in people’s homes or closer to home.
• The coalition government (2010–15) and successive Conservative governments since then have failed to heed the warning signs of deteriorating performance and preferred to use short-term fixes rather than seek long-term solutions.
Where next?
• The improvements that occurred between 2000 and 2010 demonstrate that the NHS is capable of reform if the political will exists and if governments take a long-term perspective.
• NHS revenue funding should increase in line with the long-term average. There should be realistic targets for efficiency savings, and spending on capital, education and training, and public health should be given priority.
• Gaps in social care funding must be filled and there must be fundamental changes to social care funding and provision.
• Priority must be given to investing in primary care and community services in order to anticipate people’s needs, promote independence and offer alternatives to hospitals.
• There must be a credible and fully funded workforce plan for the NHS and, ideally, social care.
• There should be a sustained commitment to prevention and early intervention, both in the NHS and in other public services, to tackle the wider determinants of health and reduce inequalities.
• The public must be fully engaged in improving health and care, and patients and the public seen as active agents in their care, with responsibilities as well as rights.
Click here to access the Rise_and_Decline_of_the_NHS_April_2023.pdf
SWF Health & Social Care Group 