UCL Policy Lab


The new government's priorities for the NHS

5 July 2024

From waiting lists to the need for reform to social care, Prof. Naomi Fulop, Professor of Health Care Organisation and Management at UCL, discusses what challenges the new Secretary of State for Health and Social Care will face.

Keir Starmer and Wes Streeting greet health professionals in a hospital

We all know that the incoming Secretary of State for Health and Social Care will have a huge to do list. Waiting times are at their highest since 2010; the 62-day waiting time cancer target has not been met since 2015; ditto the 90% target for maximum 4 hour wait in A&E; life expectancy is stalling and health inequalities are widening; public satisfaction with the NHS is at a 40 year low. What should the priorities be?

First, change the narrative: the NHS isn’t a ‘drain’ on resources. There’s a clear case to be made that spending on the NHS is an investment. Labour will need economic growth to deliver on its agenda; Keir Starmer has made growth his central mission. And we know that economic growth requires a healthy population in the short and long term. More than a fifth of working age adults are economically inactive; a third of these due to long-term sickness. The NHS can contribute to helping people back into the workforce and to growing our economy. Make that case to the Treasury and include return on investment in decision-making.

Improved population health and addressing inequalities can be supported through Government action which doesn’t have to cost. Tighter regulation of the food, alcohol, tobacco and gambling industries protects the NHS in the longer term and, perhaps surprisingly, has public support. Improving both population health and the resilience of our health and care systems will help make us more prepared for and resilient to future shocks such as the inevitable pandemic. Labour has shown a willingness to engage in prevention. They supported the ban on new smokers, with a desire to go further on other public health measures.

Ambitions to address waiting lists (and waiting times) are good but there’s a need to address the whole system of care to ensure ‘flow’ through services. Long waits in A&E are the result of hospitals being unable to discharge the estimated 13,000 patients (equivalent to 26 hospitals) who need social care support. Investing in social care, primary and community health services has to be high up the agenda as well as wider reform of these out-of-hospital services. Proposals for a National Care Service need to be fleshed out and funded.

Chronic underinvestment over many years, staff shortages, growing demand, the pandemic, and waves of industrial action mean staff morale is on the floor. The new Secretary of State needs to take staff with them, not take them on in a fight. As a first start, industrial disputes need to be brought to an end as soon as possible. But more than that, the culture of ‘being done to’ rather than co-producing the changes that are required needs to change. This needs to come from the top. Which isn’t to deny the serious failings and even worse, the institutional cover-ups, that have been exposed by the infected blood inquiry and more recent unacceptable care failings in maternity services. Senior leaders need to support and listen to staff alongside changing the culture of organizational silence in which too many have participated. Patients, service users and families need to be at the heart of a cultural overhaul. For too long, they have been ignored (and worse) and the NHS cannot improve without listening to them.

We saw at the Britain Renewed Conference (hosted at UCL) examples of how services shaped by patients and communities can help drive both quality and efficiency. The new Secretary of State should see their role as both leader and convener – learning from others as much as being a teacher or manager.

Staff shortages in the NHS and social care need to be addressed in both the short and long term. Implementation of the long-term workforce plan published last year is a key element. But it also entails a grown-up conversation about the contribution of the one in five of NHS and social care staff who are of a non-British nationality. Let’s celebrate the huge contribution they make to our health and care system as part of a wider endeavour to change the toxic narrative on immigration. Until the long-term workforce plan comes to fruition, we’ll need to continue to welcome health and social care staff from overseas.

In times of crisis in the NHS there is a tendency for governments to reach for ‘easy’ levers – especially structural change. The Lansley reforms of 2012 are widely recognized as a disaster. But please leave things as they are – structural reform won’t fix things and would be a distraction. Instead, make the best of the structures we have and focus on the knotty problems of delivery. Similarly, there is a tendency to rely on ‘magic bullets’ to improve efficiency and manage costs - digital and AI being the most recent examples. They can play their part, but start at the ‘simpler’ end of using digital to improve working conditions for staff, patient experience, as well as productivity, such as electronic patient records and electronic reminders. Similarly, addressing the deteriorating NHS estate wholesale isn’t possible overnight, but we can and must get started on it to improve staff morale as well as aid productivity.

It’s been said that the new Secretary of State for Health and Social Care will need ‘balls of steel’ to tackle these challenges. But they must be tackled and quickly. Patients and the public need to see and feel improvements within a short timeframe. This is a necessary part of the new government’s wider mission to increase public trust in politics and politicians.

As we’ve seen in UCL and More in Common polling, the NHS and social care remain a central concern for voters – they want change, but they also want a new government to respect the voices of patients and communities. The new government will face huge challenges but they also have an opportunity for a radical partnership to provide an ordinary hope that can deliver a healthier and happier nation. That’s a mission we could all be partners in.

Naomi Fulop is Professor of Health Care Organisation and Management at UCL