In a new briefing looking ahead to the Comprehensive Spending Review that the Chancellor is due to deliver on October 27, The King’s Fund sets out the challenges faced by the NHS and considers the steps the government could take to address them. The briefing comes as the latest figures from NHS England show another new record of 5.7 million on NHS waiting lists at the end of August 2021.
Key messages:
• Waiting lists and waiting times were rising before COVID-19, but the pandemic has accelerated their growth. Reducing the size of the elective backlog is now one of the most pressing challenges facing the NHS. Large backlogs of demand and unmet need are also being experienced in social care, public health, mental and primary care. While recent funding announcements have been directed at addressing the elective backlog in the NHS, it is a problem across the whole health and care system.
• The new NHS funding comes with specific targets to increase activity to reduce the backlog. This is a sensible approach but The King’s Fund points to a significant inequalities issue, as its analysis shows that those living in the most-deprived areas are nearly twice as likely to wait more than one year for treatment compared to those living in the least-deprived areas. To help reduce inequalities, government should work with the NHS to implement the activity target in a way that allows appropriate local flexibility to address health inequalities.
• The health and care workforce has faced great pressure as a result of COVID-19, but there was a workforce crisis across the NHS, social care and public health before the pandemic. Allocating specific funding to a multi-year workforce strategy to invest in training, development and wellbeing should be a priority for the Comprehensive Spending Review. Without it there is a risk of increased attrition rates, more endemic burnout and stalling recruitment rates, which could undermine efforts to reduce the current backlog and deliver the government’s manifesto commitments.
• Years of constrained capital investment have led to a growing backlog of safety issues with NHS buildings and equipment. Even now, NHS leaders do not know how much capital investment they can expect in the coming years, which hampers their ability to plan improvements to NHS buildings and facilities to improve productivity and patient care. The government has yet to deliver on its promise to set out a more coherent and sustainable multi-year capital investment plan.
• The public health system has been overlooked in recent spending announcements. According to The King’s Fund, several years of cuts mean that the public health grant is now £1 billion less in real terms per capita compared to 2015/16. Over the past decade life-expectancy improvements began to slow - and in fact went into reverse in 2020, as a result of the COVID-19 pandemic - and health inequalities have widened. Urgent action is needed to support public health services and help ensure an equitable recovery from the pandemic.
• After years of inaction, the government has taken some positive first steps on social care reform. However, the sector is far from being ‘fixed’, and to help manage current pressures, improve access to care and support the social care workforce the Comprehensive Spending Review will need to increase core social care funding significantly before reforms start to be introduced in later years.
