Challenge and change: what does 2024 hold for the health and care system?

As I take up my role as Chief Executive of The King’s Fund, I’m looking ahead to what will be a year of challenge and change for health and care.

I’m arriving from a patient-facing respiratory charity, and I know acutely the struggles millions of people are facing to access timely care, alongside the challenges of a depleted and exhausted health and care workforce. The human impact of the pressures the health and care system is real: limited preventive health care, late diagnosis, patchy management of long-term conditions and, of course, long waits for emergency and elective care. Deep societal inequalities exacerbated by a cost-of-living crisis are playing out in health. At my previous charity, the number of helpline calls about damp, mouldy housing, and the affordability of food, heating and medicines at times rivalled queries about clinical care. At the same time, many in the health and care workforce are grappling with outdated administration systems and crumbling estate.

There’s no escaping the severe pressures the health and care system is facing and consequent waning levels of public satisfaction.

Yet there is cause for optimism too, and with an imminent election, key debates about how we keep our population healthy, how health and care services can best meet people’s needs and how to develop a sustainable social care system will need to be addressed. My hope is that the election will be a catalyst for tackling issues that have been kicked into the long grass for too long. We can’t wait much longer.

2024 in focus

As 2024 gets under way, immediate winter pressures loom large. Stephen Powis, National Medical Director at NHS England, has warned that the NHS is facing one of its most difficult starts to the year. Junior doctors began 2024 with an unprecedented six-day strike, as part of a dispute that could rumble on well into the year. While the strain on NHS services will grab many headlines, social care is under pressure too. A report by the Association of Directors of Adult Social Services published last autumn found that 470,000 people in England were waiting for care, a direct payment or for their care needs to be assessed.

These pressures in the NHS and social care are compounded by uncertainty and instability. NHS planning guidance expected in December has been delayed until later this month meaning health service priorities have not yet been confirmed for 2024/25 and integrated care systems are unable to make firm plans despite the challenging financial and performance context. Local authorities are also still awaiting details of the upcoming year’s public health grant. A growing number of local authorities have effectively declared bankruptcy in recent years. A Local Government Association survey found one in five council leaders and chief executives in England think it is very or fairly likely their council will issue a section 114 notice (effectively declare bankruptcy) in 2024/25.

'The major conditions strategy is also an opportunity to think about how to better address mental and physical health together.'

Throughout the year ahead, the government is set to implement several new policies that will have an impact on the health and care workforce. We can expect ministers to press ahead with a plan to mandate a minimum level of service in the NHS during strike action, and take steps towards regulating NHS managers following the murder and attempted murder of babies by Lucy Letby. The migration debate will continue to heat up as the government grapples with migration targets amid severe workforce shortages in many areas of public service, not least social care.

In spring, the government has committed to publishing its major conditions strategy, laying out next steps to tackle the major causes of ill health and mortality, and beginning to grapple with the issues faced by the one in four people living with more than one long-term condition, who too often experience fragmented care. The major conditions strategy is also an opportunity to think about how to better address mental and physical health together.

Also in spring, the Covid-19 Inquiry turns its attention to the impact of the pandemic on the health care system. NHS decision-making, service provision, staffing, infection control and more will all be under the microscope when the public hearings for module three get under way. The hope is experts will learn practical lessons to equip the country for future pandemics.

'It’s easy to become cynical of the politicking in the run up to polling day, but what gets said in the campaign does matter.'

Health care remains in the top three issues of concern to the public as the UK heads into an election year. Flash points in debates are likely to include NHS productivity, already a topic of much scrutiny, immigration and, of course, the long waits people face to access care. It’s easy to become cynical of the politicking in the run up to polling day, but what gets said in the campaign does matter. It sets the tone – and mandate – for whoever forms the next government.

Reasons to be cheerful?

The government’s bold plan to introduce a phased ban on smoking is welcome news. If implemented effectively it will save lives, reduce inequalities and save future generations the scourge of tobacco addiction. The ban has cross-party support but is not yet a done deal. Ministers and parliament will need to act fast to pass this legislation before the election.

For all the talk of division in the run up to the election, there’s a good deal of political consensus about the need to move more care into the community, with a greater role for community pharmacy and integrated primary care, ensuring services are more personalised, joined up and appropriate to need. There is also a growing drumbeat of support for more preventive health measures across the political spectrum.

Developments in the life sciences industry also provide some cause for optimism in 2024. Thanks to a new deal for access to medicines, which includes commitments to improve uptake and support clinical research, the life sciences sector should feel more optimistic about its ability to operate effectively. And perhaps the most consequential development for global health in 2024 will be the rollout of malaria vaccines. This is incredibly significant as the disease kills more than 600,000 people a year worldwide.

2024 has undoubtedly got off to a rocky start. It will be a year when health and care staff, services, systems, and policies will be under intense scrutiny. Amid the uncertainty, 2024 will be a year of change for health and care services and the people who rely on them.