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General election 2024: 28 days and counting

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The general election is four weeks away, campaigns are in full swing, and manifestos are due to be published imminently. There will be claims, counterclaims and eye-catching announcements, but what are the real challenges facing health and care and what issues will the future government need to grapple with?

First, the context. The five years since the last general election has been a turbulent period for the UK in many ways. In health and care, the Covid-19 pandemic and its aftermath, with the highs of the vaccine programme and the lows of lengthening waiting lists are dominating national debate. Cost-of-living pressures have also had a significant impact on people’s health and wellbeing, with rising levels of poverty and deprivation taking their toll. Flatlining (and in some groups declining) life expectancy over the past decade underscores the comparative challenge the UK faces to improve health, as it falls behind many other high-income countries on longevity.

Over the course of this parliament, we have seen increased NHS funding, publication of the NHS workforce plan, the employment of more doctors, nurses and other health care professionals, particularly in acute settings, and the creation of integrated care systems (ICSs), which are designed to join up and tackle the most pressing issues facing local populations. All this has been welcome.

However, additional resources have not kept up with the demands of an ageing population in poorer health. Consequently, public satisfaction with the NHS is the lowest it’s been since the British Social Attitudes survey began in 1983. People cite difficulty accessing timely care as their number one reason for dissatisfaction. The NHS is grappling with at least 6.3 million people on NHS waiting lists (with millions more waiting for other care that isn’t counted in the same way), crumbling NHS buildings, a challenging 2024/25 financial settlement and ongoing industrial action. The lack of reform to the social care system means more people requesting support with fewer receiving it. Landmark legislation to create a smokefree generation was a casualty of the dissolution of parliament.

“Whoever forms the next government will have a busy to do list on health. The public knows this, and cares deeply, so it’s no surprise that health care is polling as the top issue for voters – 32% – ahead of the economy, according to Ipsos Mori.”

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Whoever forms the next government will have a busy to do list on health. The public knows this, and cares deeply, so it’s no surprise that health care is polling as the top issue for voters – 32% – ahead of the economy, according to Ipsos Mori. As we await manifestos and a more detailed understanding of political parties’ plans for health and care, we’ve already seen a trickle of pledges from Labour, the Conservatives and the Liberal Democrats.

What are we hoping for from the manifestos and the next government?

To fundamentally improve the nation’s health, and to ensure the health and care system is fit for purpose and able to deliver high-quality care in years to come, there need to be bigger shifts than some of the announcements so far on tackling immediate pressures and technocratic detail.

Improving access to out-of-hospital care is critical. It’s key to helping people stay well, diagnose conditions early and self-manage for longer, better for people and more cost-effective for the NHS. Our work identified the inability of successive governments to deliver this change as one of the biggest policy failures of the past 30 years.

Making this shift a reality is the sort of bold re-imagining of our health and care system that we need. It requires a radical refocusing and ‘shifting of the spotlight’ to primary and community settings, to grow the primary and community workforce, ensure future investment gets spent in the community, and improve primary care estates. It must also include meaningful reform of social care, something that governments of all colours have put off for too long.

Making health and care an attractive career should be a top priority for the next government. Resolving the ongoing junior doctors’ strikes will be high on the list of any incoming or returning Health Secretary, but the NHS and social care are beset by chronic workforce shortages, many years in the making. A new government should deliver the long-term workforce plan, but go further on retention, embrace flexible working, and address deep-seated cultural challenges to tackle widespread reports of bullying and discrimination. A sister social care workforce plan that deals with pay and gives staff a clear career pathway is urgently needed.

“Our public polling shows there’s significant support for more action on prevention. There’s an immediate opportunity for the next government to revive the tobacco legislation that fell when the election was called, and plenty more that can be done at low cost to support prevention...”

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Finally, action needs to be taken upstream, away from treating sickness towards prioritising health and the prevention of ill health in the broadest sense. The UK has a growing and ageing population, many more people living with multiple long-term conditions, placing ever more demands on the NHS. A bold government approach to support people to live healthier lives and reduce the biggest risk factors affecting people’s health is often talked about but rarely acted on. Our public polling shows there’s significant support for more action on prevention. There’s an immediate opportunity for the next government to revive the tobacco legislation that fell when the election was called, and plenty more that can be done at low cost to support prevention, for example, implementation of stricter regulations around junk food advertising and further reformulation of foods high in sugar, salt and fat. More broadly, tackling poor-quality housing and deep societal inequalities, will be a factor in how much the nation’s health improves.

All this should be underpinned by a commitment to deal with the capital and maintenance backlog, across the NHS, that is slowing the system down.

As important as what should happen post-election is what shouldn’t happen post-election. A large-scale structural re-organisation of the health and care system would be hugely disruptive and distract from the job at hand. Our work reviewing the role ICSs are playing to improve dementia diagnosis, for example, shows they are delivering their aims where provided with the right conditions. We should allow ICSs to continue to bed in and do what they were set up to do – understand and respond to local population health needs.

Winning an election on a platform to improve health is one thing. History tells us delivering real change is another, and that it often takes several years for changes to take effect and, perhaps most importantly, for it to feel different to the public and patients. The public are impatient for improvements so the next government will want to demonstrate action quickly.

Insight and analysis

General election 2024

We'll be analysing details from the manifestos and more as they emerge. Keep up to date with our election coverage, including our election special podcast series.

Find out more