The health and care outlook for 2025

January is typically a time for new year resolutions. Health and care are no stranger to this impetus for improvement, entering 2025 in a state of crisis against many metrics but with a clear resolve to change and reform. New year announcements from the Prime Minister and Secretary of State underscore the government’s belief that the NHS is broken and they have the plan to fix it, and that social care requires fundamental reform that only another long-term commission and cross-party consensus can pave the way for. There’s a huge amount on the agenda for health in 2025. The real test will be whether ministers, leaders and the rest of the system can hold their nerve and stay focused on fundamental reform rather than piecemeal fixes. 

First, the context. It's hardly newsworthy to say the health and care system is under extreme pressure, but we are experiencing a particularly difficult winter virus season, with NHS England Medical Director, Sir Stephen Powis, referring to a ‘quad-demic’ of rocketing flu, RSV, Covid-19 and norovirus cases, and urging those eligible to get vaccinated, especially since fewer people, including NHS staff, are getting vaccinated this year compared to some previous years. The President of the Royal College of Emergency Medicine has described the working conditions in emergency departments as ‘unacceptably awful’, a reminder of the long waits and resulting harm to patients in too many A&Es across the country. For the early months of the year, monitoring how the NHS is coping will be the priority for many. 

Against this backdrop, the year has also started with a series of government announcements aimed at ‘transforming social care’. These include increased support to digitise care records, better integration of health and social care services, improving the career pathway for social care workers, and offering more support to working-age disabled people to make home adaptations. These are all welcome measures. However, the set piece announcement of a new commission on social care, to be led by Baroness Louise Casey, has been met with frustration by many in the sector because of the timetable for reporting. Phase 1 will consider the critical questions to address and medium-term proposals for change and will report by mid-2026, while phase 2 which will develop a vision for long-term transformation of the care system will report ‘by 2028’. Although Casey has a formidable reputation across Whitehall for breaking logjams and getting stuff done, and will report directly to the Prime Minister who surely has the best chance of breaking the impasse on fundamental reform, kicking the can down the road for the next few years risks yet another delay in bringing about much-needed improvements to social care for the millions who rely on it.  

Early January also saw publication of the government’s elective care plan. This outlines ambitions to bear down on waits and to meet the 18-week target for planned care, while trying to accelerate other initiatives to improve care and patient experience – for example, by committing to further use of community diagnostic centres to introduce more straight-to-test options so that people can access tests more swiftly. The difficulty is that money to support the plan’s implementation is only confirmed for 2025/26. We’ll need to wait until the spring Spending Review for further detail about future years, which is clearly the nub of how much progress can be made.  

We expect much more to come in 2025 by way of big reports and plans for action. Despite a desire to give the health system more time to plan for next financial year, we are yet to see publication of the planning guidance, expected imminently. Although the Autumn Budget set aside £22 billion of additional NHS spending for the next two years, a combination of inflation, staff pay awards and other costs means that the 2025/26 fiscal year will be incredibly tight across the health service, with the real prospect of some services having to be cut and systems having to make hard choices about trade-offs in the treatments and services offered. 

Talking of financial pressures, industrial action is ongoing with GPs still taking collective action. Unions have also said there is a ‘real risk’ of industrial action based on the government recommending a 2.8% uplift for public sector workers in 2025/26. The pay review body will make a recommendation soon, but the bottom line is we could see more strikes. 

Meanwhile, following Lord Darzi’s investigation in 2024, we are currently in the middle of a ‘national conversation’ on how to fix our ‘broken’ NHS. A new 10-year plan charged with setting out government plans to deliver three shifts – from hospital to community, analogue to digital and sickness to prevention – will publish in the spring. To retain credibility and show a connection between the plan and how it will be implemented, it needs to dovetail with the Spending Review, which will set out government spending plans for the next three years. We also expect publication of a revised long-term workforce plan. In an environment where staff morale remains challenging, this offers the opportunity to set out more detail on improving working conditions, alongside an updated assessment of the workforce needs of the future. 

The government recently relaunched its Plan for Change, a series of ‘missions’ on which it hopes to be judged. One of these is health focused and it will be interesting to see how this develops over the course of the year. To date, despite high hopes that this could be an opportunity to get Whitehall, regional and local government working differently to promote health, with a genuine ‘health in all policies’ approach, progress has been limited. Stalling life expectancy, poor population health and increasing multi-morbidity should provide a burning platform for further action on prevention. The reintroduction of the Tobacco and Vapes Bill, with its ambitious plans to create a ‘smokefree generation’ and restrict the marketing and sale of vapes to young people, is very welcome, as are the measures to restrict junk food advertising to under-18s. But we’ll need to see more courage and boldness from the government in addressing the causes of ill health if the mission is to fulfil its early promise. 

There are several other pieces of health legislation progressing through parliament this year which will have significant impact. The Terminally Ill Adults (End of Life) Bill (Assisted Dying Bill) is continuing through legislative scrutiny and will herald a big change to policy and practice if it passes the parliamentary process and is implemented. The Mental Health Bill seeks to strengthen the rights of patients to be involved in planning their care, giving them greater choice and autonomy. And the Data (Use and Access) Bill will make provision about information standards for health and social care. 

The devolution drive being led by Angela Rayner has implications for health and care. The government seems to be placing faith in combined authorities as the best geographic footprint for making locally tailored decisions. It has announced more unitary authorities and more powers for regional mayors. The English Devolution White Paper says government ‘will introduce an expectation that Mayors are appointed to Integrated Care Partnerships and are considered for the role of Chair or Co-Chair’. If this indicates a broader move to align mayors and the health service, there could be interesting implications for integrated care systems’ boundaries, the relative power of integrated care partnerships within them, and the join up between NHS and local government planning.  

Just as important as the big-ticket items will be the smaller but more regular drumbeat of messages on health and care – for example, the tone of day-to-day asks of the system and the approach taken to performance management. We have a government promising to do things differently, to work with the health and care workforce and the public to drive improvements, and to free up the system to innovate in support of national priorities. Whether it feels different day to day will be a test of this approach as the year rolls on. 

We’ll have plenty to reflect on at The King’s Fund. In the spring we will publish the latest British Social Attitudes polling on public satisfaction with health and care. Last year saw the lowest levels of satisfaction ever recorded, so it will be interesting to see whether there’s been any shift since the election. Building on our 2024 report, we will also set out further ideas about how we can move care closer to home, a key government priority, and publish work on patient admin, often overlooked but an important bellwether of how well the system is working for those who use it. 

More than anything, 2025 will be a year where the government will need to make some clear choices.  

True reform takes time, but voters can be impatient. There has already been criticism that the government is dodging decisions in favour of reviews and taskforces, while the electorate has been told the pain they will feel in taxes will be rewarded with improved public services. That creates tension between long-term reform and short-term firefighting. The local elections in May will be the first time the public goes back to the ballot box since the general election, and the result will (rightly or wrongly) be seen as an assessment of Starmer’s government. If the results are bad for Labour, it will be a test of their resolve to stay focused on tough decisions and long-term reform. 

The government can’t do everything required to improve health and care, certainly not in the short term. Trade-offs are required if it is serious about rewiring the NHS and improving social care, so that we begin to reorientate to prevention, community, digital and the health needs of our 21st-century population. The King’s Fund will be watching closely and encouraging effective solutions to the challenges we face.