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The health and care system is in crisis: what should (and shouldn't) be done?


Covid-19 represented a historic challenge to our health and care services as it did to the country as a whole. As it has receded (but alas not disappeared), it is increasingly clear that the threat of Covid has been replaced by a more intractable crisis affecting almost all aspects of the NHS, social care along with all those working in, or depending upon, health and care. Any hopes of a quick recovery post-Covid are well and truly sunk.

In my (quite long) career I do not think I have ever seen such widespread and deep problems and the signs of stress are everywhere. Public satisfaction with the NHS has been blown back to the level of the 1990s (when Tony Blair in the 1997 election told voters they had 24 hours to save the NHS), while satisfaction with GP services have never been lower. Waiting times have ballooned, whether in emergency or planned care. Beneath it all, as the Health and Social Care Select Committee has just said, `the National Health Service and the social care sector are facing the greatest workforce crisis in their history’. A fact forcefully underlined by the first ever annual decline in the social care workforce. Of course, this cannot all be laid down to the pandemic – the workforce crisis and its consequences have been years in the making and Covid-19 did not start the decline in performance, even though it did accelerate it.

'The NHS has played only a minor part in the current election for a new Conservative leader... Debate on social care seems to have been completely absent.'

We have been here before and, predictably, it leads to some calls for major reform or indeed, the wholescale dismantling of the NHS, overlooking the fact that the government has just passed its biggest set of reforms since 2012. The critique of the NHS follows a number of well-trodden paths: that the NHS is a bottomless pit, no longer affordable from general taxation; that it has too many managers; that it is being privatised. To this list has been added some fresh twists: that the government has `fixed’ social care, and that the problem with GPs is that they don’t work hard enough. We’ve published some analysis of these claims but suffice to say here, that they don’t stand up. I should add that this is not an exhaustive list but is a place to start.

One might expect such a state of affairs to be core to the political debate. Perhaps our politicians are now spoilt for choice for which crisis to address first, but whatever the reason, the NHS has played only a minor part in the current election for a new Conservative leader, despite Rishi Sunak declaring that the NHS backlog is a national emergency. Debate on social care seems to have been completely absent.

So where may the answer lie to the current crisis? We can hope that the current declines in Covid-19 both in the community and in hospital may provide some short-term relief as beds are freed up in hospital and as falling staff sickness rates raise capacity more generally across the system. More fundamentally it is also important to remember that the NHS has bounced back before. The dark days of the 1990s were succeeded by years of rising staff numbers, falling waiting times and high levels of public satisfaction all visible as the 2000s progressed (though still far from problem free, as the experience at Mid-Staffordshire showed). Equally, as deep as the social care workforce shortages are, there are ways to alleviate them (notably through pay).

'But whatever they do, [the new Prime Minister] will need to avoid flawed analysis of the problems facing the system.'

The next big step in the policy and planning calendar will be a proper workforce plan, due from NHS England and Health Education England towards the end of the year. A lot of hopes rest on this plan given how central workforce issues are, but there are concerns too as previous attempts have failed to translate into reality (or even get published). However, it is primarily a health workforce plan so cannot be expected to ‘sort’ social care. Of course, as we move into the autumn we will also have a new Prime Minister and possibly, a new Secretary of State for Health and Social Care. They will face some big choices: whether to back this new workforce plan; whether to stick with the current direction on spending and reform; taken together this implies hoping that incremental gains in reducing waiting times will give the public greater confidence that the NHS and social care are on the mend, even if slowly. They could choose to be more radical. But whatever they do, they will need to avoid flawed analysis of the problems facing the system, at least if they want to actually improve health and care in England.