The health policy year in 12 charts 2023

January

2023 started as 2022 ended – with many NHS nurses and paramedics on strike. January also brought a warning from the Royal College of Emergency Medicine that up to 500 people could be dying each week because of delays in accessing emergency care; a Church of England commission recommended how England could redesign its social care system and rethink its attitude to care and support; and reports that large numbers of NHS trusts were providing food banks for their staff during the cost-of-living crisis (see Figure 1).

February

Strikes continued into February, with 6 February reported as the largest strike day in NHS history (see Figure 2). This month also saw a report from the House of Commons Health and Social Care Select Committee warning that integrated care systems (ICSs) would struggle to focus on longer-term priorities because of shorter-term challenges on A&E and elective care performance; further warnings that NHS waiting lists for routine hospital care were unlikely to fall before 2024; reported cuts to NHS technology funding because of financial pressures; and concern over the possibility of bird flu spreading between humans – adding to the already long list of worrying potential pandemics.

March

In March the latest British Social Attitudes survey found overall satisfaction with the NHS fell to its lowest level since the survey began in 1983; integrated care boards were asked to make a 30% real-terms cut to their running costs by 2025/26; studies suggested the summer heatwave in 2022 led to one-fifth of UK hospitals cancelling operations; the annual NHS Staff Survey showed more than 30% of staff felt exhausted at the thought of another day/shift at work; a leaked copy of the draft NHS workforce plan suggested the NHS would need hundreds of thousands of additional staff over the coming years; and data from the Nursing and Midwifery Council highlighted how reliant the NHS is on staffed trained in other countries (see Figure 3).

April

Spring saw the publication of Patricia Hewitt’s review of ICSs, which among other things recommended concrete action to increase the share of ICS spending on prevention. In response, the government said it did not agree with ‘imposing a national expectation of an essentially arbitrary shift in spending’ (an odd thing to say given its own targets on 50,000 more nurses, 40 new hospitals and 50 million more GP appointments are largely arbitrary too…). This month also saw the government halve its £500-million funding commitment to improve workplace conditions and workforce support in social care; and reports of ‘dental deserts’ in England (see Figure 4) where people were crowd-funding dental care or literally taking matters, such as tooth extraction, into their own hands.

May

May brought further proof that a strong economy requires a healthy workforce, as Office for National Statistics data were reported to show more than 2.5 million people were not working due to health problems. This month, data collected by The BMJshowed there were more than 35,000 incidents of sexual misconduct or violence on NHS premises between 2017 and 2022; five hospitals at risk of collapse because of deteriorating concrete planks joined the New Hospital Programme; and there were reports that targets to reduce mixed-sex ward accommodation were now routinely missed (see Figure 5).

June

The big health policy news in June was the publication of the long-promised NHS Long Term Workforce Plan, which focuses on training more staff, retaining current staff, and reforming staff training and working practices. The plan was broadly welcomed, though questions were raised over whether adult social care would get its own plan; whether the plan was too optimistic on how productive the NHS could be; and whether robot receptionists would be the way of the future. In other news, the head of the New Hospital Programme called for greater stability in planning – noting ‘building new hospitals should be like painting the Forth Bridge – it should never stop’; and research by the Office for Health Improvement and Disparities highlighted that tobacco is still the risk factor making the largest contribution to lost years of life in England (see Figure 6).

July

July rounded off a trio of anniversaries marking 75 years since the founding of the NHS, the National Assistance Act that laid the foundations of the current social care system, and the arrival of the HMT Empire Windrush at Tilbury Docks. Despite the current pressures on services, the public’s faith in the founding principles of the NHS seem undimmed (see Figure 7). The government announced more funding for recruitment and retention in social care services over winter; the Care Quality Commission (CQC) announced the first two pilots for its assessment of ICSs; and the National Audit Office published its review of the government’s New Hospital Programme, which concluded ‘by the definition the government used in 2020, it will not now deliver 40 new hospitals by 2030’.

August

The most significant news in August was the sentencing of Lucy Letby, the former neonatal nurse who was convicted of the murder and attempted murder of infants in the Countess of Chester Hospital. Letby’s conviction was followed by calls to regulate NHS managers. August also brought a focus on NHS waiting lists with reports that nearly one million appointments and treatments in England had been postponed by strike action in the NHS; an unedifying exchange between health and care secretaries on how England, Scotland and Wales could share learning on tackling backlogs; and reports that insurers were increasingly seeing ‘big opportunities’ to expand private health cover because of long waits for NHS care (see Figure 8).

September

September saw stronger hints of the rising financial pressure in the NHS; news about the growing use of ‘miracle’ weight-management drugs in private and public health care; and calls from the Parliamentary and Health Service Ombudsman to introduce Martha’s rule – a proposal to give patients the power to get a second medical opinion, named after Martha Mills, a 13-year-old girl who died of sepsis. This month, ambulance service representatives also warned about the large increase in delayed ambulance handovers to hospital over the past decade (see Figure 9).

October

This month the CQC’s annual State of Care report highlighted the increased risk of ‘unfair care’ because of the combination of the cost-of-living crisis and ongoing problems in accessing health care. Also this month, the Covid-19 inquiry continued to hear evidence from former officials and politicians on the UK’s response to the pandemic; there were calls for an extra £1 billion of new funding support for the NHS (it would end up getting only a fraction of this in November’s Autumn Statement ). Steve Barclay wrote a confusing letter that included both his view that ‘we should devolve more to integrated care systems’ and his clear instruction that ICSs should ‘review with a view to cease recruitment into standalone diversity, equity and inclusion roles’. In more positive news, Prime Minister Sunak used his party conference speech to announce plans to create a smoke-free Britain (see Figure 10).

November

In November NHS England awarded a long-term contract to operate the NHS’s national ‘federated data platform’ to a consortium led by Palantir; the Chancellor’s Autumn Statement provided more funding for life sciences but brought relatively little other news or cheer for health and care services; the government announced it was meeting its commitments to increase the number of nurses and primary care appointments but was silent on its struggle to meet other commitments to build new hospitals, recruit more GPs and reform adult social care; a Demos report highlighted how the NHS could improve its communication with patients and the public; and Victoria Atkins became the fifth person to hold the post of health and care secretary since 2021 (see Figure 11).

December

The end of 2023 saw the NHS under pressure from rising cases of winter viruses and the announcement of further strikes from junior doctors. December also saw Boris Johnson give his first evidence to the Covid-19 inquiry; the latest data showed the increasingly tired condition of NHS buildings and equipment; and monthly performance figures suggested it will be a long time before A&E performance targets are met (see Figure 12).

Conclusion

The end of each year is a time for reflection – but especially so at a time in a year that has seen three significant 75th anniversaries.

In the second reading of the NHS Bill, Nye Bevan said of the legislation: ‘I believe it will lift the shadow from millions of homes’. But 75 years on, some shadows remain. Once unprecedented strikes by clinicians are now increasing common. Concerns are growing again of a two-tier health service. Performance targets feel increasingly far from reach.

But at the same time, the end of the year can be a time for cautious hope. 2023 was the year the NHS got a long-term workforce plan and the UK took firmer steps towards a smoke-free future. Sometimes it can be hard to believe that things are darkest before the dawn. But as the winter gloom sets in for 2023, it’s perhaps important to remember that shadows can be cast, but they can also be lifted.