The health policy year in twelve charts 2024

January

Perhaps January is the cruellest month. The NHS began 2024 without any planning guidance for 2024/25, a further junior doctors strike, and parliamentarians observing that dental appointments were becoming as scarce as Taylor Swift concert tickets.

The month also saw the launch of the Pharmacy First scheme, which allows community pharmacists to supply some medicines without a prior GP prescription, and a BMJ commission that reaffirmed the founding principles of the NHS.

To close out a gloomy month, new figures showed life expectancy in the UK had fallen back to the levels of a decade ago.

February

This month, the Prime Minister said the government would miss its key objective of reducing hospital waiting lists. A new scheme was announced for hospitals in England to introduce Martha’s rule, giving seriously ill patients easier access to a second clinical opinion.

The Times Health Commission made 10 recommendations to improve the NHS, with its launch event seeing the Shadow Secretary of State for Health and Social Care send a vivid warning to people in the food industry who fail to tackle obesity: ‘You either get on board the steamroller or you’re going under it’.

New data showed serious declines in the health of under-fives in the UK, and high  numbers of people who are economically inactive because of long-term sickness. In Bristol, hundreds of people queued in the early morning for appointments at a newly opened dental practice – a rare oasis in the dental deserts that have sprung up across England.

March

The end of the financial year brought problems old and new. The month saw a, at times, rancorous extraordinary general meeting of the Royal College of Physicians over the role of physician associates; reports of racist and violent comments from the CEO of a health care tech company; warnings from the Parliamentary and Health Service Ombudsman that cancer patients were at risk because doctors are exhausted; a furore over A&E departments being offered extra capital funding if they achieved some last-minute improvements to A&E performance in March; satisfaction with the NHS fall to a record low; and the very late (even by its own traditional standards) appearance of the national planning guidance (see Figure 3).

But it wasn’t all doom and gloom. This month also saw the Spring Budget promise £3.4 billion of dedicated funding over the next three years for technology improvements in the NHS; the BMA backed a new consultant pay deal offer; the NHS staff survey showed some green shoots; and a major study found that compared with the early 1990s fewer middle-aged people are dying from cancer in the UK.

April

The new financial year started with consultants voting to accept the government’s pay offer; calls from a think tank to abolish NHS England and devolve many of its functions to local government; and reports that the NHS was being asked to cut spending on doctors and nurses at the same time as the Royal College of Emergency Medicine was warning that long waits in A&E were potentially contributing to 250 deaths a week.

This month, a report from the World Health Organization found that the UK had the worst rate of child alcohol abuse in the world (see Figure 4); there were warnings that planned cuts to Royal Mail deliveries could put patients at risk of missing information about appointments; debates began in the House of Commons on the government’s plans to ban smoking; a former Conservative health minister crossed the floor to join the Labour Party, in part because of rising pressures on the NHS; and the Cass review on gender identity services for children and young people was published.

May

Nursing vacancies fell to a record modern low, a UK toddler was the first child to have their hearing restored after a gene therapy trial; WorkWell pilots were launched to provide services such as physiotherapy and counselling to help people stay in or return to work; and the last NHS acute trust was lifted out of an inadequate rating by the Care Quality Commission.

May also saw increasing reports of medicines shortages because of global manufacturing issues; a stark warning about the impact of obesity on employment was published; and the report into the infected blood scandal showed how much avoidable harm people had endured. And at the end of the month Prime Minister Rishi Sunak made the surprise announcement to call a snap general election for 4 July.

June

June brought the 11th strike by resident doctors in their pay dispute, and a ransomware attack that heavily affected pathology services in two NHS hospitals. Sarah Wollaston, the respected former Chair of parliament’s Health and Social Care Committee, resigned from her role chairing the NHS Devon Integrated Care System because she refused to sign off a financial plan that would be ‘promising the unachievable’. Financial plans would be an issue that would run and run throughout the rest of the year. 

This month also saw the publication of the general election manifestos, which had much to say on the NHS but were a case of ‘topic avoidance’ for the two major parties when it came to adult social care.

July

The results of the general election dominated this month’s news. Wes Streeting, the new Secretary of State for Health and Social Care, started making waves from his first day in office, telling staff at the Department of Health and Social Care, ‘From today, the policy of this department is that the NHS is broken’. The government asked Lord Darzi to carry out a rapid independent investigation into the state of the NHS. Plans to reform adult social care charging were stopped and the national programme to build new hospitals was paused.

Also this month, a critical interim report into the effectiveness of the Care Quality Commission was published, and the spring survey of directors of adult social services found the financial situation they faced was ‘as bad as it has been in recent history.’ In short, the new government had a job on its hands.

August

Race riots broke out in parts of England in August. Amanda Pritchard, Chief Executive of NHS England, condemned the ‘deplorable thuggery’ and how it had left many health and care workers in fear.

Also this month, GPs voted for collective industrial action by taking actions such as capping the number of daily patient consultations; community pharmacies warned they would have to stop providing some services and reduce their opening hours because of financial pressures; and while the risks to the UK were low, the World Health Organization declared mpox a global health emergency.

September

September saw the Prime Minister, Lord Darzi, and the health and care ministerial team come to The King’s Fund to launch Lord Darzi’s review into the state of the NHS. In a 150-page report and 330-page annex, the report provided a forensic analysis of the poor state of parts of the NHS.

This month also saw the first party conference speech from the new Health and Social Care Secretary, in which he set out how the NHS could contribute to the government’s mission to boost economic growth by targeting the use of crack surgical squads in areas with high numbers of people off sick from work.

Also this month, resident doctors agreed a deal with the government to end strikes, and hearings began at the Thirlwall Inquiry into deaths at the Countess of Chester Hospital. And the UK came third place in the Commonwealth Fund’s latest ranking of international health care systems.

October

This month saw a cash boost to the NHS in the Autumn Budget, which would see health budgets rise in line with the historical average. The budget also increased financial pressures on employers in adult social care and other non-NHS health and care organisations who would face an increase in national insurance employer contributions.

Richard Meddings, Chair of NHS England, announced he would be leaving his post; the Department of Health and Social Care launched a national listening exercise as part of the new 10-year government plan to reform health care; the Children’s Commissioner published a report into the hidden waits for assessment and support experienced by children with suspected neurodevelopmental conditions; and the final report into the state of the Care Quality Commission was published and would be followed by a further review into patient safety.

November

Wes Streeting ordered a review of physician and anaesthesia associate roles to try to bring clarity to a ‘toxic debate’; Alan Milburn, the former Health and Social Care Secretary, was brought back into the Department of Health and Social Care and warned that the NHS is in the ‘last-chance saloon’.

The tough rhetoric continued at the NHS Providers conference, where Wes Streeting said he would reintroduce performance league tables and move from a system where ‘there are zero consequences for failure, to zero tolerance’ – which will come as news to the many chief executives who have left their jobs because of systemic performance pressures in the NHS.

This month also saw MPs back proposals to legalise assisted dying in England and Wales, and the Covid-19 inquiry continued to hear evidence about the response to the pandemic, painting a picture of a health and care service that was ‘right on the edge’.

December

At the start of December, a report was published into the implementation of the Right Care, Right Person programme. And polling suggested the public were positive about the impact of technology on health care, although there was more hesitation about technologies that might be seen to ‘distance’ patients from health care staff.

Also this month, the Prime Minister Sir Keir Starmer used a speech at Pinewood Studios to set out a different type of ‘hairdryer treatment’ for public services and an ambition to meet a ‘health milestone’ of 92% of people starting consultant-led treatment for planned hospital care within 18 weeks of referral. Subsequent reports pointed out the consequences that a singular government focus could have on other waiting times and more fundamental reform of the health service.

Conclusion

This was a year of two halves politically, as the mid-year election returned a new government with a new plan for the health and care system. But as for the underlying tone of the health and care service in 2024? It was familiar.

Some of that familiarity was depressing – more care scandals, more warning of financial pressure, more warnings that waiting times wouldn’t be met. But some of the familiarity was the opposite, as health and care services continued to evolve, with new treatments becoming available to improve lives.

Someone in the health and care service once told me about their plans for change and then paused before noting, ‘But I can’t break free in one leap’. The incoming government has plans to transform the NHS and adult social care. But it is perhaps experiencing the same sensation.