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Action to tackle the growing crisis in health and social care is essential for a sustainable future

Today we publish our agenda for action to tackle the growing crisis in the NHS and social care. The aim of the agenda is to build on our analysis of finance and performance in the NHS by outlining what should be done by government and NHS leaders.

It draws on our work in relation to three big challenges: sustaining existing services and standards; developing new and better models of care; and reforming the NHS from within. It also sets out our views on the additional funding needed for health and care.

Sustaining existing services and standards requires a renewed focus on better value, by engaging clinical teams in reducing variations and improving how care is delivered. It also requires organisations to work together in place-based systems of care to decide collectively how to use the resources available to them. One of the most urgent priorities is to tackle workforce shortages and make working in the NHS an attractive career choice.

Developing new and better models of care should start by giving people more control over their own health and care. It should place much higher priority on prevention and public health through greater collaboration between the NHS, local government and the third sector in population health systems. And it should accelerate progress in the implementation of integrated care through specialists working more closely with primary care teams and general practices collaborating in federations and networks.

Reforming the NHS from within requires the NHS to adopt a quality improvement strategy in which every NHS organisation makes a board-level commitment to quality improvement. National bodies should change the way they work with NHS organisations – adopting a more proportionate approach to regulation and inspection, offering practical support to organisations in difficulty, and creating an environment in which innovation is encouraged and rewarded. Much higher priority should be given to valuing and developing leadership, including clinical leadership, at a time when there are difficulties in filling top-level vacancies.

As well as addressing these three big challenges, the NHS and social care will need additional funding. While there are many opportunities to deliver better value and release resources in the ways we have described in our work, we do not believe this can be achieved at the pace and scale needed to deliver improvements equating to £22 billion by 2020/21. An honest debate is needed on how to fund health and social care on a sustainable basis.

This should build on the work of the Barker Commission, with the aim of bringing public spending on health and social care up to 11–12 per cent of GDP by 2025. More immediately, it is not credible to expect the NHS to manage within the very low spending increases in budgets which the Spending Review provides for in 2018/19 and 2019/20. Without additional funding the growing crisis in health and care could become much worse, with patients waiting longer for treatment, quality of care compromised, and fewer people receiving publicly funded social care, which is already stretched to the limits.

The proposals set out in our agenda are the essential actions needed to ensure the NHS and social care can be both sustained and transformed. Failure to act will result in the slow but steady decline of services highly valued by the public. The NHS will survive, but an unwillingness to recognise publicly what is well-understood privately by leaders across England is simply storing up much bigger problems for the future.