The NHS at 75: a letter to party leaders

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As the NHS turns 75, the Chief Executives of The Health Foundation, Nuffield Trust and The King’s Fund have written to the leaders of the three largest political parties in England, calling on them to make the upcoming general election a decisive break point, by ending years of short termism in NHS policy-making.  

The joint letter highlights four key areas where long-term policies coupled with considered investment would help chart a path back to a stronger health service:  

  • invest in the physical resources the NHS needs to do its job including equipment, beds, buildings and new technology. 
  • deliver long overdue reform of adult social care 
  • commit to a cross-government strategy over the course of the next parliament to improve the underlying social and economic conditions that shape the health of the nation 
  • build on the recently published NHS long term workforce plan with sustained commitment to providing the resources it needs to succeed 

Dear Mr Sunak, Sir Keir and Sir Ed,

75 years after its creation, the National Health Service is in critical condition. Pressures on services are extreme and public satisfaction is at its lowest since it first began to be tracked 40 years ago. Despite this, public support for the NHS as an institution is rock solid – it still tops surveys about what makes people most proud to be British, and the public are unwavering in their support for its founding principles: free at the point of use, comprehensive and available to all.

As leaders of three leading independent health and care research institutes, we urge you to make the next election a decisive break point by ending years of short-termism in NHS policy-making. Recovering NHS services and reducing waiting times for treatment should be a key priority for any government. However, our work shows that promising unachievable, unrealistically fast improvements without a long-term plan to address the underlying causes of the current crisis is a strategy doomed to failure. The path back to a stronger health service is through long-term policies that support innovation, boost productivity and provide the resources, capacity and technology it needs over multiple years.

The NHS has endured a decade of under-investment compared to the historic average, and capital spending has been well below comparable countries. As a result, the health service has insufficient resources to do its job: fewer hospital beds than almost all similar countries, outdated equipment, dilapidated buildings and failing IT. Despite long-term objectives to reduce reliance on acute hospitals and move care closer to people’s homes, spending continues to flow in the opposite direction. Long-term thinking is essential to meet the challenges ahead – from responding to changing health needs to harnessing AI and new technology.

Last week’s publication of the NHS long term workforce plan signals a welcome cross-party consensus on the need for a long-term approach to health service staffing. The plan now needs a sustained cross-party commitment to updating forecasts and providing the resources it needs to succeed. However, ambitious steps to increase the number of staff through training, apprenticeships and international recruitment risk being frittered away if trainees continue to drop out and poor morale and sickness continue to drive staff to leave the service and retire early. A failure to act to retain existing staff would be fatal to the NHS and the health of the nation – again, this needs sustained action over the long-term to make the NHS a better place to work.

Serious reform of adult social care has been shamefully neglected by successive governments. Changing this is critical for the people, families and carers who rely on social care services and would also make a major contribution to reducing pressures on the NHS. A long funding squeeze has led to chronic staff shortages, high levels of unmet need and providers struggling to deliver high quality care. To overcome these challenges, new funding should be carefully deployed as part of a reform package that improves access to high quality care, prioritises better pay and conditions for staff, and gives people far greater protection against social care costs. The next government must succeed where its predecessors have failed by forging a long-term consensus on social care reform.

Long-term political action is also needed to address the fraying health of the UK population. The NHS was not set up to go it alone. Protecting and improving people’s health depends on a wider system of services and support that includes local government and social security. Yet people are falling between the cracks of public services and the NHS is often left to pick up the pieces.

Life expectancy has stalled and compares poorly with other countries. A recent study showed that the UK had the second lowest life expectancy among 19 countries analysed, with only the United States faring worse. Inequalities in health are deep and growing – people in the most deprived areas of England can expect to spend almost two decades less living in good health than those in the wealthiest areas. The challenging economic climate and the NHS crisis are interlinked – a healthy economy needs a healthy population, yet ONS figures show that the number of people absent from the workforce due to long-term sickness has continued to climb since the pandemic.

Our health should be treated as an asset to be invested in. The next Prime Minister should commit to a multi-year, cross-government strategy over the course of the next parliament to improve the underlying social and economic conditions that shape the health of the nation – like people’s income, education, jobs, housing and food.

For the public, the NHS remains the jewel in the country’s crown, even if it is losing its shine. The next government will face a choice between providing the investment and reform needed to preserve the NHS for future generations or continuing with short-termism and managed decline that gradually erodes the guarantee of safety in place of fear it was designed to create. Persisting with the current addiction to short-termism and eye-catching initiatives will risk the health service being unable to adapt to the huge challenges ahead and reach its centenary. It is time to move away from quick fixes and over-promising what the NHS can deliver and give it the tools it needs to succeed.

Yours sincerely,

Richard Murray, Chief Executive, The King's Fund
Nigel Edwards, Chief Executive, Nuffield Trust
Jennifer Dixon, Chief Executive, The Health Foundation


Tim Wilson

public advisor -public health and mental issues,
Comment date
08 July 2023

urgent need for up stream public health, switch to prevention , keep people in health, tackle inequities in society, intersectionality issues discrimination , power imbalances racist classism - more resources for up stream - governments must play a role in facilitating health (a human right) our NHS should become an health service - not a down stream service - governments and stakeholders must have food policy housing income health and safety climate environment clean air water energy policy transport policies, just starters - my piece below about how govt dealt with or didn't deal with covid in first 15 months - this has implications for who goes into public health. see below
The Government's response to Sars Covid 2 Tim Wilson
– Member of the Health Equity Maintenance strategy
(HEMS) group
It was reputed that on his death bed Pasteur the exponent of specific aetiology,
that diseases have specific causation e.g., a microorganism said “the terrain is
everything the microbe is nothing “by the terrain he was perhaps referring to a
person's innate inner immunology. The biome and microbiota and social
interaction with their environment – their food and immunological and health
defences and the state of the environment, the state of public health provision
and the number of inequities a person suffers from.
This article details some of the issues why the UK has such a high number of
deaths and morbidities due to Sars co-vid 2, when you compare New Zealand's
25 deaths, yes only 25, Australia's 800 Norway and Finland around 500 deaths
from co-vid 19 UK's as of 12/3/21 is officially count 125000 but many experts
see Richard Marmot actual think the count nearer to 170,000
Respiratory diseases are diseases of poverty, social diseases, deprivation.
Inequities, air pollution, obesity (associated with and inequities poverty) poor
working conditions overcrowding , discrimination, poor housing and lack of
power create health problems – we have in last 42 neo-liberal years never been
“all in it together” - this ideological power (markets, laissez faire, minimal
state, private good, public bad polarisation started by Thatcher) has contributed
to millions of early deaths and un -equal morbidities (chronic health problems,
ill health) at relatively early age (sometimes 15 years before those living in
affluence). This is a form of structural violence see Galtung 1969 (example
since 2010 deliberate austerity) by the state on the people. Globally this
ideology has led to climate change and habitat and ecological destruction, the
main cause of increasing zoonosis (animal to human transmission Covid 19 is a
zoonosis). The 21 st century could be the century of pandemics, ones far worse
than Sars 2. Ecological destruction increases inequalities, habitat change and
climate change and much more. The growth of anti-microbial, resistance
(AMR) and factory farming and over prescribing of antibiotics, highly
processed food, inflammatory food creating huge health /public health (e.g.
obesity) time-bombs. The UK is a main air polluting country particularly in
deprived urban areas. There is too much air travel yes inequities and is a disease
of destruction and has produced in UK stalk inequalities in health and
contributed to pandemic growth by weakening the terrain. Inequities and
intersectionality factors (people experience existence structurally, and have one
problem on top of others)) are drivers of inequalities in health.
Tragic mistakes and not prepared for pandemics -Governments response
to Sars covid 2 first eighteen months.
In late February 2020 should have had a complete travel ban abroad, no ins or
out – those people who had to come back should have 14 days quarantine– UK
only instigated a travel ban in Feb 2021 but not for all countries -thus 12
months too late! Johnson didn’t attend the first four cobra meeting on the threat
of Covid.
March 2020 allowed Cheltenham and Rugby internationals to go ahead events
and 3000 Spanish football fans to come to Liverpool, it is estimated that
because of this football match 43 people died of Covid– all the wrong approach
totally – needed people with public health experience shoe leather public health
to guide country, required people with experience of public health e.g.,
environmental health officers and local directors of public health.
In Feb 2020 should have instigated a local authority-based test track trace and
isolate system importantly run by a local authority elite environmental health
practitioners and directors of public health – with strong links to local
GP’s. The Government in the summer of 2020 gave testing to private
companies (why the delay?) like Serco and Delotte using call centre staff who
had no expertise in infection control only traced and tracked 55%. Local
authorities when given some information and power in August/September 2020
were reaching 98% of contacts.
Significantly the government never had a comprehensive finance package for
self-isolating so infected care workers had to choose between no money or
passing the virus on to the elderly, they did.
Not prepared for pandemic: In the last 40 years increased inequities in health
(particularly since 2010) deliberate austerity policies to cripple the poor and
disabled, benefit cuts and cuts to local authority funding particularly in poorer
labour voting areas, reduced local authority funding, and money for public
health, library closing and support were cut as were day centres closed in places
like Liverpool /Knowsley.
The growth in poorer working conditions, zero-hour contracts, less health and
safety inspections or environmental health officers to inspect overcrowding
housing has reduced the terrain of poorer groups and BAME individuals and
families, child poverty is far too high. In neo-liberalism one of their dominant
ideologies is of a minimum state. This and the 2012 Health and Community
Care Act stripped all the of infrastructure of public health, these are some of the
reasons why the UK has a terrible response to this virus and one of the highest
deaths tolls in the World.
They the Government have run down the health and terrain of the people – too
much deliberate poverty , deprivation , lack of nutritious food, poor housing
poor health conditions, racialism and discrimination , lack of community
resources in deprived areas – hence widening inequalities in health and
inequalities in morbidity , inequalities in mortality and morbidity are stalk in
the UK In the last 42 years and particularly since 2010 deliberate policies to
make rich richer and poor poorer Co vid deaths were highest in poorer, and
BAME communities and this included at work. The poor and BAME were often
on the front line, keeping the country running, nine Arriva Merseyside bus
drivers died from covid.
The Government Ignored the 2016 Cygnet report findings for pandemics,
report spoke of lack of PPE, and public health, integrated preparedness, lack of
public health /Local authority infra structures lack of personal. There is a lack
of GP’s doctors environmental health officers, local public health resources all
been deliberately been run down and starved of adequate funding. Up-stream
has become dominated by downstream for a long time. Nothing done about
Cygnet report – criminal and someone needs to be prosecuted under corporate
manslaughter, crime and a violation (stalk inequalities in mortality and
morbidity) of people's human rights, surely the right to health is an intrinsic
From 2003 closed 60 public health labs and the environmental protection
agency done away with. So, when pandemic which had been predicted, hit
inadequate preparedness. Johnson when elected leader of conservatives in 2019,
one of his first decisions was get rid of the pandemic committee, why?
Running down NHS staff vacancies, many inverse care laws so those who need
care most get least, GP’s Environmental health officers, other doctors, public
health personal cut to minimum - too much emphasis on health services instead
of upstream public health and social models of health – expecting a magic
bullet the vaccine to solve all the problems. Health is mainly to do social
economic political social justice and environmental health issues, the health
also of the environment.
Should never have stopped lock down in early December 2020. Q. why did
come out of it, shopping? Christmas? Should have remained in lock-down, the
R number too high should have given clear message about Christmas no mixing
at all even on Christmas day – too late in stopping 4 day intended mixing,
people did mix.
They were far too late to lock down in January 2021 why did they open upon
December is a tragedy which led to many deaths.
Lock down in March 2020 four weeks too late – governing idea in public health
(practical shoe leather and upstream public health) is to get the R number as
low as possible by the above measures – aim should be to try and eliminate covid 19 or get R number below 0.1 this is something we as a country we didn't
do as of 10 march 2021 still haven’t got test track isolate right
Not enough attention given to air flowing in building (demonstrates again a lack
of environmental health savvy) should have been compulsory to open windows
e.g., on buses don't rely on artificial air conditions may spread co-vid also
haphazard approach to masks should have been introduced for all in February
2020. When UK introduced masks about a year too late.
UK came out of first lock down too early R number far too high nearer to one
needed to aim for 0.l and below now variants given the opportunity to
development and have which may make the vaccine less effective in the long
Government responsible for 20,00 deaths in transferring Covid 19 patients
from hospitals into care homes, releasing infected people into care homes, who
is going to take responsibility for this?
In the last 40 years increasingly privatised (care homes)
and used temporary staff who travelled to different care homes increasing
infection spread– generally there was lack of appropriate PPE in care homes.
The “eat out scheme” of summer 2020 was a disaster in terms of covid spread.
Also, the Government allowing people to go abroad in summer late summer of
2020 a disaster and wrong, should have had a total ban on foreign travel.
Should not in September 2020 allowed all children to go back to school and
allowed students to travel to universities from all over the country – maybe they
should have stopped universities for a year.
Locked down 5 weeks to late in October 2020 -still had not got R number
Government’s decisions lack of decisions confusing messages and delaying
decisions, has paved the way to this crisis
Q why did they open up from lock-down in December 2020 when R
number far too high
Q. why did they drop 2 metre rules to one?
thus, increasing likelihood of new variants to develop
no local preventive up stream public health approach. The Government is
relying on a magic bullet – the vaccine.
From 1850 to 1945 most respiratory diseases fell due to better public health
and state intervention, better nutrition, before vaccination see Thomas
McKeown 1974 The Role of Medicine.
Why has New Zealand (an island like the UK) had only 25 deaths they had
early travel ban and good quarantine
UK has no clear plan to get R down below 0.1 no border policy still as of
11/3/21 no comprehensive border control and quarantine, no expert local
authority led track trace and isolation of contacts.
We paid for summer holidays with winter deaths
why do other countries like Finland Norway who have deaths below 500
offer generous isolation allowances.
The dominant ideology neo -liberalism has a negative view of liberty
individualistic not the common good or all citizens flourishing and equal
opportunities, in UK privilege is often mistaken for talent e.g., Johnson.
Why did it take months for the UK Government to inform local authorities
about people who had tested positive for Covid, and why no notification to
environmental health officers and local directors of public health?
The semi privatising health and social care act 2012 reduced finance to
and fragmented public health – why?
Public health England lacks independence from government doesn't
critique or speak up enough for the people’s health, public health, too quiet
about inequities the causes of inequalities in health, poor work conditions
overcrowding air pollution, poor housing – why – clinicians or too strong
links to big pharm, not practical public health people.
This has big implications for how we decide who specialises in public
health. Should select people on their knowledge and practical experience of
shoe leather up stream public health not on psychometric testing – Johnson
is responsible for all these deaths but public health England didn't have a
good early pandemic many examples e.g., telling people it was alright to
have Liverpool football match, evidence of lack of knowledge of proper
public health.
Why did government abandon testing on the 12 march 2020 because
probably for the last ten unnecessary austerity years they had run down
local authorities’ public health and fact that councils didn't have enough
money to employ more environmental health officers – government wants a
minimal state and laissez faire part of its dominant ideological madness.
As Albert Camus in the plague correctly stated (pandemics) “it brings the
hidden truth of a corrupt world to the surface) and death making, (TW)
lots of it.
Why did the government ignore and starve local authorities and spent
billions (37 billion on ineffective test track and trace) giving money to its
private chums and friends and the money spent was very poor service for
the amount spent – robbery and corrupt, Camus was right.
Why in the budget of March 2021 did the government give 30 out of 36
areas (areas which voted conservative and not in the top deprived areas,
e.g., Richmond - were was the money to Liverpool or Knowsley and other
deprived and cash starved areas by the cons in last ten years?
Why from 2010 the greater the need the greater the reduction in money
why – in poorer areas more social care cuts compared to rich areas so govt
deliberately creating inequities all the time.
IN last 250 years, 200 of them UK been in debt, in 1945 seven times more in
debt than 2009 but promoted the common good and created NHS and
other welfare in 2010 the conservative dominated coalition decide to
cripple the poor, the disabled the marginalised and cripple they did – hence
the low terrain of many sectors of society when the predicted pandemic
It was reported on 10 March 2021, concern over the findings in the new
report from the Public Accounts Committee (PAC) on the Government’s
flagship Test and Trace programme.
Set up to support efforts to tackle the COVID-19 pandemic, NHS Test and
Trace was designed to give a clear picture of the spread of the virus, allowing
the Government to target specific households and areas for isolation and lock
down measures.
The programme has cost £37bn, with most of the funds being spent on labs,
testing systems, and a 12,000 strong contact tracing team. {(who have done
very little tracing and isolating people virtually redundant but getting paid –
amateurs not experts in test track trace and isolate)
However, the report from the PAC has outlined serious concerns over the
reliance on an expensive army of consultants, the lack of scrutiny for the
awarding of private sector contracts, and repeated missed targets to process
tests in 24 hours.
These finding are perhaps not surprising.
Since last spring, organisations like the Directors of public health the Charted
Institute of environmental health CIEH has been calling for the UK
Government and Public Health England to utilise existing local networks and
expertise when creating their test and trace system. They also offered hundreds
of Environmental Health Practitioners as volunteers to support the setting up of
the system.
Unfortunately, government was wedded to pursuing an overly centralised
approach from the very beginning and chose to ignore existing structures
(structures they had run down but still available). Deciding to build this all from
scratch, instead of working with local authorities, has obviously proven to be
very costly.
There is still time for the government to change, the Government needs to focus
on working with local authorities going forward, and to ensure that the
significant resource put into NHS Test and Trace is also made available to
support local efforts.
This is all deliberate to privatise the NHS further maybe offering NHS workers
only 1 % was a deliberate act to increase discontent leading to an explosion of
health leavers so they can privatise more – what do you think?
So, who is responsible for 200,000 deaths – I know who is? Another example of
structural violence by the state on the people particularly since 2010 – we need
a revolution for health and all flourishing.
Gultung 1969 violence peace and peace research 2014-15 Journal of peace
research 6(3) : 167-91
Mckeown T, The role of Medicine Basil Blackwell

Christine Arrowsmith

Retired IT Professional,
Comment date
08 July 2023

I was locked down by the NHS. I received a number of letters and at one point was asked to save the NHS postage and paper costs by handing over my email address. As an ex-IT professional of course I have an email address.
I then received an email. Two weeks later I received the same message in a large print letter, so more paper and postage. That continued up to the final letter!
This is not the only transfer to using technology the NHS has done.

Michael Burt

Comment date
07 July 2023

We need a health service that is under democratic control NOT a free market system like the American 's Have The Conservatives have deliberately pushed the NHS in that direction because they can then wash their hands of it And Say Not MY fault nothing to do with us. What do they think they are so highly paid for, to sit and talk nonsense in the commons telling untruths for a pastime and expect us the taxpayer to cough up taxes to keep them in the lifestyle they have become accustomed to. Well you Idiots need to think again!

Nick Mann

GP and MSK Specialty Doctor/Osteopath,
Comment date
07 July 2023

A welcome intervention. I disagree only with two points:
Behaviour of government 2010-23 demonstrates the inexorable will of Tories to transform the NHS into a capitalist enterprise, using tried and tested method. Evidence favours the socialist model and planning for this is incumbent on those seeking change for the better. Nor is a royal commission necessary.
So less emphasis on cross-party impediment and models nonsense.
Also tech: implementation is fundamentally key and currently we have Palantir and Babylon in pole positions, with a government led by the nose by industry.

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