Multi-year funding increases and a series of reforms resulted in major improvements in NHS performance between 2000 and 2010, but performance has declined since 2010 as a result of much lower funding increases, limited funds for capital investment, and neglect of workforce planning. Constraints on social care spending has also resulted in fewer people receiving publicly funded social care and a repeated cycle of governments promising to reform social care but failing to do so.
The health and social care sector now finds itself facing unprecedented challenges, from increasing demand and growing waiting lists, to a workforce in crisis. This paper, from former Chief Executive of The King’s Fund Chris Ham, analyses how a major public service that is highly valued by the public was allowed to deteriorate. It focuses on the period since 2010 and the factors that contributed to the decline of the NHS after the progress that had been made in the previous decade.
While the current situation can feel overwhelming, the improvements that occurred between 2000 and 2010 show that change is possible where the political will exists. The paper concludes by setting out what now needs to be done to sustain and reform the NHS, with a focus on spending decisions, moderating demand and sharing responsibility with patients and the public, alongside a long-term perspective.
As with all previously privatised industries a period of managed decline prior to being off-loaded to private sector.
People are dreaming if they believe the Tories have any other agenda
I would like to praise the NHS, however its affect on my life has been disastrous, in 2000 I had a motorbike accident and although I visited the hospital nothing was found to be wrong and a week later I was back at work, still a little stiff but walking, however, problems got worse and doctors failed to find a cause until one said my legs were weak which made me laugh as I trained regularly and lifted high weights and large reps and finally they put a camera in and found I had snapped a ligament, 5 years had pasted since my accident and I now had my own business and expecting to be unable to work effectively for 3 months I took extra staff on to cover me while I was unable to work thinking I would just answer the phone and run the business, but this was not the case. When I spoke to the surgeon I was informed 18 month minimum and this was just before operation, there was no way my business could survive this and I had no option to close and go bankrupt, DWP refused me benefits and I was actually released from my bankruptcy before I got anything from them, if it had not been for my father I would have starved to death within the 6 months it took them to wake up to my predicament.
It did not end there, doctors told me not to train until 18 months where they declared me fit for work even though 1 leg was half the size of the other, there was no way I could do my trade fixing cars but DWP said if I don't get a job they will stop my benifits so I got a job at the post office and although I never got back to the gym because I was too tired after being at work a more serious problem was on it's way when I injured my back, doctors failed to listen to my concerns and said it was a deep muscle tissue tear, they stated this in court, failed to list my many visits to them failed to list all the sick notes and even lied stating physiotherapy to be successful which is far from what I would have said. I had loads of time off and Royal Mail sent me packing with ill health retirement and the doctors declared me fit for work in 2016 when I signed on and this lead to my second bankruptcy and despite my best efforts they refused help, eventually I have had an MRI on 24/5/2023 14.5 years after my accident and my back is broken and even after telling my GP I was still refused painkillers until the consultant over the hospital put his findings on the system nearly 2 months after.
I've suffered considerable pain for about 23 years been made bankrupt twice have not received the benifits I think I should be entitled to as I am refused mobility help and I am expecting to loose my council house that I cant afford all because of the NHS, but every solicitor I have spoken to wont take the case on because of the legal aid system.
The NHS is a failure pure and simple
I would like to praise the NHS, however its affect on my life has been disastrous, in 2000 I had a motorbike accident and although I visited the hospital nothing was found to be wrong and a week later I was back at work, still a little stiff but walking, however, problems got worse and doctors failed to find a cause until one said my legs were weak which made me laugh as I trained regularly and lifted high weights and large reps and finally they put a camera in and found I had snapped a ligament, 5 years had pasted since my accident and I now had my own business and expecting to be unable to work effectively for 3 months I took extra staff on to cover me while I was unable to work thinking I would just answer the phone and run the business, but this was not the case. When I spoke to the surgeon I was informed 18 month minimum and this was just before operation, there was no way my business could survive this and I had no option to close and go bankrupt, DWP refused me benefits and I was actually released from my bankruptcy before I got anything from them, if it had not been for my father I would have starved to death within the 6 months it took them to wake up to my predicament.
It did not end there, doctors told me not to train until 18 months where they declared me fit for work even though 1 leg was half the size of the other, there was no way I could do my trade fixing cars but DWP said if I don't get a job they will stop my benifits so I got a job at the post office and although I never got back to the gym because I was too tired after being at work a more serious problem was on it's way when I injured my back, doctors failed to listen to my concerns and said it was a deep muscle tissue tear, they stated this in court, failed to list my many visits to them failed to list all the sick notes and even lied stating physiotherapy to be successful which is far from what I would have said. I had loads of time off and Royal Mail sent me packing with ill health retirement and the doctors declared me fit for work in 2016 when I signed on and this lead to my second bankruptcy and despite my best efforts they refused help, eventually I have had an MRI on 24/5/2023 14.5 years after my accident and my back is broken and even after telling my GP I was still refused painkillers until the consultant over the hospital put his findings on the system nearly 2 months after.
I've suffered considerable pain for about 23 years been made bankrupt twice have not received the benifits I think I should be entitled to as I am refused mobility help and I am expecting to loose my council house that I cant afford all because of the NHS, but every solicitor I have spoken to wont take the case on because of the legal aid system.
The NHS is a failure pure and simple
Shared responsibility would also mean the NHS takes responsibility - something it has a track record of not doing for its patients.
I worry with this responsibility ethos that it is another avenue to blame patients when things go wrong and therefore not help them. There's been plenty of NHS adverts blaming patients for ruining the NHS (the A&E time wasters one stands out in particular).
This elitism of assuming what is best for us is awful because it doesn't work. This paper doesn't mention NHS culture that has created illness, addiction (lots of opiate prescriptions without med reviews) and hurt in the patient population that's created a cyclical illness that wasn't there as much before. There's a lot missing from the perspective of the people who actually use this service who could bring new ideas.
Also, that rhetoric from a comment about the public taking advantage etc, this is the type of propaganda I'm talking about, it's shaming us to accept poor care and bullying. I'm always grateful for my medical treatment, I'm never grateful for being made to beg for it, being ignored, insulted or allowed to get sicker in the process of getting that treatment.
I’m actually Amazed that one of the Comments above says we Shouldn’t just take the NHS for Granted ? We don’t we have paid High Taxes & National Insurance Contributions for very many Years. These are what used to be put into our NHS. So People are paying for the NHS. So if we are still paying All these taxes & contributions Why are they NOT being put into our NHS ? Deliberate Underfunding is happening ? If underfunding with Our tax money is Happening where is our Tax & NI money Going ? Being spent ? Because it’s not being spent where it should be is it ? No of course Not. So this Conservative Government are going to be having us Pay twice, with our Taxes & NI contributions But also Soon to be wanting us to Pay separate Private Healthcare Insurance too. I say what about the Families that can’t afford that ? Will they Not get healthcare of any type ? Even though they may still be paying Tax & NI contributions ? Where will That money be going ? I feel this is like the biggest Fraud a Government can do to its people. It’s also very Alarming the Conservatives are doing this to us after under funding our NHS service for the Last 10 Years. I myself have seen a major decline in All medical services available to the public. Even though that Public has paid more out towards it. That money therefore should have put it into the NHS so No reason to underfund. You can’t tell me there is a reason for this how ever hard you try to tell me there is. What have the Conservatives Been doing with All this Money ? They have good wage rises,their Utilities paid for & actual exorbitant Expenses Claimed. Is that where our taxes are being Spent ? Because that’s not what we pay taxes for. Greed/Gluttony is one of the Sins of which the Conservatives seem to have. Also over the Covid time the Billions of our tax payers money lost on equipment PPE was not only negligent but also some cases Fraudulent. But as time goes by these people are not even being brought to Justice for their Fraudulent activities. Why Not ? Is it another Loophole that they discovered ? Laws can be changed. Michelle Mone should be brought/taken to Court for her lies and Fraud so to should the others. You The Conservatives have allowed this to happen & You can change the Laws to Stop this But have chosen not to at this time Why ?
As expected, an accurate and challenging analysis but the steps now required are incomplete. We are unlikely to create a service which "puts health improvement at the heart of the NHS' unless financial systems are changed to dis-incentivise hospital admission and local NHS bodies created with clear accountability for health gain within a defined population.
Without economic growth (which stalled after 2008) the only way departmental spending can rise is through taxation. Taxation is already higher than for many years. Add to this the demography of less younger workers and more retirees. The sums don't work and will get worse. The basic tenets on which the 'Welfare State' was founded (and with it the NHS - Assumption B; Beveridge) no longer hold. More money on its own can not be an answer. Is it in the final bullet point that a new reality will need to sit?: "The public must be fully engaged in improving health and care, and patients and the public seen as active agents in their care, with responsibilities as well as rights."
An insightful and thought provoking analysis from Chris Ham. It was pleasing to see references to prevention, the public health grant and to pressures on wider issues such as housing. However, the analysis probably underplays the huge challenges on local authority budgets overall. These are largely driven by challenges of meeting unfunded care needs for children and adults, but as convenors of place, everything local authorities do creates the conditions for health. Interesting to see Wanless referenced. Considering what the Wanless recommendations would translate to in 2023+ would be an interesting excercise.
To my mind three major Strategic factors, Funding, Workforce training, cultural change in Management. Lack of Funding in particular has had major knock on adverse effects on the latter two. Perhaps something to be learnt from International Benchmarking. France and Germany both have better per capita hospital bed and Doctor, Nurse, Midwife ratios. They both have Insurance Schemes. In addition local authority as not adequately provided for Social care and been afraid to raise local taxation. The UK population have taken for granted the NHS -there is possibly a need to win the population over to contributing more. The Nation need to also consider just what treatments the NHS provides for. Rationing? It’s possibly already there. How long is it going to turn the super tanker of the NHS round. Well how long does it take to build new hospitals, repair the existing estate. Train new doctors, nurses et al and change the culture so that we encourage and retain people to work in the NHS. At least a couple of Parliamentary terms. That’s another fundamental problem.
T R C Fletcher
The NHS has been gutted by the current government, no doubt to be offloaded to the private sector, which was the plan for sometime. There have, are there still are, talks with American Insurance Companies to secure the NHS as part of the American Trade Agreement. The current government are trying to gaslight the electorate into this dreadful situation, where the ethos and spirit of the NHS will be decimated. The RCN members have indicated to the "conservative" RCN leadership, that we will not be bullied or coerced into agreeing to the RCN and government paltry offer. We stand with the BMA and the junior doctors as screaming the reality of what is the danger to patients, namely the government. This paper shows the reality of the sham that is the current government and it's ill considered, rundown of the NHS.
Comments
As with all previously privatised industries a period of managed decline prior to being off-loaded to private sector.
People are dreaming if they believe the Tories have any other agenda
I would like to praise the NHS, however its affect on my life has been disastrous, in 2000 I had a motorbike accident and although I visited the hospital nothing was found to be wrong and a week later I was back at work, still a little stiff but walking, however, problems got worse and doctors failed to find a cause until one said my legs were weak which made me laugh as I trained regularly and lifted high weights and large reps and finally they put a camera in and found I had snapped a ligament, 5 years had pasted since my accident and I now had my own business and expecting to be unable to work effectively for 3 months I took extra staff on to cover me while I was unable to work thinking I would just answer the phone and run the business, but this was not the case. When I spoke to the surgeon I was informed 18 month minimum and this was just before operation, there was no way my business could survive this and I had no option to close and go bankrupt, DWP refused me benefits and I was actually released from my bankruptcy before I got anything from them, if it had not been for my father I would have starved to death within the 6 months it took them to wake up to my predicament.
It did not end there, doctors told me not to train until 18 months where they declared me fit for work even though 1 leg was half the size of the other, there was no way I could do my trade fixing cars but DWP said if I don't get a job they will stop my benifits so I got a job at the post office and although I never got back to the gym because I was too tired after being at work a more serious problem was on it's way when I injured my back, doctors failed to listen to my concerns and said it was a deep muscle tissue tear, they stated this in court, failed to list my many visits to them failed to list all the sick notes and even lied stating physiotherapy to be successful which is far from what I would have said. I had loads of time off and Royal Mail sent me packing with ill health retirement and the doctors declared me fit for work in 2016 when I signed on and this lead to my second bankruptcy and despite my best efforts they refused help, eventually I have had an MRI on 24/5/2023 14.5 years after my accident and my back is broken and even after telling my GP I was still refused painkillers until the consultant over the hospital put his findings on the system nearly 2 months after.
I've suffered considerable pain for about 23 years been made bankrupt twice have not received the benifits I think I should be entitled to as I am refused mobility help and I am expecting to loose my council house that I cant afford all because of the NHS, but every solicitor I have spoken to wont take the case on because of the legal aid system.
The NHS is a failure pure and simple
I would like to praise the NHS, however its affect on my life has been disastrous, in 2000 I had a motorbike accident and although I visited the hospital nothing was found to be wrong and a week later I was back at work, still a little stiff but walking, however, problems got worse and doctors failed to find a cause until one said my legs were weak which made me laugh as I trained regularly and lifted high weights and large reps and finally they put a camera in and found I had snapped a ligament, 5 years had pasted since my accident and I now had my own business and expecting to be unable to work effectively for 3 months I took extra staff on to cover me while I was unable to work thinking I would just answer the phone and run the business, but this was not the case. When I spoke to the surgeon I was informed 18 month minimum and this was just before operation, there was no way my business could survive this and I had no option to close and go bankrupt, DWP refused me benefits and I was actually released from my bankruptcy before I got anything from them, if it had not been for my father I would have starved to death within the 6 months it took them to wake up to my predicament.
It did not end there, doctors told me not to train until 18 months where they declared me fit for work even though 1 leg was half the size of the other, there was no way I could do my trade fixing cars but DWP said if I don't get a job they will stop my benifits so I got a job at the post office and although I never got back to the gym because I was too tired after being at work a more serious problem was on it's way when I injured my back, doctors failed to listen to my concerns and said it was a deep muscle tissue tear, they stated this in court, failed to list my many visits to them failed to list all the sick notes and even lied stating physiotherapy to be successful which is far from what I would have said. I had loads of time off and Royal Mail sent me packing with ill health retirement and the doctors declared me fit for work in 2016 when I signed on and this lead to my second bankruptcy and despite my best efforts they refused help, eventually I have had an MRI on 24/5/2023 14.5 years after my accident and my back is broken and even after telling my GP I was still refused painkillers until the consultant over the hospital put his findings on the system nearly 2 months after.
I've suffered considerable pain for about 23 years been made bankrupt twice have not received the benifits I think I should be entitled to as I am refused mobility help and I am expecting to loose my council house that I cant afford all because of the NHS, but every solicitor I have spoken to wont take the case on because of the legal aid system.
The NHS is a failure pure and simple
Shared responsibility would also mean the NHS takes responsibility - something it has a track record of not doing for its patients.
I worry with this responsibility ethos that it is another avenue to blame patients when things go wrong and therefore not help them. There's been plenty of NHS adverts blaming patients for ruining the NHS (the A&E time wasters one stands out in particular).
This elitism of assuming what is best for us is awful because it doesn't work. This paper doesn't mention NHS culture that has created illness, addiction (lots of opiate prescriptions without med reviews) and hurt in the patient population that's created a cyclical illness that wasn't there as much before. There's a lot missing from the perspective of the people who actually use this service who could bring new ideas.
Also, that rhetoric from a comment about the public taking advantage etc, this is the type of propaganda I'm talking about, it's shaming us to accept poor care and bullying. I'm always grateful for my medical treatment, I'm never grateful for being made to beg for it, being ignored, insulted or allowed to get sicker in the process of getting that treatment.
I’m actually Amazed that one of the Comments above says we Shouldn’t just take the NHS for Granted ? We don’t we have paid High Taxes & National Insurance Contributions for very many Years. These are what used to be put into our NHS. So People are paying for the NHS. So if we are still paying All these taxes & contributions Why are they NOT being put into our NHS ? Deliberate Underfunding is happening ? If underfunding with Our tax money is Happening where is our Tax & NI money Going ? Being spent ? Because it’s not being spent where it should be is it ? No of course Not. So this Conservative Government are going to be having us Pay twice, with our Taxes & NI contributions But also Soon to be wanting us to Pay separate Private Healthcare Insurance too. I say what about the Families that can’t afford that ? Will they Not get healthcare of any type ? Even though they may still be paying Tax & NI contributions ? Where will That money be going ? I feel this is like the biggest Fraud a Government can do to its people. It’s also very Alarming the Conservatives are doing this to us after under funding our NHS service for the Last 10 Years. I myself have seen a major decline in All medical services available to the public. Even though that Public has paid more out towards it. That money therefore should have put it into the NHS so No reason to underfund. You can’t tell me there is a reason for this how ever hard you try to tell me there is. What have the Conservatives Been doing with All this Money ? They have good wage rises,their Utilities paid for & actual exorbitant Expenses Claimed. Is that where our taxes are being Spent ? Because that’s not what we pay taxes for. Greed/Gluttony is one of the Sins of which the Conservatives seem to have. Also over the Covid time the Billions of our tax payers money lost on equipment PPE was not only negligent but also some cases Fraudulent. But as time goes by these people are not even being brought to Justice for their Fraudulent activities. Why Not ? Is it another Loophole that they discovered ? Laws can be changed. Michelle Mone should be brought/taken to Court for her lies and Fraud so to should the others. You The Conservatives have allowed this to happen & You can change the Laws to Stop this But have chosen not to at this time Why ?
As expected, an accurate and challenging analysis but the steps now required are incomplete. We are unlikely to create a service which "puts health improvement at the heart of the NHS' unless financial systems are changed to dis-incentivise hospital admission and local NHS bodies created with clear accountability for health gain within a defined population.
Without economic growth (which stalled after 2008) the only way departmental spending can rise is through taxation. Taxation is already higher than for many years. Add to this the demography of less younger workers and more retirees. The sums don't work and will get worse. The basic tenets on which the 'Welfare State' was founded (and with it the NHS - Assumption B; Beveridge) no longer hold. More money on its own can not be an answer. Is it in the final bullet point that a new reality will need to sit?: "The public must be fully engaged in improving health and care, and patients and the public seen as active agents in their care, with responsibilities as well as rights."
An insightful and thought provoking analysis from Chris Ham. It was pleasing to see references to prevention, the public health grant and to pressures on wider issues such as housing. However, the analysis probably underplays the huge challenges on local authority budgets overall. These are largely driven by challenges of meeting unfunded care needs for children and adults, but as convenors of place, everything local authorities do creates the conditions for health. Interesting to see Wanless referenced. Considering what the Wanless recommendations would translate to in 2023+ would be an interesting excercise.
To my mind three major Strategic factors, Funding, Workforce training, cultural change in Management. Lack of Funding in particular has had major knock on adverse effects on the latter two. Perhaps something to be learnt from International Benchmarking. France and Germany both have better per capita hospital bed and Doctor, Nurse, Midwife ratios. They both have Insurance Schemes. In addition local authority as not adequately provided for Social care and been afraid to raise local taxation. The UK population have taken for granted the NHS -there is possibly a need to win the population over to contributing more. The Nation need to also consider just what treatments the NHS provides for. Rationing? It’s possibly already there. How long is it going to turn the super tanker of the NHS round. Well how long does it take to build new hospitals, repair the existing estate. Train new doctors, nurses et al and change the culture so that we encourage and retain people to work in the NHS. At least a couple of Parliamentary terms. That’s another fundamental problem.
T R C Fletcher
The NHS has been gutted by the current government, no doubt to be offloaded to the private sector, which was the plan for sometime. There have, are there still are, talks with American Insurance Companies to secure the NHS as part of the American Trade Agreement. The current government are trying to gaslight the electorate into this dreadful situation, where the ethos and spirit of the NHS will be decimated. The RCN members have indicated to the "conservative" RCN leadership, that we will not be bullied or coerced into agreeing to the RCN and government paltry offer. We stand with the BMA and the junior doctors as screaming the reality of what is the danger to patients, namely the government. This paper shows the reality of the sham that is the current government and it's ill considered, rundown of the NHS.
Add your comment