Reaffirming our commitment to the NHS is needed now more than ever

The acute response: Where do we begin?

The BMJ commission recommended a relaunch of a new NHS as a whole country effort, with all the different stakeholders uniting in support of a high-quality accessible health service free at the point of care.2 We also recommended a cross-government and cross-sector strategy for health, care, and wellbeing.

As part of this new approach, the commission proposed that an Independent Office for NHS Policy and Budgetary Responsibility for England be established to provide unbiased, robust reports on health and healthcare.3 A five year detailed strategic plan needs to be created, supported by a robust financial settlement over five to 10 years. However, to tackle the current NHS crisis, the commissioners recommend that we need an immediate cash injection of £32 billion (£37 billion was recommended by the Darzi report) to recover the loss of investment over the decade from 2010 to 2020, in order to help tackle the surgery backlog, the mental health crisis, and improve access to primary care.

With winter coming, the very first steps should be to ensure that basic services are delivered in key places of demand. Following this, immediate priority should be given to tackling inequalities in access and outcomes, with particular attention on the disadvantage and racism experienced by minority ethnic groups both as patients and staff of the NHS.

The strategic response: Removing barriers to providing a comprehensive healthcare system

We identify seven priority areas the NHS plan must tackle, although the vision for the NHS must look beyond 10 years.

1. Effective and efficient allocation of resources across the NHS, particularly in areas of need. The current system is fragmented and requires integration and coordination of care across primary, secondary, and specialised care services, as well as social care. This integration is often lacking, which leads to a disjointed patient experience.

2. Invest in the areas of primary care which lead to a reduction in expensive and inefficient visits to the emergency department, notably improving rapid access to clinicians in the community. Overall, we need to prevent unnecessary admission to hospital and ensure that length of stay is as short as possible. Focus must shift from hospital care to primary and social care. A case can be made for investment in acute hospitals to improve productivity in the shortest time frame. At the same time, new social care interventions can be piloted in specific geographic areas. Successful models should be rolled out more widely based on evidence and financial incentives.

3. A comprehensive healthcare service requires technology that can be used safely and effectively across a whole range of services. These include, for example, electronic care records, online consultations, health apps, and other digital solutions. Artificial intelligence can be used more widely, but its use must be closely governed. However, this will require significant investment, training, and infrastructure support. We must find better ways to connect the NHS to patients, the public, and community groups, particularly to ensure service developments will meet peoples’ needs.

4. Improvements in workforce planning and workforce stewardship are key priorities. We need workplace environments where staff are happy to work, are respected for their rich diversity, and feel valued and proud to work in the NHS.4 Their roles and competencies should be appropriately configured, with sufficient people in these roles to deliver high quality, safe care. Workforce retention is a major cause of staff shortages. We should ensure that career pathways in all roles are attractive, enable career progression, and are financially well rewarded. We need to devise incentives for newly qualified doctors to stay in the NHS for a fixed minimum term, learning from similar incentives used in other professions such as law. The recent move towards a long term pay settlement for junior doctors is a welcome first step.

5. In terms of the social determinants of health that go beyond health service provision, government policy should adopt the Marmot principles.5 These include giving every child the best start in life; fair employment; the prevention of ill health; developing healthy and sustainable places and communities; environmental sustainability; and tackling racism, discrimination, and their outcomes. Commitments should be made to end racial discrimination. Twenty six per cent of the NHS workforce are currently from ethnic minorities, and this is set to increase, so it is vital that this is tackled.6

6. Climate change is no longer a distant threat. It is here. Each place of work in the NHS must commit to short and medium term goals for sustainable practice. The department of health already has a greener NHS website and sustainable practice leads are emerging across the NHS, but there is much still to be done.7

7. To successfully reduce demand on the NHS in the long term, we need to focus on prevention strategies aimed at maintaining population health. The population should be supported with education on healthy lifestyles, eating healthily to prevent obesity, and the beneficial effects of exercise, as well as being given incentives to stop smoking. The government should not be shy about legislating for better health, for example, through taxes and advertising restrictions on harmful products. These “top down” measures should be complemented by community co-produced health creation initiatives, supported by central and local governments and NHS England.8

Staff and government: Winning hearts and minds

The increased spending for the NHS announced in the October 2024 budget provides useful and welcome first steps in the right direction. The three big priorities identified by the government—from hospital to community, from disease to prevention and from analogue to digital—are the right ones. However, staff harbour widespread and understandable fears that the NHS 10 year plan will not be delivered because of day-to-day pressures and a stretched service.

A clear bridge is required between where we are currently to where we need to get to. This bridge needs to be based on creating the conditions for rapid learning and spread of successful whole system pilots, prioritisation of current spending, and incentives to deliver clear short and medium term paths towards the three identified priorities. All of this will require central government to take responsibility to define, promote, and deliver clarity and support for system leadership which is both inclusive and outcome focused.

Medium term investment in the NHS workforce and its infrastructure, in digital health, and in community care must follow the initial cash injection. Crucially, improving population health must be a shared goal across government, and an integral part of every major policy area, including transport, education, housing and social benefits. While the proposed NHS reforms to tackle poor areas of performance are warranted, league tables and naming and shaming risk an overstretched workforce, already operating at the limits of what it can offer, feeling criticised and driving down morale. A positive re-affirmation to an NHS that provides high quality care to all regardless of ability to pay, and a clear commitment to supporting the NHS workforce to help them deliver the high-quality care they want to provide is an essential starting point.