It is time to face up to the difficult questions facing the NHS

Miriam Deakin profile picture

08 October 2019

Miriam Deakin
Director of Policy and Strategy


When you step back and look at the bigger picture it becomes strikingly apparent that we are at a point of political and social flux, and a time of considerable uncertainty for the NHS and public services more generally.

Against the hazy backdrop of a potential general election – the third in five years – and the all-consuming polarised debate about the country’s relationship with the European Union, the NHS is seeking to address big questions about how it remains sustainable and meets the needs of the public in future years.

The NHS is seeking to address big questions about how it remains sustainable and meets the needs of the public in future years.

Miriam Deakin    Director of Policy and Strategy

The NHS, rightly, remains our national religion. There continues to be strong public support for the founding principles of the NHS – free at the point of use and universal service. The current government has placed the NHS at the top of its domestic priorities. And trusts have welcomed increases in funding compared with other public services and an ambitious plan for the next decade.

But it would be wrong to assume that the NHS is 'sorted'. While welcome, the £20.5bn funding settlement committed by the last government does little more than to cover rising costs and demand. There’s a lot of catching up to be done to recover performance. Worryingly, the most recent British Attitudes Survey showed that overall satisfaction with the NHS had slipped to the lowest level in a decade amid lengthening waiting times and staff shortages. These worries reflect those of NHS trust leaders.

National conversation

In our latest The state of the NHS provider sector report, it is telling that 91% of trust leaders are worried that there hasn’t been the full, frank and open national conversation about the severe pressures facing the NHS and how much these constrain what it can deliver.

It is telling that 91% of trust leaders are worried that there hasn’t been the full, frank and open national conversation about the severe pressures facing the NHS

Miriam Deakin    Director of Policy and Strategy

These pressures are well known. The NHS faces a triple whammy of rapidly rising demand – 9% over the last three years alone – against over 100,000 vacancies across the NHS and the need to recover from the longest and deepest funding squeeze in NHS history. Current performance levels have slipped to the worst levels in a decade, and the approach of surviving off the goodwill of dedicated and hard-working NHS staff is simply unsustainable.

Trust leaders are warning that the neglect of other critical areas of public expenditure is ebbing away their confidence in delivering the ambition of the NHS long term plan. This includes a built-up £6bn backlog maintenance bill, of which £3bn is safety-critical, and years of funding restraint in an adult social care sector on the verge of collapse, as well as vital public health and prevention services, which should be at the heart of future service delivery.

Trust leaders are warning that the neglect of other critical areas of public expenditure is ebbing away their confidence in delivering the ambition of the NHS long term plan.

Miriam Deakin    Director of Policy and Strategy

Only 29% of trust leaders are confident of making the necessary progress towards 'system working' in the next 12 months, while more than half don't believe the necessary support is in place to properly join up working between GPs and hospital and community care.

Uncomfortable truths

The uncomfortable truth is that despite the enduring power of the universal NHS offer, despite the superhuman effort at the frontline and despite the range of positive achievements we can point to, including a long term plan with worthy aspirations, overall, the NHS is not currently performing as well as it needs to. This is not a source of pride for anyone that works in the NHS.

Unless politicians level with the public about what the NHS can deliver and how quickly, we risk damaging public trust and faith in the NHS. A trust leader recently told me that we are “not anywhere near” having the sort of conversation we need about the choices and challenges ahead, while another leader decried the quality of political discussion about the service and social care as an “embarrassment”.

Unless politicians level with the public about what the NHS can deliver and how quickly, we risk damaging public trust and faith in the NHS.

Miriam Deakin    Director of Policy and Strategy

It’s an uncomfortable debate to have. The government wants to be seen as an effective steward of the NHS. NHS England and Improvement want to lead the service effectively. And frontline leaders want to provide outstanding care to every patient. But we need greater realism about how much the NHS can deliver, and how quickly, given where we currently are and the challenges we face.

We have to ask difficult questions about growing demand and an ageing population. If our health and care system is already struggling when we are at the beginning of the demand bulge, what will it look like in five, eight, ten, years’ time, when we’re in the middle of that bulge?

If our health and care system is already struggling when we are at the beginning of the demand bulge, what will it look like in five, eight, ten, years’ time?

Miriam Deakin    Director of Policy and Strategy

In this uncertain pre-election period, we know that the NHS remains at the heart of public concern and affection. Make no mistake the NHS will be as important in the next election as any other. Research from the King’s Fund shows, despite Brexit, concern for the NHS has not gone away and continues to cross traditional political divides. It is still the second most important issue after Brexit as cited by 43% of respondents.

These findings also indicate that the funding settlement has had little effect on public concerns about workforce and funding concerns on the back of growing waiting time and slipping performance. It is time that patients, NHS staff and taxpayers got honesty, realism and transparency about what the NHS needs to meet the challenges of tomorrow.

This was first published in HSJ.

About the author

Miriam Deakin profile picture

Miriam Deakin
Director of Policy and Strategy
@MiriamDeakin

Miriam is our director of policy and strategy and is currently leading our programme of work on sustainability and transformation partnerships and accountable care to inform our influencing activities on trusts’ behalf and ensure we are offering the support that trusts and their partners need to deliver new, collaborative arrangements. Read more

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