In the lead-up to the UK’s general election tomorrow (4 July), the country’s National Health Service (NHS) has been in the spotlight, with political parties pledging a variety of policies to address its issues.
A 2023 YouGov survey found that one in eight Britons had turned to private healthcare in the previous 12 months, in part due to chronic waiting times and a lack of access to public services.
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While political parties are courting voters with eye-catching numbers and projects to fix the NHS, think tanks have identified that these lack comprehensive planning to address the severity of the problems.
The state of the NHS
Policy analyst Danielle Jefferies, from health-system-focused think tank the King’s Fund, describes the NHS as being in a “position of crisis.”
“For the last decade, we’ve seen declines in performance across all areas of the NHS – everything from elective waits, A&E waits, ability to see a GP, dentistry. Pretty much across the whole NHS, we’ve seen a decline,” she says.
“It’s going to be a huge pressure and strain on anyone waiting on that list. They might have had their operations cancelled. They might have been on the list for months, even years, and it’s probably going to have a huge impact on them, on their day-to-day lives.”
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By GlobalDataData analysis of NHS statistics in the Institute for Government’s report The Precarious State of the State displays the scale of the decline, with each category showing a significant decline in the organisation’s ability to service demand since 2011.
Stuart Hoddinott, senior researcher at the Institute for Government (IfG) explains that the chronic wait times in the NHS are caused by a combination of factors including poor patient flow, underinvestment in physical capital, equipment and IT systems, a lack of management and administrative staff as well as competing and confusing priorities.
Jefferies highlights that a combination of austerity causing a lack of funding for the system and an ageing population have combined to create pressure on the NHS that is only set to increase. He stresses that, on top of a huge backlog, the physical infrastructure and equipment of the NHS need serious attention, with an estimated £11.6bn investment required.
With demand outstripping the growth of the workforce, there simply are not enough staff to service the UK’s need for medical attention. Moreover, Jefferies highlights how burnt out the current workforce is, which means the system is struggling to retain or attract enough practitioners.
While the NHS staff survey indicates that roughly three in 10 NHS staff thinking of leaving the organisation, Jefferies notes that while some of these staff are thinking of moving to the private sector, private healthcare in the UK is still a relatively small sector in comparison, so not everyone that would want to move could.
An increased demand for private healthcare?
Data from Private Healthcare Information Network found that private hospital admissions were at record levels in 2023, with 900,000 admissions to private hospitals in 2023, with a rise in both insured and self-paid admissions.
Media coverage suggests that the chronic wait times are causing a rise in demand for private healthcare, with some suggesting this could help to alleviate the burden on the NHS.
Various speakers also emphasise that, with the backdrop of the cost-of-living crisis, people turning to private healthcare in a time when budgets are tighter underscores a desperate need for medical attention.
Although statistics show a rise, IfG’s Hoddinott says it is very difficult to tell if the declining performance of the NHS is fuelling demand for private healthcare due to a lack of consistent data on how many people are using private services. While media coverage of YouGov polling on private healthcare use indicates a rise in people using private services, he says this data should be considered with some caveats.
“It doesn’t give any indication of intensity or type of use,” Hoddinott explains. “Someone could have paid for one private GP appointment and that would have been the first time they used private healthcare. Someone else might have paid for a hip replacement. Those people might have since used the NHS again.”
What needs to be done?
From the King’s Fund’s perspective, Jefferies says there are three areas an incoming government needs to target to begin to solve the issues. Firstly, she states that there needs to be attention given to how to attract and retain a homegrown workforce to meet the demand for the NHS.
Secondly, Jefferies highlights the need for a shift to preventative measures, stating the NHS must shift from thinking about how to just treat people with illness to helping prevent illness in the first place. She explains that there could be measures to help people in their community, more GP practices and district nurses and a more active role for pharmacies, all of which could reduce pressure on the NHS and economy.
Lastly, Jefferies emphasises a need to move care closer to home, refocusing attention onto primary and community care.
Underpinning what could make all of these changes possible, is the need for capital funding. Jefferies acknowledges the difference in economic climate to the early 2000s, noting that, while large cash injections may not be possible, there needs to be planning to ensure the money going into the organisation is being used in the most efficient and productive way.
While the IfG does not make policy recommendations, Hoddinott highlights that stable funding, a greater focus on prevention and tangible reform of adult social care could all help to improve the state of the NHS.
Healthcare pledges
With issues of underfunding, a lack of GPs, long wait times, lack of access to dental care and more, each party is announcing different focuses and plans for how they will address the state of the NHS.
Labour
Recognising the appalling state of the NHS’s waiting list, the Labour Party has pledged to build an NHS “fit for the future” through “fundamental reform”. Part of the party’s transformational aims are plans to cut NHS waiting times with 40,000 more appointments each week, double the number of cancer scanners, enact a new dentistry rescue plan, add 8,500 mental health staff and bring about a return of the family doctor.
Throughout campaigning, Labour dropped the statement “the NHS is not for sale”, stating instead “With Labour, the NHS will always be publicly owned and publicly funded”.
Conservative
The Conservative party manifesto pledges to “continue to increase NHS spending above inflation in each year of the next Parliament”, with plans over the next term to have 92,000 more nurses and 28,000 more doctors.
The party has stated a commitment to building a social care system, delivering 40 new hospitals by 2030, a dental recovery plan and reducing the number of managers in the NHS by 5,500.
Liberal Democrats
During election campaigning the Liberal Democrats have been making headlines promoting their pledge of free personal care.
Alongside this, the party have pledged to give everyone the right to see a GP within seven days, or within 24 hours if they urgently need to, with 8,000 more GPs to deliver on it, improve access to mental health services, guarantee access to an NHS dentist for everyone needing urgent and emergency care, boost cancer survival rates, and help people to spend five more years of their life in good health by investing in public health.
Green
To respond to the NHS crisis which the Green party attributes to Conservative underfunding. The Green party states it is “committed to a fully public, properly funded health and social care system, and to keeping the profit motive well away from the NHS”.
The party has pledged to push for a year-on-year reduction in waiting lists, guaranteed access to an NHS dentist and rapid access to GPs. Alongside this, they have offered an immediate boost to the pay of NHS staff, including the restoration of junior doctors’ pay to help with staff retention.
Response from think tanks
Considering the electoral pledges regarding healthcare Jefferies states: "Each of the different parties are all focusing on slightly different things. They all have some really good policies that tick some of the right boxes, but I think what all of them lack is a comprehensive plan that recognises the scale of the problem that we’re seeing at the moment.”
Similarly, Hoddinott notes that it’s difficult to ascertain which of the party manifestos is most likely to tackle the issues the NHS is facing due to their broad nature and re-announcements of existing policies.
“Both parties (Labour and Conservative) have committed to funding the long-term workforce plan. That alone isn’t enough to fix the problems in the NHS – there have been large increases in hospital staff since 2019 and arguably worse performance. But it is good that they’ve committed to funding it.”
Responding to Labour plans, Jefferies states that the party’s “plan to increase the number of appointments is a good idea and could help bring down the waiting list but there are caveats of how do you get the staff to fill those extra appointments on weekends and evenings, particularly as many NHS staff are feeling undervalued, stretched and unwell?”
Likewise, Thea Stein chief executive of the Nuffield Trust has said: “We support the intention to spend more money on equipment, historically the victim of short-termism. However, the sum of money they are proposing will cover only a limited amount of extra care, not enough for a rapid or sudden improvement.”
Looking at the incumbent party and their previous treatment of the NHS, Jefferies highlights that, while it’s good to see the Conservative Party pledging more GPs and practices, since 2019, GP practice numbers have been falling and it seems consistently difficult to recruit GPs.
Stein, although approving of the Conservative’s aspiration to move care closer to people’s homes also highlights the party’s history of underfunding. “Let’s be under no illusion: these are small-scale proposals and they come after years of money flowing away from community services and towards hospitals,” she says.
On the Liberal Democrats healthcare pledges, Jefferies notes that while their community focus is good to see, their manifesto still lacks detail on how they plan to train and recruit more staff.
“The Liberal Democrats are right to put the desperate need to improve social care as a key part of their election proposals,” says Nuffield Trust fellow Camille Oung. “Free personal care in England could help more people to access some state-funded care, but the costing attached to both this and increasing the pay of care workers looks to be inadequate.”
Overall looking at how well various funding pledges could affect NHS wait times, Jefferies states that it’s important to put funding commitments into scale, adding “This is one of the biggest public services in the world, employing 1.3 million people. It’s 190 billion pounds we spend each year. When you put it in that context those commitments might not be the scale that they sound like initially.”
