The NHS crisis: Does the government have a plan?

Think tank: Institute for Government

Author(s): Stuart Hoddinott

January 26, 2023

This report from UK think tank the Institute for Government looks at the government’s claims for why the NHS crisis is happening and the effect of its response.

The government’s emergency measures to support the NHS will likely be too little and too late to solve this winter’s crisis. The report evaluates the government’s claims for why the NHS crisis is happening and assesses the likely effectiveness of its response – including measures set out in Rishi Sunak’s 4 January speech in which he promised that “waiting lists will fall and people will get the care they need more quickly”. In response to pledges set out by the prime minister, the paper finds that: Increased NHS funding: Inflation and probable 2023/24 and 2024/25 pay award hikes means NHS is still likely to experience a lower real-terms rise in spending than forecast in 2021. 7,000 new hospital beds: An additional 7,000 general and acute beds now would mean that there were still 7.9% fewer than in 2010. To bring capacity back up to 2010 levels would require some 16,423 G&A beds. Beds also require staff to work on them – a resource that is in short supply, with more than 133,000 roles, or 9.7% of the workforce – vacant in September 2022. £700m of funding for social care discharge: Providing funds on a short-term, emergency basis like this makes it hard to spend that money effectively as it is difficult to ramp up social care capacity in a matter of months. Recruiting more doctors and nurses: while there were 27,807 more nurses and 12,027 more doctors working in hospitals in August 2022 compared to March 2019 – an increase of 13.4% and 12.1% respectively – retention has arguably never been worse meaning that the service is experiencing some of the highest vacancy rates on record, with almost one-in-ten posts unfilled.

The paper finds that Sunak was ambiguous enough in the wording of his speech – for example the prime minister referred to both “waiting times” and “waiting lists” – that he will be able to point to almost any improvement, anywhere in the service, at any point between now and the election, as a promise kept. However, “people’s experience of the health service is often deeply personal and many will base their judgments on a much narrower set of performance indicators than the prime minister’s.” It also warns that the crisis will be repeated next winter if the government does not take immediate steps to improve performance in the NHS by addressing the crisis’s underlying causes of poor staff retention, underinvestment in capital, a lack of effective management, inadequate community and social care provision, and a poorly resourced primary care service.