What health and care needs from the next government: #4 Improving access to treatment

The NHS and social care in England are struggling. A combination of sudden shocks from the Covid-19 pandemic and high inflation, and the long-term pressures of poor workforce planning, morale problems, failure to deliver promised efficiency savings and decades of delay in welfare reform, all are doing their damage. . The strains and dysfunction are deep-seated and won't improve anytime soon, and the public can see that clearly: satisfaction with both services is at historic lows. Credible long-term plans to improve this situation are vital for any political leader who wants to win the support of the British people.

Our general election briefing, produced with funding from the Nuffield Foundation, looks at the key issues where we believe a government taking or returning to office needs to act in order to meaningfully improve health and care. The fourth in our series looks improving access to treatment.

Waiting times for healthcare are the single biggest cause of public dissatisfaction with the NHS, according to the British Social Attitudes survey. They are rightly a central battleground in the 2024 general election: delays of months or years in getting treatment, which grew over many years before Covid-19 hit, and then worsened alarmingly, hit the sense of security that people were once proud to feel because they knew the health service was there for them.

Each political party has its own slogans, claims and objectives. But when the election is over, the next government will have to choose its policies with extreme care, learning from long histories of success and failure to deliver and demonstrate the improvement that is needed. We identify seven tests that must be met, and which must be put to politicians as they struggle to convince the public that they have the answers.

Test 1: There should be a limited number of targets and promises, based on how much care the NHS can actually deliver

The NHS in England has never delivered to patients the eleven targets listed as promises in its Constitution handbook. Even going back to their ancestors, it has been more than eleven years since he met everyone who existed at that time. Having unattainable goals is distracting, demoralizing, and encourages behaviors unhelpful to moving patients through the system. The next government must have commitments that are backed by a clear calculation of how much the NHS can actually deliver based on finance and efficiency.

Test 2: Improve people's access to all NHS services, not just hospitals

There have been long-standing promises across parties and governments to provide more out-of-hospital care, but this has not translated into improved access and capacity. Spending has been diverted from community services such as rehabilitation and children's services, and mental health areas such as autism and hospital care remain neglected. Latency and access are often not even measured. The next government should make these more of a priority.

Test 3: Invest in buildings and equipment

Buildings and equipment in the NHS are in a poor state and limit what it can offer patients because not enough of the budget has been devoted to long-term investment over many years. Funding has been repeatedly raided to meet day-to-day deficits. Available data suggests that the UK has remarkably few diagnostic scanners compared to other developed countries. Budget raids must stop and England must spend as much on healthcare capital as comparable countries do.

Test 4: Set long-term improvement programs over many years and don't raid them

Initiatives to improve access to care, or to improve care in general, work best when they are sustained over the long term. The next government must cut small, specific and short-term funding for improvement, which makes it difficult for the NHS or social care to make big or permanent changes. Less, larger initiatives that don't raid for money would be an improvement.

Test 5: Address how planned treatment favors luck

There is systematic inequality where people in the poorest areas have worse access to planned care than their wealthier counterparts, for example the most deprived deciles receive 20% fewer hip replacements than the English average. The next government should set a clear target to reduce the gap in planned care between rich and poor.

Test 6: Don't obsess over closing the gap between the best and the rest

The next government should not assume that it is easy to improve efficiency and waiting times by closing the gap between the best and the rest. Getting different areas to do the same thing has often failed, best practices don't spread easily, and general requirements for each trust
or area in the NHS will be irrelevant to both those who do much better and those who do much worse.

Test 7: Improve data collection to understand what works and what is right

Limited data means it's hard to tell whether many initiatives to improve access are working. Community services data are limited, ethnic group coding is unreliable and information is not fully linked to services. It is increasingly difficult to compare the English NHS performance with Scotland, Wales, Northern Ireland or other countries. These gaps need to be addressed.