Ham calls for funding increase and realistic efficiency savings

Sir Chris (pictured), who has also chaired an integrated care system and worked at the Department of Health, has reviewed the 20 years from 2000 to 2020 to identify how the NHS and social care have ended up with their current challenges. He identified two distinct periods, with major improvements in NHS performance in the 10 years to 2010 on the back of multi-year funding increases above the long-term average and a series of reforms. But this was followed by a subsequent decline in performance as a result of ‘much lower funding increases, limited funds for capital investment, and neglect of workforce planning’.

In a paper published by the King’s Fund – The rise and decline of the NHS in England 2000–20: How political failure led to the crisis in the NHS and social care – Sir Chris said that while performance held up in the early years of the 2010s, by 2014 trust deficits were widespread and the NHS started to miss waiting time targets.

The downturn in performance coincided with a reduction in growth funding. Over the long-term, the NHS has experienced average annual increases of around 3.6% in real terms, the King’s Fund paper said. The largest increases came between 1999/2000 and 2003/04 using five year moving averages. Adjusting figures for the size and composition of the population, healthcare spending per person adjusted by age grew by 2.6% a year in real terms between 1979/80 and 2020/21. The biggest increases occurred between 1997 and 2010 and the lowest in the period after 2010.

Long-term improvements in population health stalled or went into reverse after 2010, with cuts in public health grants further hindering work. Social care was also under pressure, with knock-on consequences for the NHS. But welcome moves such as the introduction of the better care fund were ‘sticking plaster solutions’ in the face of cuts in real-terms spending on social care.

Sir Chris argued that the improvements between 2000 and 2010 demonstrated that ‘the NHS is capable of reform if the political will exists and if governments take a long-term perspective’. But on top of an increase in funding, restoring the long-term average increase, there should be realistic targets for efficiency savings. ‘Gaps in social care funding must be filled and there must be fundamental changes to social care funding and provision,’ the report said.

And the increase in hospital activity and funding since 2000 relative to other services should be combatted by investing in primary care and community services as a priority. Sir Chris also called for a ‘credible and fully funded workforce plan’ for the NHS and, ideally, for social care. And there needs to be a sustained commitment to prevention and early intervention.

The report said that one of the consequences of funding constraints was ‘to put the onus on NHS organisations to find ever more challenging, and often less credible, efficiency savings’. There had been a reliance on ‘blunt controls’ over staff pay and prices paid to providers and an over-reliance on non-recurrent savings, which only provided a short-term stop-gap.