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The NHS needs more than a workforce plan


4 min read

It is good that the NHS finally has a long-term workforce plan, even if it’s nearly a decade late. But it will take more than this for the NHS to escape the quagmire it’s in.

The public knows that the NHS and social care are in deep trouble. In March the latest British Social Attitudes survey revealed that “overall satisfaction with the NHS fell to 29 per cent”. This was the lowest level since these surveys began in 1983. Nearly a third of people thought the NHS wasted money. The public view of social care was even worse, with only 14 per cent satisfied.

After a decade of austerity, an unpopular 2012 reorganisation and the loss of European Union personnel from Brexit, NHS staff were weary and fed up even before the Covid-19 pandemic hit. It is unsurprising that so many remain disgruntled over their pay and working conditions. NHS performance dropped well before 2020, but the pandemic and aftermath simply made a bad situation worse, with NHS waiting lists now stubbornly stuck at about 7.4 million people. Again, unsurprisingly, the public is adjusting its spending patterns and using the private sector to speed up treatment – a trend likely to continue. 

If we want a tax-funded NHS to reach its centenary, radical delivery changes will be required

Those in charge of the NHS are struggling to secure the service improvements required. This was shown in a report by the National Audit Office (NAO) in November 2022 which said NHS productivity had fallen by 16 per cent since the pandemic. The NAO criticised a “reduced management focus by NHS trusts and NHS England on cost control and operational rigour”.

Traditionally the NHS has been rescued by governments throwing extra money at it. But with low economic growth, and high inflation, no United Kingdom government will have the fiscal headroom to do this for the foreseeable future. The NHS needs to adapt to doing more with less and improve its efficiency. The time has come to change our mindset about the NHS. Instead of viewing it as a national icon, we should see it more as a social business that could be better managed to meet current health needs rather than stuck in 1948 aspic. We could still have a largely tax-funded NHS, for the most part free at the point of clinical need, but it would be delivered very differently.  

First, a move away from excessive central command and control. Delivery of expanded community services (primary care including GPs, community health services, some local hospitals, mental health, maternity services and population health) would be devolved to regional bodies. They would have protected weighted capitation budgets based on health needs, plus grant aid for improving social care. 

Second, concentration of specialist services on fewer hospital sites after independent clinical assessment. These would have more beds and better equipment. As part of this change more elective surgery should be concentrated on standalone surgical hubs in line with Royal College of Surgeons advice, increasing patient choice over where they are treated.

Third, a major strengthening of the funding and delivery of public health and prevention, providing a stronger focus on reducing obesity and demand on the NHS. This change would be overseen by a new independent office of public health reporting to Parliament, with a budget governed by statute as a percentage of the NHS budget.

Fourth, rebooting the centre with a clear policy of operational devolution and a greater focus on long-term workforce issues, better business processes, capital investment and performance delivery. This would require major changes at DHSC, with a business-focused chief executive rather than a permanent secretary. Also, an overhaul of the role of NHS England and a scaling down of other NHS quangos.

If we want a tax-funded NHS to reach its centenary, radical delivery changes will be required. 


Read more in The NHS at 75 – A Reality Check and New Priorities available on the Social Market Foundation website.


Lord Warner, Crossbench peer and former health minister 

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