Five-year investment needed to deliver prevention and productivity plan

13 September 2023 Martyn Bryson and Steve Brown
 The think tank said that UK health and care services were falling behind international peers and put forward a 10-point plan – involving a greater focus on prevention and improvements in productivity – to deliver ‘once in a generation reform’.Parth Patel L

Its report – Reforming health and social care – claimed that around 240,000 deaths in the 2010s could have been averted if the UK had matched the avoidable mortality rates of European neighbours. Cancer survival is also ‘stubbornly lower’ in the UK compared to other advanced economies and dementia mortality is far higher than in western European, Nordic and Anglophone countries.

The report also highlighted other ways in which care quality is reducing, with fewer than one in six people with a preferred GP getting continuity of care with that doctor. And six in 10 people aged 17 to 24 with a probable mental health disorder are not getting treatment from health services.

The picture is also worrying for social care, with requests for adult social care support having risen by 10% since 2016, while the number actually receiving local authority support has declined 4%.

‘We spend more years in sickness than ever before, yet it has never been harder to access timely healthcare. The NHS, world-leading not so long ago, has now fallen far behind international peers,’ said Parth Patel (pictured), IPPR senior fellow and lead author of the report.  ‘With political will, health services in this country can once again be world-leading. Not by following red herring reforms to the funding model, but through an ambitious plan to move from a reactive 20th century model to a proactive 21st century one that works for public health and public finances.’

The IPPR’s 10-point plan covers three areas: prevention, productivity and financing. It identified excellent primary care as a precondition of any shift towards prevention and called for the national roll out of neighbourhood health hubs, providing both the benefits of scale and continuity of care and offering salaried employment to ‘primary care consultants’.  

The report said that social care – another key pillar for prevention – was currently stuck in the ‘too difficult box’, with challenges around affordability, access and quality. However fundamental reform was essential with its proposed social care guarantee replacing ‘unfair user charges with free personal care’ and ‘ethical commissioning’ driving up the quality of providers.  Its final recommendation on prevention was for centrally set targets for integrated care systems to be replaced with a long term healthy lives mission.

The think tank’s proposals on productivity aimed to change the focus to outcomes instead of outputs – rather than targeting more treatments, the service should be concentrating on helping people back to work following treatment. To achieve this, it called for better pay and conditions for health and care workers, better representation for workers’ voices, the upgrading of physical and digital infrastructure, improvements to the leadership pipeline, and new systems for patient and public feedback.

On financing, the IPPR argued that its proposals would be ‘ultimately less expensive in the long run’, but it said spending on health and care would have to go up. It called for NHS funding to increase by 3.6% and adult social care by 5.6% per year for five years. A new infrastructure restoration fund, worth £3.3bn a year over the next decade, would also be needed to catch up with European levels of capital investment.

This long-term commitment to funding would provide certainty – ending the suboptimal ‘feast and famine’ model of NHS funding. And it would provide an opportunity to ‘lock in sustainability. It also claimed that the reform proposals could save taxpayers up to £205bn over the next decade by freeing up growing sums each year – with an annual saving worth the equivalent of the current UK defence budget by 2033/34.

To deliver on its proposals, the IPPR estimated that the government would need to find £58bn in additional total revenue over the period 2023/24 to 2027/28, with considerable amounts coming from economic growth. However, it also set out the tax options for raising increased funding. The report concluded that there is little time left to delay a change in direction. ‘We can either persist blindly with the status quo, spending more and getting less, or we can boldly finance the reform plan this report outlines to transform health, care and prosperity for the decade to come,’ it said.

Matthew Taylor, chief executive of the NHS Confederation and one of the commissioners for its Commission on Health and Prosperity, said the human and economic case for investment in health was inarguable. ‘With record numbers excluded from work by sickness, and high levels of avoidable mortality in the UK, the government must do more to support the NHS,’ he said. ‘That includes doing more to stop people falling ill, as IPPR's research highlights. Health leaders have long advocated for more prevention and will welcome the argument to make this a core principle for reform.’