HFMA 2021: Health Foundation underlines pressures on health and care

Anita Charlesworth (pictured on screen), director of research and the Real Centre at the Health Foundation, said the spending review figures had been set on the basis of Covid-19 ‘being over by Easter’. ‘But the move from pandemic to endemic is unlikely to be an event but a process,’ she said.

She also highlighted that UK health capital was now due to be in line with the Organisation for Economic Co-operation and Development average. However, she said the UK had been an outlier for the last decade, spending less than the OECD, contributing to a £9bn maintenance backlog. And she added that much of the new capital was ringfenced for the diagnostics replacement and the new hospital programmes.

‘Capital investment needs to be in line with the OECD not just for four years but for a sustained period,’ she said.

However, while the NHS had had a tough decade, social care spending was actually below the level of a decade ago, stripping out direct Covid costs. ‘With the funding that is announced in the spending review and through the levy, on core social care we’ll still be spending per head of population and age-adjusted substantially below what we were spending 15 years ago on social care,’ she added.

She said the difficult financial position raised ‘enormous questions’ about whether the plans announced fixed social care.

The are significant challenges in recovering services with the waiting list, which now stands at six million. She said this was about more than just waiting a bit longer for treatment. For example, delayed hip replacements meant people experienced a direct loss in waiting longer, were in more pain, and received less gain from the surgery. ‘Sometimes we talk about waiting as if it doesn’t really matter – it does matter,’ she said.

Modelling suggests this that if 50% of missing patients come forward for treatment, the waiting list could rise to 12 million. Compared with the £10bn funding announced to address the elective backlog, Ms Charlesworth said £17bn would be needed to meet the 18-week standard by 2024/25 or £13.3bn to hold waiting lists at their current level.

Severe workforce challenges will also limit the ability to keep increasing activity levels.

The Health Foundation director of research criticised the reduction in public health grant over the last five years at a time when the country should be looking to increase investment in prevention. While the spending review stops further reductions, it does not replace the lost funds, yet public health interventions provided a greater return on investment in overall value than healthcare treatment.

She said the service needed to do three things: respond to the pandemic, recover services, and build resilience as it still faced the increase in pressure from a growing and ageing population. She said systems needed to do things radically differently compared with the last decade to respond to these demographic pressures. ‘Are we scrutinising integrated care system plans with rigour to make changes on the scale needed and have people absorbed the scale of the challenge ahead?’ she asked.

She said the NHS had options in responding to its long-term pressures. However, increasing thresholds for care and limiting pay increases could be false economies. It needed to focus on reducing unwarranted care, improving treatment for long-term conditions and productivity improvements such as reducing length of stay.