What is the right level of spending needed for health and care in the UK?

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health.

The changing health needs of the UK population.

The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and there is a growing burden of mental illness. Successes exist, such as the striking improvements in oral health, but inequalities in health persist as well. The growth of the ageing population relative to the working-age population, the rise of multimorbidity, and persistent health inequalities, particularly for preventable illness, are all issues that the National Health Service (NHS) will face in the years to come. Meeting the challenges of the future will require an increased focus on health promotion and disease prevention, involving a more concerted effort to understand and tackle the multiple social, environmental, and economic factors that lie at the heart of health inequalities. The immediate priority of the NHS will be to mitigate the wider and long-term health consequences of the COVID-19 pandemic, but it must also strengthen its resilience to reduce the impact of other threats to health, such as the UK leaving the EU, climate change, and antimicrobial resistance.

Securing a sustainable and fit-for-purpose UK health and care workforce.

Approximately 13% of the total UK workforce is employed in the health and care sector. Despite substantial workforce planning efforts, the effectiveness of this planning has been criticised. Education, training, and workforce plans have typically considered each health-care profession in isolation and have not adequately responded to changing health and care needs. The results are persistent vacancies, poor morale, and low retention. Areas of particular concern highlighted in this Health Policy paper include primary care, mental health, nursing, clinical and non-clinical support, and social care. Responses to workforce shortfalls have included a high reliance on foreign and temporary staff, small-scale changes in skill mix, and enhanced recruitment drives. Impending challenges for the UK health and care workforce include growing multimorbidity, an increasing shortfall in the supply of unpaid carers, and the relative decline of the attractiveness of the National Health Service (NHS) as an employer internationally. We argue that to secure a sustainable and fit-for-purpose health and care workforce, integrated workforce approaches need to be developed alongside reforms to education and training that reflect changes in roles and skill mix, as well as the trend towards multidisciplinary working. Enhancing career development opportunities, promoting staff wellbeing, and tackling discrimination in the NHS are all needed to improve recruitment, retention, and morale of staff. An urgent priority is to offer sufficient aftercare and support to staff who have been exposed to high-risk situations and traumatic experiences during the COVID-19 pandemic. In response to growing calls to recognise and reward health and care staff, growth in pay must at least keep pace with projected rises in average earnings, which in turn will require linking future NHS funding allocations to rises in pay. Through illustrative projections, we show that, to sustain annual growth in the workforce at approximately 2·4%, increases in NHS expenditure of 4% annually in real terms will be required. Above all, a radical long-term strategic vision is needed to ensure that the future NHS workforce is fit for purpose.

Are we prepared to pay more for healthcare?

Lost in the news on a big day for the Brexit saga was a sobering analysis of the NHS's long-term sustainability.

How the NHS has become caught in a perfect storm.

Look beyond the NHS's headline deficit and it soon becomes clear that efficiencies and productivity can only do so much.

Short of capacity? Why the government must address the capacity constraints in the English National Health Service.

A decade of low investment in the English National Health Service (NHS) resulted in strong headline productivity growth but undermined the health system's resilience and left it exposed during the COVID-19 pandemic. Projected demographic pressures, driven by the aging of the baby-boom generation and the rise in multi-morbidity levels in the population, will add pressures to already stretched health care resources. As the NHS faces the twin challenges of recovering services after the pandemic and meeting care needs from an aging population, our projections of demand for care indicate the NHS almost certainly needs significantly more beds as well as more staff. Productivity improvements in hospital care can reduce the amount of additional resources needed, but this will require significant concomitant investment in community-based health and long-term-care services.

Long-term projections of health care funding, bed capacity and workforce needs in England.

OBJECTIVES: Changes in population structure and underlying health put a significant strain on health care system resources. In this context, projecting future health care needs can contribute to better health care system planning and resource allocation over the long term. This paper presents a model of future demand and costs of care to estimate long-term funding and resource needs up to 2030/31. METHODS: Using data from England, we first calculate health care utilization rates by age, gender and comorbidity, where available, and multiply them by the projected future populations to estimate future demand for a wide range of service areas. We then cost this future demand using 2018/19 unit costs for each service area which we project by accounting for assumptions around future inflation and productivity. RESULTS: Our results indicate in the longer term, funding for the English NHS would need to increase by around 2.8% per year in real terms to meet these underlying funding pressures. Further, our projections imply that the number of general and acute care beds would need to grow by between 1.3 and 4.1% a year and the NHS workforce would need to grow by between 1.8 and 2.6% a year by 2030/31, depending on productivity assumptions. CONCLUSIONS: Our projections of workforce and hospital beds illustrate the extent of underlying pressures from population ageing and changes in morbidity. Improvements in care emerge as crucial for meeting these pressures.

Health and care spending and its value, past, present and future.

In times of relatively low public spending in the UK since 2009-2010, health spending has been protected above all else. At the same time budgets for education, housing and public safety have fallen. This is in part due to the presence of growing demand for healthcare: while the population has increased by around one-third since 1950, healthcare spending as a share on national income has more than doubled. Continuing increases in quantity and complexity of the use of the health service as well as the unit costs indicate that these pressures will not be alleviated any time soon. However, there are clear benefits to investing in health; research finds that a 10% increase in health spending was associated with a gain of 3.5 months of life expectancy across the Organisation for Economic Co-operation and Development from 1995 to 2015. In this paper, we discuss the potential value of additional -spending.

Improving productive efficiency in hospitals: findings from a review of the international evidence.

At present, health systems across Europe face the same challenges: a changing demographic profile, a rise in multi-morbidity and long-term conditions, increasing health care costs, large public debts and other legacies of an economic downturn. In light of these concerns, this article provides an overview of the international evidence on how to improve productive efficiency in secondary care settings. Updating and expanding upon a recent review of the literature by Hurst and Williams (2012), we set out evidence on potential interventions in the policy environment, hospital management, and operational processes. We conclude with five key lessons for policy makers and practitioners on how to improve productive efficiency within hospital settings, and identify several gaps in the existing evidence base.