An election manifesto for the NHS — and a healthy economy

Unlock the Editor’s Digest for free

The writer is chief executive of the Health Foundation charity

Pressures in the NHS top the news and public concerns. Ill health swells the welfare bill and is the prime reason why 2.83mn working-age Britons are economically inactive. In this general election year, the UK’s political parties must ensure that their manifestos treat health as a central plank of getting the economy back into condition.

The answer lies in shorter-term practical wins the public can get behind, plus medium to longer-term plans for overdue change. More investment is unavoidable. The government has told the OBR to assume 1 per cent real-terms growth a year for public spending to 2028-29, but healthcare pressures are growing at least three times that fast.

For the NHS, the priorities are to get waiting times down and improve access to GPs. Not far behind are the shocking lack of dental care and mental health services, particularly for children and young adults. The solutions are known — the NHS has dramatically reduced waiting times before — and include focus, investment, use of private hospitals, clearer incentives and effective frontline management with stretching but realistic targets. Investing in social care will be crucial to success.

A chunk of our population equivalent in size to Greater Manchester is not working due to ill health: this is a huge and avoidable cost. Better mental health support, particularly for depression and anxiety, should be a priority, with jobcentres as well as employers part of a much wider strategy to get people back into work. The prime minister’s ban on tobacco sales is a win. But we need stronger regulation to curb obesity — for example, taxes for producers of food high in sugar or salt and advertising restrictions for unhealthy products. The public supports these and other interventions to prevent ill health.

The manifestos must signal action on pressing longer-term issues. One in five of us will live with major ill health by 2040 on current trends, mostly due to an ageing population. Productivity-enhancing, labour-saving technology, including artificial intelligence, is the best hope to offset these eye-popping headwinds, and this is where political energy must focus, and avoid unnecessary confrontation or tinkering with structures.

The NHS needs to use its heft to target private and public investment at technologies that can reduce the number of steps a patient has to take to treatment and recovery. These must reduce bureaucracy, help people manage their own health and lower costs while improving care. Technology is also vital to improving administration (such as automated transcription of clinical notes) and supporting patients (such as appointment booking and care of chronic conditions).

This means investment in kit and skills, in helping staff and patients make the changes, and more risk-taking in trialling different ways of delivering services. Importantly, change must be led by the frontline clinicians and patients who know best how to improve services. Weary staff urgently need changes that improve their working lives and free up their time to care for patients. If not, progress will stall.

The dials on mental health, chronic pain, obesity and inequality are all going in the wrong direction, leaving the NHS to pick up the pieces. But the root causes lie in wider issues such as poverty, stress, poor-quality work, housing and education. Co-ordinated cross-government action is needed on these building blocks, with far greater support for local government’s crucial role.

All this depends on investment — no industry would expect to improve productivity without it. UK capital spending on health has fallen to half the OECD average since 2010. New fiscal rules must allow more. There is also a strong case for protecting spending on preventive health. But a bold, ambitious goal for the nation’s health, enshrined in legislation and hard-wired into government decision-making, would galvanise action.