NHS at 75: A Reality Check and New Priorities

The NHS’ long anticipated workforce plan is finally here, but it won’t be enough to reverse the health spiral of decline. This pamphlet outlines ways of trying to fix some of the NHS’ problems, by proposing much more devolution of decision-making on services, both regionally and locally, and with a bigger focus on population health and prevention of ill health.

  • A combination of circumstances – Brexit, COVID-19, austerity, and two reorganisations thrown in – created an existential threat to the NHS.
  • Public satisfaction with the NHS and social care is at an all-time low, 29% and 14% respectively.
  • The long-awaited Workforce Plan faces formidable challenges: currently there are 112,000 staff vacancies and is on a trajectory for this to grow to 360,000 by 2037.
  • To survive another 75 years, and beyond, policymakers must radically reform the NHS to meet changed expectations and demographics, and reckon with the damage done over the past decade or so that has landed the NHS in its current mess.
  • Radical change required to save the NHS includes: devolution of expanded community services; concentrating specialist services on fewer sites; more standalone surgical hubs and more diagnostic capacity in the community, and a robust plans for improving population health and prevention of ill health, with a new independent Office of Public Health.
  • There are three big changes needed at the centre for the pursuit of the radical reform agenda:
    • Reforming DHSC: A more businesslike approach is required. If the business’s delivery systems need changing – as they do – then DHSC top management should be capable of understanding how to do that
    • Quangos and efficiency reviews: The DHSC needs to have a more organised and transparent programme directed at improving efficiency and productivity
    • Workforce planning and delivery: Treasury and DHSC negotiating a new longer-term system for NHS and social care remuneration with six key features.


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