The financial reality - How far will the budget stretch?

Image by Artem_ka via Envato Elements

The NHS has long been a topic of political debate, but the financial strain the system is under has never been clearer. According to data from the first three months of the current financial year, the NHS had already overspent its budget by £387 million. This is a sobering figure, especially when considering the broader financial outlook for the NHS. The planned spending for 2024-25 will increase to £192 billion, which seems impressive at first glance. However, inflation has slashed the real-term impact of this rise, reducing it to a meagre 0.6% increase compared to the previous year. In other words, despite the nominal rise in funding, the NHS is essentially running in place.

The Health Foundation, an independent charity that works to improve health and healthcare in the UK, has warned that the NHS is “trying to run to stand still”. The current funding trajectory is insufficient to meet the growing needs of an ageing population and increasing demand for services. Health officials are pushing for a real-term budget increase of 3-4% for the 2025-26 fiscal year, but even this may not be enough. A significant portion of any budget increase will likely be absorbed by the costs of pay deals with junior doctors, which alone are expected to consume around 2% of the health budget. This creates a scenario where even a 4% increase may feel more like 2%, leaving the NHS to continue grappling with financial instability.

At the same time, the physical state of NHS infrastructure is deteriorating rapidly. The bill to repair NHS buildings and facilities has surged to almost £14 billion, with £2.74 billion classified as “high-risk” repairs that threaten the safety of patients and staff. Years of underinvestment have left much of the NHS estate in a perilous condition. The UK lags behind comparable nations regarding hospital beds and diagnostic equipment per head of population, with outdated buildings and technology impeding staff from delivering the best possible care.

The staffing crisis - A system at breaking point

Image by ratmaner via Envato Elements

If the financial strain on the NHS is daunting, the workforce crisis is even more so. Staffing shortages have long dogged the NHS, but the situation has deteriorated significantly in recent years. There are currently 100,000 NHS staff vacancies across England, including one in 13 posts for registered nurses, midwives, and health visitors. This chronic shortage of healthcare professionals is placing an unbearable strain on the system, with overworked staff often unable to provide the quality of care they strive for.

In 2021, the NHS published a long-term staffing strategy that aims to double the number of training places for doctors, nurses, and midwives by 2031. While this initiative is essential, it is a long-term solution to a crisis that is happening right now. It will take years for new recruits to complete their training and become fully qualified professionals, and in the meantime, the NHS will continue to struggle with understaffing.

The root of the staffing crisis can be traced back to several factors. Low pay, poor working conditions, and the pressures of working in an underfunded system have led to high burnout among healthcare professionals. The British Medical Association (BMA) and Royal College of Nursing (RCN) have warned that the NHS will continue to haemorrhage staff unless significant improvements are made to pay and working conditions. The result is a vicious cycle: as more staff leave the NHS, those who remain are forced to work longer hours under more stressful situations, leading to further burnout and resignations.

Wes Streeting, the Secretary of State for Health, has recognised the scale of the challenge and has called for a radical rethinking of how the NHS recruits, retains, and supports its staff. Drawing inspiration from Singapore’s “Get Rid of Stupid Stuff” initiative, Streeting has launched a nationwide consultation, inviting NHS staff to share their ideas on reducing inefficiency and improving working conditions. This consultation is part of a broader effort to give NHS staff more agency and control over their working lives, which Streeting hopes will boost morale and improve patient care.

Shifting the focus - From hospitals to communities

Image by guyswhoshoot via Envato Elements

One of the most significant challenges facing the NHS is its overwhelming focus on hospital-based care. Hospitals account for a large portion of NHS spending, and while they are essential for treating acute and severe conditions, many patients could be treated more effectively, and more affordably in the community. Successive governments have recognised the need to shift healthcare focus away from hospitals and towards prevention and community-based care, but progress has been slow.

Wes Streeting’s new 10-year plan for the NHS strongly emphasises prevention and early intervention. The plan envisions a “neighbourhood health service” that uses cutting-edge technology to help patients stay healthy and out of hospital. This shift towards community-based care has been a cornerstone of NHS policy since 2006. Still, despite this, spending on hospital services has continued to increase as a proportion of total NHS expenditure. Meanwhile, the proportion spent on primary care and community health services has fallen.

Part of the solution lies in harnessing the power of data and technology. The NHS is uniquely positioned to take advantage of advances in genomics, predictive medicine, and artificial intelligence (AI). By using patient data to predict and prevent illness, the NHS could transform its approach to healthcare. For example, AI algorithms could analyse patient data and identify individuals at risk of developing chronic conditions like diabetes or heart disease. By intervening early, the NHS could help patients avoid these conditions altogether, reducing the need for expensive hospital treatments down the line.

Streeting’s plan also includes the introduction of “patient passports,” which would allow healthcare professionals to access a patient’s full medical history, regardless of whether they are being treated by a GP, a hospital, or another healthcare provider. This would not only improve the continuity of care but also reduce the likelihood of errors and unnecessary treatments.

However, the success of these initiatives will depend on whether the NHS can address the underlying structural and financial issues that have plagued it for years. Without adequate funding and support, even the most innovative technologies will struggle to make a meaningful impact on patient outcomes.

The role of the public and staff - A Collaborative effort

Image by Wavebreakmedia via Envato Elements

One of the key messages from Wes Streeting is that the government cannot reform the NHS alone. The scale of the challenges facing the health service is too great for a top-down approach to be effective. Instead, Streeting has called for a “national conversation” about the future of the NHS, inviting both the public and NHS staff to share their ideas for reform.

This marks a significant departure from previous NHS reform efforts, which have often been characterised by centralised decision-making and a lack of consultation with frontline staff. Streeting’s plan includes the largest staff engagement exercise in NHS history, giving healthcare professionals a platform to voice their concerns and offer solutions. By empowering staff to identify inefficiencies and propose changes, the government hopes to create a more responsive and agile health service.

Similarly, the public will play a crucial role in shaping the future of the NHS. The government plans to hold citizens’ assemblies across the country, where members of the public will be invited to discuss what they want from their healthcare system. This is an important step towards creating a health service that is truly accountable to the people it serves.

A crucial turning point

Image by iLixe48 via Envato Elements

The NHS in England is at a crossroads. Years of underinvestment, combined with the pressures of an ageing population, have left the health service struggling to keep up with demand. Staffing shortages, crumbling infrastructure, and outdated technology are preventing NHS staff from delivering the high-quality care they are trained to provide.

Wes Streeting’s 10-year plan for the NHS represents an ambitious attempt to address these challenges. By shifting the focus from hospital-based care to community-based prevention, embracing new technologies, and giving staff and the public a greater say in the future of the health service, the government hopes to create an NHS that is fit for the 21st century.

However, the road ahead will not be easy. The financial challenges facing the NHS are enormous, and even with increased funding, it will take time to rebuild the health service. But with a collective effort from the government, NHS staff, and the public, there is hope that the NHS can once again become the world-class health service that its founders envisioned.

Explore innovative compliance solutions with ComplyPlus™

To learn how ComplyPlus™ can support your organisation in navigating the complexities of regulatory compliance in healthcare, get in touch with our team today. Discover how our comprehensive platform streamlines compliance, improves efficiency, and fosters a culture.