Two weeks into a six week campaign, content director Lyn Whitfield considers what the election will mean for health and care funding and policy – and the digital investment needed to deliver it.
Two weeks ago, Rishi Sunak stood outside 10 Downing Street in the pouring rain and announced that a general election will take place on 4 July. The prime minister was all but drowned out by the sound of New Labour’s 1997 campaign song, ‘Things will only get better.’ But how will the election affect the NHS? And what it will mean for digital technology?
The NHS is top of voters’ concerns stree
A fortnight into the campaign, one thing has become clear. After several years in which the Conservative government managed to keep a lid on the NHS as an issue, even as waiting lists grew and staff struck, it’s back at the top of voters’ concerns.
The May Ipsos Issues Index shows the NHS has overtaken the economy as the most important issues facing the country today, with 35% of those polled putting it top of their list (29% picked inflation/prices, 28% the economy, and 27% immigration).
The fiscal outlook is terrible…
This presents a challenge for the Conservatives and Labour. The Institute for Fiscal Studies has argued that both parties have painted themselves into a corner by promising to get debt falling as a share of GDP by the end of the next Parliament.
Achieving this will require economic growth. If it remains anaemic, the next government will find it difficult to borrow and stick to its “fiscal rules.” It will also have to spend money servicing the debt that could go on tax cuts or spending.
As things stand, the tax take will continue to rise as a percentage of national income for the next three years, because of fiscal drag – chancellor Jeremy Hunt’s decision to fix the “thresholds” at which people pay tax or higher rates of tax.
Yet government investment and funding for public services is set to fall; with £20 billion of cuts pencilled in for ‘non-protected’ services – broadly, anything except health and defence. Most think-tanks believe will be impossible to deliver.
So, the next chancellor will either have to dodge around the promises both parties have made not to raise personal taxes, corporation tax, or VAT to reverse the cuts. Or impose means testing and charges. Or see the state exit some services entirely.
… so a big cash injection for the NHS feels unlikely
The IFS is asking all the parties in the election to be open and honest about the “difficult trade-offs” that will be needed as soon as this autumn, when a new chancellor will need to deliver a Budget and launch the comprehensive spending review that Hunt dodged last year.
So far, its pleas have fallen on deaf ears. But it’s clear that against this backdrop there won’t be scope for an immediate injection of cash into the NHS. Even though it probably needs one.
The NHS in England only broke even last year because central funding pots for waiting list reduction, winter, and capital investment – including IT – were slashed (Highland Marketing pre-Budget analysis). It still came out of 2023-4 with some systems and trusts reporting worse deficits than they had reported in-year.
Then it went into 2024-5 with funding effectively flat in real terms, and with a difficult pay round ahead of it. NHS England has responded by calling for big reductions in agency spending, headcounts, and even services (Health Service Journal, news).
So, it looks as if the NHS will be contracting just as a new government takes power. Indeed, the Conservatives have said they would accelerate the process by removing 5,500 management posts to pay for more Pharmacy First, 100 GP surgeries, and 50 more community diagnostic centres (HSJ, news).
As the Highland Marketing advisory board discussed recently, this is bad news for digital and technology, because IT is too-often seen as the kind of “back office” function that can be targeted for cuts; leaving systems and trusts without the capacity they need to maintain systems and support transformation efforts.
Please, no big reorganisation
If the next government is unlikely to increase NHS spending, what other policies could it look at? Grand re-organisations tend to be popular with right-wing papers, think-tanks and ministers.
But if there is one thing that health experts are agreed on, it is that the NHS doesn’t need another bout of upheaval, two-years after a slimmed down NHS England and 42 integrated care boards started work.
The NHS Confederation made “no top-down structural reform” its number one ask for the next Parliament. Instead, the Confed is calling for a “short-term stabilisation plan for the first 12-months” alongside a boost for capital spending to improve falling productivity.
Old facilities and aging infrastructure may get attention…
Old facilities and failing infrastructure became the prime suspect for falling productivity in January, when the BMA claimed 13.5 million working hours are being lost to “inadequate or malfunctioning IT systems or equipment every year.
Outgoing health and social care secretary Victoria Atkins picked up on this claim in a Daily Mail article claiming that the NHS needs an “M&S moment” turn-around. She said some of the £3.4 billion that Hunt found for NHS IT in the last Budget would be spent on “front-line computers” to support this.
Shadow health and social care secretary Wes Streeting has also used the BMA numbers to argue the NHS should “adopt new technology to become more efficient.” In another retail-heavy article for the Daily Mail, he argued that if it doesn’t it is “in danger of going the way of Woolworths.”
… but will Hunt’s £3.4 billion survive and go far enough?
In principle, this recognition that the NHS needs better infrastructure, modern computers, and updated, integrated records and software systems – and political enthusiasm for the NHS App and AI – should be good for the health tech sector.
However, Hunt’s £3.4 billion will have to stretch a long way (digitalhealth.net news). The Treasury “red book” says £2 billion will go on “updating fragmented and outdated IT systems”, but it also says the lions-share will go on the frontline digitisation programme to complete the roll-out of electronic patient records at trusts and on AI programmes.
Another £1 billion will go on “reducing unproductive administrative tasks”, most of which will go on the Federated Data Platform; leaving £400 million for the NHS App and other patient-facing tech. That’s assuming the money is delivered since the Treasury would, presumably, have to agree to include it within a new CSR.
And that’s assuming the money is actually spent on technology. The Highland Marketing advisory board has pointed out that NHS England has a bad habit of playing “digital hokey-cokey” with tech funding – announcing programmes and then clawing them back when times get hard.
Workforce is urgent. Social care should be
Even without a reorganisation, a new ministerial team will have plenty on its plate. Item three on the Confed’s list is to sort out the workforce issues that have not been resolved by Atkins or her predecessor Steve Barclay. Streeting has not endeared himself to the NHS workforce, by appearing to suggest it is resistant to change or to putting in overtime to clear waiting lists.
But if the polls are right and Labour takes power, it will have to find a way to address staff burnout, working conditions, and pay on the back of junior doctors striking for the eleventh time just a few days before polling day.
Then, there’s social care. This seems to have been filed in the “too difficult to talk about” box for the duration of the campaign. But, as the Observer pointed out, it needs urgent attention, as it’s starting to bankrupt councils, as well as leaving elderly and disabled people without the care they need and piling pressure on NHS beds and discharges.
NHS policy: integration and public health look set for a reboot…
There’s also plenty of “reform” to push ahead with. Items four and five on the Confed’s list are “moving care closer to home” and re-investment in public health, which has seen budgets slashed since it was moved back to local government.
The Confed’s chief executive, Matthew Taylor, was a New Labour advisor and is supposed to be close to the current Labour health team. So, it’s not surprising that these priorities are aligned with the direction of travel that the NHS has been on since the Five Year Forward View was published a decade ago.
Or that they’re aligned with the priorities Labour set out in its “mission” to “build and NHS fit for the future” published last October. The mission argues that even if the NHS didn’t face an “immediate crisis” it would need to “change” in response to “demographic change, an aging population, and more people living with long-term conditions.”
It then says the change required is a move to “a seamless, personalised service” delivered in the community or “at home, where possible” allied to a “cross-Whitehall” drive on prevention to stop “a growing, aging population” becoming “increasingly unwell earlier in their lives” and “totally overwhelming the health and care system.”
… and that would be good news for health tech. In theory
In principle, again, this should also be good for health tech vendors. Significant investment will be needed to deliver the data and analytics required to deliver population health management approaches, improve communication between services and care teams, and deliver new models of care.
However, this has been the case since the 5YFV and its successor, the NHS Long Term Plan, was published, and many suppliers have found it hard to engage with integrated care boards or to get ideas adopted at scale.
Meanwhile, some of the foundational work that has been done to roll-out shared care records and virtual wards will not be funded centrally from the end of March. So, if this is going to be its health policy, Labour will not just need to commit to Hunt’s IT spending but find additional investment from somewhere.
Access and waits will get most scrutiny
The manifestos that will be published in the next few weeks will let slip more hints about the parties’ intentions. For the moment, the focus is on access to primary care and on waiting lists because that’s what worries voters. While the Conservatives have focused on access, Labour has made a “first steps” promise to deliver an 18-week referral to treatment time for most patients within five-years.
Streeting said this would be achieved by delivering an additional 40,000 “evening and weekend appointments per week”, some of which will be for scans and treatment, paid for by a £1.3 billion “crack down on tax evasion and non-doms.”
Various think-tanks have crunched the numbers and concluded this will be tough. The staff Streeting hasn’t courted may not want to do the overtime. There might not be enough money – The Health Foundation pointed out that New Labour increased spending on the NHS by 7% a year for a decade to deliver the original RTT.
If there are the staff and there is the money, 2 million additional appointments per year should close the 3.2 million pathways that have been open for more than 18-months today. But it won’t be enough to deliver an 18-week RTT if people continue to pile onto the list. So those bigger issues around investment, reform, and addressing demand at source won’t go away.
Conclusions: it’s for suppliers to help make the case for investment to deliver
Unless the polls are out significantly, the general election will mean that a different party will take charge of the NHS. But it’s unlikely to mean a big injection of cash, at least in the short-term. Which will make it difficult to address workforce issues and service contraction.
Politicians will have to deliver progress on access and an 18-week RTT, while bigger policy issues are worked out. With luck, those issues won’t be addressed by a big reorganisation, but will take the form of a reboot of the existing agenda to create a more integrated, personalised health service, aligned with a push on public health.
This should be familiar territory for tech vendors. Labour has said that it will invest in IT to improve productivity, in AI, and in scanning capacity. If it turns its attention to integration, public health and social care, it will need data, analytics, communications tools, and virtual wards. The NHS App fits with its “modernising” agenda (Highland Marketing ConfedExpo coverage, 2023).
But to do all this, the new government will need to at least match Hunts’ spending pledges, and probably find additional money. It will be up to vendors to help make the case for that investment; and then to persuade individual systems and trusts that they have the solutions they need.
