Posted on 07 July 2023

​Back in September of 2021 the government set out an ambitious £36 billion scheme to invest in the NHS and level up services which have become bogged down by record patient numbers, lack of resources and struggles during the then active pandemic. This also included controversial changes to the health and social levy and national insurance contributions. However, now that two years have passed, how are the promises being delivered on? Now we look back to September 2021 and see what the commitments promised were then;

The UK government confirmed this week that the national insurance rate will be increasing to 1.25% from April 2022 to fund the social care sector which has seen long term neglect and lack of funding. This lack of funding has reached disastrous levels only worsened by the coronavirus pandemic and the combined effect of increased life expectancy across society. The changes have received criticism from Labour leaders and the general public alike, with tory minister Robert Buckland stating, "The British public are sensible enough to know that when it comes to the issue of social care we have to find some way in which it will be adequately funded,". Talks on the 3rd September 2021 concluded with a stark warning from health leaders the proposed figures may only raise £5 billion, instead of the £10 billion they require.

“The Government will tackle this elective backlog in the biggest catchup programme in the NHS’s history. We will spend £2 billion this year, double our previous commitment, to start to tackle the backlog. In addition, the Government plans to spend more than £8 billion in the following three years from 2022-23 to 2024-25. The £9 billion that we are putting in now, on top of the £1 billion that was included in the 2020 Spending Review, could deliver the equivalent of around nine million more checks, scans and procedures. It will also mean the NHS in England can aim to deliver around 30 per cent more elective activity by 2024-25 than it was before the pandemic”.

Comparing to now, there have been capitalisations on this investment and innovation across all sectors;

The most serious ambulance calls are now being responded to in under 8 minutes for the first time in two years, in signs that the service is turning its performance around. Urgent, emergency care and cancer care are all seeing waiting times fall in what will surely be a welcome improvement for patients. The number of patients waiting a year and a half for treatment fell to just 10,737 by April of this year – down massively from nearly 125,000 in September 2021. Area which received extra funding such as the North West have seen reductions of nearly 90% since September 2012 to 1,719. Even better, the 62-day cancer backlog fell year-on-year, with those waiting two months or more down from 21,823 at the beginning of last year (March 2022) to 19,248 at the end of this year (March 2023). This reduction of 15,000 down from a 34,000 peak in summer last year. Again, the North West saw a big reduction of 3,305 from a peak of 7,397 in October last year.

Some of the progress has been hit by industrial action, with the NHS reporting that around 500,000 hospital appointments were postponed since the start of December with almost 200,000 appointments affected during the four day junior doctor strike action recently. Government officials have acknowledged difficulties in deploying resources to the adult social care workforce and has taken steps to try to improve the situation. Care workers, assistants and community workers have been added but still below the shortage occupation list (SOL)55. Following the commencement of this list, the proportion of new starters in the social care workforce arriving from outside the country increased from 4% in 2021 to 11% in 2022. There are signs though of a backlog in health and social care could mean that there is pent-up demand for care. Initial insight from the Institute of Government shows that:

  • The Association of Directors of Adult Social Services (ADASS) demonstrated that as of August 2022, 245,821 people were awaiting assessment for care, up from 204,241 in November 2021,86 but down from the peak of 294,449 in April 2022.

  • Of the 245,821 people awaiting assessment in August 2022, 80,967 of those had been waiting for more than six months.

  • The reduction in the number of people in care aged 65 and over, up to 2019/20, despite an increase in the number of requests for care, means it is likely there was substantial unmet demand even before the pandemic. Unmet demand for social care may increase pressures in primary, community and secondary care, although evidence for this is mixed

As ever, the NHS is a complex and dynamic system, with competing resources across all sectors. The pledges from Johnson’s government and Sunak’s recent initiative are sure to have bolstered budgets and provided more resources, as seen in the improvement in NHS ambulance times. This pledge will likely unravel in the future decade, and it remains to be seen whether the Conservative party can first win the next election and second begin to create momentum with new hospitals and services.

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