Hugh Alderwick

Our new assessment of Labour's first year

Main story:

- Labour has set out a broad vision on the NHS
- But detail on how change will happen is lacking
- And resources to deliver are limited
- Standing back, it's hard to find a coherent policy agenda
- More reorganization will make it all harder

Thank you! Late, but here

Lessons from history for bringing NHS England back into the department

Dazed and confused? Policy ideas behind the NHS 10 year plan

www.health.org.uk/reports-and-...

@healthfoundation.bsky.social @charlestallack.bsky.social @mancunianmedic.bsky.social @martinmckee.bsky.social @helensalisbury.bsky.social

Rhetoric about NHS reform is misplaced The NHS is in crisis, and talk of fundamental reform is little more than a distraction The NHS in England is in crisis. The health service entered the new year—as it did the last one—with several NH...

You'd want to design some exemptions and various rules... But—luckily—government already has a fairer and more efficient way of raising revenue for the NHS… tax!

We should focus on the real problems facing the NHS, not made up ones

www.bmj.com/content/380/...

The RAND Health Insurance Experiment, Three Decades Later We re-present and re-examine the analysis from the famous RAND Health Insurance Experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending. We begin by su...

And on more user charges (eg £X to see your GP), evidence tells us they can reduce demand for health care, but that includes the care people need to stay healthy

The poorest and sickest patients suffer as a result

pmc.ncbi.nlm.nih.gov/articles/PMC...

My colleagues summarised this and other evidence here:

www.health.org.uk/sites/defaul...

How Do Health System Features Influence Health System Performance? International comparisons are an important tool for benchmarking health system performance, shedding light on health systems’ relative strengths and weaknesses. The present work examines how different...

People want government to improve the NHS, not reform its funding model. This would waste years of time and money and would not address the NHS’s problems

Evidence on health system characteristics and performance points us to this conclusion too

www.oecd.org/en/publicati...

When presented with detail on how other models work—including social insurance, like in some European countries, or some version of our current model with additional user charges—they overwhelmingly favour sticking with our current tax-funded system

www.health.org.uk/reports-and-...

Public Satisfaction With The NHS And Social Care In 2024 | BSA | The King's Fund This report explores public satisfaction with the NHS and social care in 2024. Just 1 in 5 people in 2024 said they were satisfied with the NHS. This is the lowest level of satisfaction recorded since...

And despite low public satisfaction with NHS services, the public have strong support for the NHS’s model—free at the point of use, comprehensive, and primarily tax funded

www.kingsfund.org.uk/insight-and-...

The way the NHS is funded—largely through general taxation—is an efficient and equitable way of raising revenue, with comparatively low admin costs

In either case, there’s no clear evidence that one model performs better than the other

(and recent work suggests that, if you were starting from scratch, you would not choose SHI)

core.ac.uk/download/pdf...

onlinelibrary.wiley.com/doi/10.1002/...

The dangers of magical thinking on health policy We must carefully consider how changes in the funding model might affect the healthcare system

Both systems basically rely on the same thing: risk pooling across the population, funded by compulsory payments (whether you call these a tax or not)

www.ft.com/content/602f...

Spending on health in Europe: entering a new era Publicaciones de la Organización Mundial de la Salud

How countries fund health care is shaped by history, culture, politics, values, more

The distinction between Beveridge (tax funded) and Bismarck (social insurance) systems has blurred over time, as countries with social insurance increasingly rely on extra government £

www.who.int/europe/publi...

The NHS – a Suitable Case for Treatment? - Policy Exchange Download Publication Online Reader ‘The NHS – a Suitable Case for Treatment?’ makes the case that the NHS is not fit for purpose and is in urgent need of reform.The report finds that NHS performance r...

Policy exchange, backed by Sajid Javid, think we need to switch the NHS funding model to social insurance, and introduce new charges for NHS services, like to see a GP

policyexchange.org.uk/publication/...

These are not new ideas, but they are bad ideas

A thread with some evidence

1 in 5 care workers live in poverty—much higher than the average UK worker. Poverty is even worse for migrant workers in social care

New analysis @healthfoundation.bsky.social

www.health.org.uk/reports-and-...

@mancunianmedic.bsky.social @healthfoundation.bsky.social @hpiandycowper.bsky.social

Government’s 10 year plan for the NHS in England Familiar ambitions; familiar questions about delivery The Labour government published its 10 year health plan on 3 July1—a year after it entered office. Life expectancy in the UK has stalled,2 and pu...

The 10 year plan—more hope than substance. My take in @bmj.com

www.bmj.com/content/390/...

Illustrative

What’s been tried? A curated catalogue of efforts to improve access to general practice
➡️ doi.org/10.3399/BJGP...
‬Using 449 different sources, this review offers a comprehensive, thematically curated catalogue of attempts to improve access to general practice.

🎧 @hughalderwick.bsky.social joins @thelancet.bsky.social podcast to explore the impact of Labour's health policies since coming to power last July.

Also hear Hugh's analysis on the balance between funding and reform, the role of AI, and improving access to primary care.

Listen now ⬇️

Rejigging NHS structures while the health service is in crisis is a distraction that NHS staff and patients could do without. See more @healthfoundation.bsky.social

Government could achieve the same objectives with far less disruption—for instance, by bringing some functions into the department over time, leaving others at arms length from ministers, and avoiding distracting legislative changes needed to scrap NHS England entirely

But scrapping NHS England altogether will be a massive distraction. Evidence tells us that NHS reorganisations cause disruption and rarely deliver the benefits politicians expect. They also waste time and effort that could be spent on work to improve services

There is some logic in bringing NHS England and the department closer together—for instance, to reduce fragmentation and improve clarity for the health service

Labour government scraps NHS England Performative politics that will disrupt the health service when patients most need it On 13 March, the UK prime minister announced that the Labour government will scrap NHS England—the national body ...

This morning on Today, #BBCRadio4 reported on our views on government abolishing NHS England

Here's the long version of what we think @bmj.com : www.bmj.com/content/388/...

Brief thread here with some key points:

Labour government scraps NHS England Performative politics that will disrupt the health service when patients most need it On 13 March, the UK prime minister announced that the Labour government will scrap NHS England—the national body ...

On the end of NHS England in @bmj.com

www.bmj.com/content/388/...

Feels like a massive distraction

Things can only get better? What does the public make of the new government’s early agenda for the NHS and social care? Have perceptions and expectations of NHS and care services changed? This analysis presents findings from the...

New data suggest the public's top priority for the NHS is improving GP access

But government's headline NHS pledge is reducing elective waiting times

Hospitals risk crowding out other priorities

Polling @healthfoundation.bsky.social @ipsosintheuk.bsky.social: www.health.org.uk/reports-and-...

Labour’s 10 year plan for the English NHS Government must provide hope, clarity, and investment The NHS is in crisis after a decade of austerity, covid-19, and political failures since 2010 that weakened the health service and constrained wh...

Government is writing a new 10 year plan for the NHS. (The NHS has a long history of long term plans…)

What should the latest plan do?

Short paper @bmj.com:

www.bmj.com/content/388/...

Longer one @healthfoundation.bsky.social:

www.health.org.uk/reports-and-...