The UK government’s role in developing healthcare services

What are the issues facing health and social care services in the United Kingdom?

The current situation for the UK public health system is challenging – and increasing demand and declining performance remain key concerns. While the system operated under extreme pressure prior to COVID-19, the pandemic exposed a number of critical and ongoing issues within the system: persistent health inequalities; chronic underfunding of medical services; and lower levels of doctors and nurses than other high-income countries.

The National Health Service (NHS) is the UK government-funded organisation that delivers comprehensive, free-of-charge medical and healthcare services to the public. The latest NHS Key Statistics report, produced in July 2023, highlights the scale of the issue facing the UK care system:

• The waiting list for hospital treatment rose to a record 7.2 million in January 2023, and the 18-week treatment target has not been met since 2016
• The number of patients waiting over 12 hours for elective hospital admission has increased substantially over the last two years
• The 62-day waiting time standard for cancer treatment has not been met in recent years, falling to a record low in December 2022
• NHS vacancy rates rose from 8.3% to 8.9% between December 2021 and December 2022.

This is merely a snapshot of the situation the care system is facing. Clearly, many of the issues facing public healthcare are systemic and undermine its future sustainability. They are intricately linked – and exacerbated – by government decision-making, influence and budget cuts.

So, what is the government’s role in tackling and improving health outcomes and quality of life? How can ill health be addressed at both local level and national level?

The government and healthcare funding

The NHS falls within the public sector. It’s the largest of the UK’s public services, and comprises several NHS organisations: NHS England, NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland.

Central government is responsible for developing the NHS’ overarching framework, and is held accountable by parliament for its operations and delivery. Together with local government, it’s also responsible for its funding. NHS spending – which is mainly funded via public taxation – has steadily increased since the system’s inception. This is due to a large variety of factors, including increasingly complex healthcare needs, ageing populations, and increases in drug and treatment costs.

Each of the UK nations holds individual responsibility for spending its healthcare budget. Budgets are divided between revenue funding (day-to-day resources, such as employee salaries, and administration costs) and capital funding (long-term, fixed assets such as clinics and hospitals). Planned spending for NHS England, for example – which receives its funding from the Department of Health and Social Care (DHSC), and is presided over by a Secretary of State – amounted to £180.2 billion in 2022/23, with the majority allocated to maintaining and improving services. The King’s Fund – an independent, charitable organisation that works to improve health and social care in England – has produced an NHS funding diagram which explains the flow of funding in more detail.

However, with restrictions on the budgets given to them, local NHS Foundation Trusts and local authorities must make difficult decisions regarding budget allocation and how best to meet the health needs of local populations. Which NHS services are most critical? Are there clinics or facilities that could be reduced?

The British Medical Association (BMA) report that while spending has increased, it hasn’t increased in line with demand. Lack of investment in key infrastructure has led to an insufficient number of hospital beds, as well as some estates being deemed unsafe, and sub-inflationary wage increases have undervalued and angered staff.

What is the Care Quality Commission?

The Care Quality Commission (CQC) is an independent regulator for health and social care in England that is sponsored by the DHSC and regulated by the statutory guidance of the Health and Social Care Acts. It inspects numerous primary care, secondary care, inpatient/outpatient and local health hubs. This includes care homes, clinics, GP practices, dentists, pharmacists, hospitals, home care services, community services and local services, mental health services and care providers of all types.

The CQC provides essential insights into how services are operating in order to, ‘provide people with safe, effective, compassionate, high-quality care and encourage services to improve’. As well as registering, monitoring, inspecting and rating providers, it offers an independent voice that gives the government key insights to track and ensure care standards are high and improvements are being made, and publishes an annual report to track progress and performance.

What is the government’s plan to improve health and social care?

How might improving the health of local and national populations be achieved?

The NHS Long-Term Plan is a series of objectives developed in collaboration with government, health professionals, patients and other stakeholders. It sets out the priority areas for improvement – supported by the Government’s Spending Review – which include:

• Developing a service model fit for the 21st-century – including dissolving the divide between primary care and community health, reducing pressure on emergency services, empowering patients to take control of their health, enabling digital care across primary and outpatient settings, and focus on population health and health integration
• Focusing on prevention and addressing health inequalities – including smoking, obesity and pollution
• Improving care quality and care outcomes – including giving children, young people and older people the high quality care they require and prioritising major health conditions such as cancer and diabetes
• Supporting NHS staff – including expanding the workforce – from clinicians to carers – across primary and community care services, enabling productive working and driving leadership and development initiatives and interventions
• Making digitally-enabled care mainstream – including improving clinical efficiency and improving personalised healthcare
• Using taxpayer money to maximum effect – including restoring financial balance and making better use of capital investment.

These measures require sufficient and reliable funding. While emergency funding and support is occasionally made available – for example, the governmental financial package and vaccination drive that followed the coronavirus outbreak – funding needs addressing as a matter of urgency.

Additionally, the government recognises the requirement for cooperation, collaboration and integration between clinical commissioning groups, regulatory bodies, and other care and cross-sectoral partnerships. Barriers still persist, such as duplication of governance arrangements, an absence of strategy and planning, and disconnected health information technology systems.

There are also suggestions by the current government that the NHS should become a private sector organisation.

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