What does 2023 hold for health?
Jack Bell, Account Director at Lodestone, gives his take on the outlook for health this year.
Having guided our clients through the turbulence of 2022, Lodestone’s team is well-placed to judge the key opportunities and threats likely to influence the year ahead. Over the coming weeks, keep an eye out for other sectoral deep-dives in areas including investment, technology, and energy.
The NHS currently faces the most significant and far-reaching crisis in its history. While still recovering from the impact of the pandemic and the need to recover capacity to reduce backlogs in elective care, the health service is now being rocked by industrial action. The cost-of-living crisis has laid bare and exacerbated the refusal of consecutive Conservative governments to fund above-inflation public sector wage growth. This has created the conditions for a level of coordinated industrial action unprecedented in the health service, including votes in favour of strike action from the ambulance service and, for the first time in its history, the Royal College of Nurses (RCN).
Beyond the basic question of pay, two systemic problems lie at the root of the current crisis. First, the reticence to invest in the staffing needed across the NHS and social care to treat an ageing population has left staff overworked and burnt out. Second, and despite repeated promises from successive governments, the social care system remains overstretched and under-funded, reducing the speed with which patients deemed to be clinically fit can be discharged from hospital – backing up the entire system and creating scenes of ambulance crews queuing outside Trusts across the country.
In this context, what can we expect from the year ahead?
2023 represents a genuine threat to the long-term survivability of the UK’s health service in its current form. As outlined by The Health Foundation, the UK entered the pandemic with lower health care spending per person and fewer staff and beds compared with other wealthy countries in the OECD. This included 100,000 vacancies in December 2019, rising to 110,000 in December 2021.
With junior doctors voting on potential industrial action later this year, and the government’s intransigence on offering a 5% above RPI inflation pay-rise for the sector, there exists a real prospect of more nurses and doctors leaving the NHS for good and the service struggling to fill these increasing shortages. These immediate pressures must also be considered in the context of challenges facing the higher education sector, which could reduce the pool of future junior doctors willing to work in the NHS.
The UK’s social care system is also tottering. There were 165,000 vacancies across adult social care in England – circa 9% of roles in the system – according to annual figures released in March 2022, reducing the effectiveness and availability of out-of-hospital care for the UK’s most vulnerable people. In November, the Chancellor also delayed the introduction of reforms, due to come into effect from October 2023, which would have included a £86,000 cap on personal care cost contributions and provided an expanded means test that is more generous than the existing system.
The government’s failure to address both staffing and social care reflects an unwillingness to recognise systemic dependencies. Any attempt to reform the NHS and tackle the persistent issues around flow through hospitals will require an equal, if not greater, investment in social care reform.
As minds collectively turn towards the next General Election, due in 2024/2025, there is an opportunity for NHS, social care and wider health sector stakeholders to outline new ideas for sector reform aimed at tackling the existing structural problems. There is a clear opportunity to engage with the Labour Party in particular as it focuses on developing a unified programme of reform to include in its next election manifesto.
While the question of pay rises remains politically fraught in the context of inflation and wider economic uncertainty, there is potential to offer a suite of piecemeal measures as part of a longer-term strategy to address the pressures on demand and supply for both the NHS and social care.
One such measure might include the enhanced roll-out of electronic patient records across Trusts. This has the potential to increase efficiencies, promote better integration between primary and secondary care settings and replace the outdated systems still in place at many Trusts which currently bog down doctors, nurses and professional staff with handwritten paperwork. While there are certainly some large tech players seeking to capitalise, it is likely that smaller, more community-focused businesses could also benefit, especially with the right messaging.
The expansion of virtual wards – supporting the provision of hospital-level treatment at home and reducing the risks for many older people associated with admission to hospital – is also being considered a viable measure to help expand Trusts’ ward capacity, though from 2024-25 there will be no ring-fenced recurrent funding from Government for these initiatives. The deployment of new and innovative measures such as these may become the vogue in 2023.
Moments of unprecedented crisis, such as that which the UK’s health sector currently finds itself in, can offer the most space for innovative thinking and impetus for reform. In 2023, we should expect to see proposals for reform which look to secure the long-term future of the UK’s health service – which will, of necessity, also require a reckoning with the root causes of our failing social care system.
Jack Bell is an Account Director at Lodestone.