The Health Foundation has listed what it believes should be the priorities for the next government to address problems in health and social care in England.
Essential parts of the NHS in England are experiencing the worst performance against waiting times targets since the targets were set. This includes the highest proportion of people waiting more than four hours in A&E departments since 2004, and the highest proportion of people waiting over 18 weeks for non-urgent (but essential) hospital treatment since 2008.
The target for treating cancer patients within 62 days of urgent GP referral has not been met for over five years, and survey evidence suggests more people are experiencing lengthening delays in getting GP appointments.
Longer waits are a symptom of more people needing treatment than the NHS has the capacity to deliver. This reflects a decade of much lower than average funding growth for the NHS and workforce shortages, coupled with growing and changing population health needs. These pressures are exacerbated by cuts to social care and public health budgets, which make it harder to keep people healthy outside hospitals.
Recovering performance against targets will require initial investment to stabilise staff numbers, increase the workforce in key services, and increase investment in buildings and equipment.
For general practice, staff shortages of GPs and practice nurses need to be reversed. Setting rigid waiting time targets is unlikely to be the right approach as patients need a combination of continuity and quick access, and this varies by area. Investment in the workforce will need to happen alongside investment in buildings and premises. It is vital to ensure resources reach those general practices where need is greatest.
Improving emergency hospital waiting times will require a sustained focus on multiple parts of the system, including staffing within A&E but also the management of patients across hospital departments, particularly services to enable patients to leave hospital safely. This, in turn, needs an urgent solution to social care services, which are understaffed, unstable and unable to meet the needs of older and younger adults.
Longer-term solutions to keeping people well, preventing deterioration of illness and finding more efficient ways to manage patients’ journeys through the NHS do exist. However, these will require hospital staff and managers to have the time and skills to stand back and find ways to redesign services, so patients avoid long delays and are prevented from reaching crisis points that require hospital admissions.
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