IPPR - Deliver once-in-a-generation NHS reform to avert killer costs and end second-rate care, landmark report warns

• IPPR's ‘plan for prevention and productivity' in England's health and social care service could save annual equivalent of the defence budget and secure the future of the NHS
• Deep-dive audit of health and care services shows UK lagging behind peers on dementia, cancer and mental health
• UK could have averted around 240,000 deaths in the 2010's if it had matched avoidable mortality of European neighbours

A landmark new report for the cross-party IPPR Commission on Health and Prosperity has revealed that UK health and care services are falling further behind international peers - and sets out a 10-point plan to put them right.

IPPR's proposals to reform health and care services would shift the NHS from a sickness service to a prevention service, focused on effectiveness rather than just efficiency, and so improving both public health and public finances.

In one of the most comprehensive audits of health and care services since Covid-19 emerged, IPPR and CF analysis shows that:

• If the UK had an avoidable mortality rate similar to those in comparable European countries, 240,000 fewer people would have died in the decade from 2010

• Cancer survival is stubbornly lower in the UK than in almost all other advanced economies, while dementia mortality is far higher in the UK than in western European, Nordic and Anglophone nations

• Of those with a preferred GP, fewer than one in six get continuity of care with them - and UK patients are less likely than those in other countries to be involved in decisions about their care, or have enough time with their doctor

• Requests for adult social care support have risen 10 per cent since 2016, but the number receiving local authority support has declined 4 per cent

• Nearly six in 10 people aged 17 to 24 with a probable mental health disorder are not getting treatment from health services

The report warns that this is costing lives, but also livelihoods. With economic inactivity due to sickness at a record level of 2.6 million people across the UK, it says flourishing health and care services are crucial to deliver a high growth economy with a strong labour market.

Without reform, comprehensive new modelling of NHS expenditure by LCP Health Analytics and IPPR finds taxpayers will pay more for worsening services. On the post-pandemic trajectory, government healthcare spending in England (by DHSC) is on course to rise from 9 per cent of GDP to 11.2 per cent of GDP by 2033/34.

However, IPPR's reform proposals could save taxpayers up to £205 billion over the next decade in comparison by freeing up growing sums each year - with the annual saving worth the equivalent of the current UK defence budget by 2033/34.

Following extensive consultation with patients and service users, IPPR's report puts forward a 10-point plan to deliver what it says would be a once in a generation reform. Its recommendations include:

1. A new ‘hub-and-spoke' model to re-invent primary care, creating two Neighbourhood Health Hubs linked to the local GP network in every constituency - to give people easy access to a much wider range of local preventative services, from diabetes care to housing services - while making continuity of care the norm again

1. A social care guarantee with personal care made free, on a par with the NHS, ending the unfairness of diagnoses like dementia leading to avoidable suffering and patients being forced to bear potentially catastrophic costs

1. A new deal for health and care workers, who would have their student loan debts cancelled, be offered greater control over their working time and be given a greater voice in planning services, alongside the professionalisation of care work with a new Royal College of Social Care

1. A new five-year funding deal of 3.6 per cent budget growth per year for NHS England to break the current ‘feast and famine' model of funding and to fuel an ambitious modernisation project, funded by progressive tax reform

The report argues that failure to invest in reform now will lead to NHS costs rising ever faster, either crowding out investment in other public services or leading to a steady decline in the quality of universal healthcare. It argues that the universal tax-funded model is better for public health and public finances than alternative models of healthcare financing, which it describes as ‘red herrings'.

IPPR's new ideas and evidence will be considered by the Commission on Health and Prosperity in making its final recommendations in Spring 2024.

Lord Ara Darzi, former health minister, Paul Hamlyn Chair of Surgery at Imperial College London, and co-chair of the IPPR Commission on Health and Prosperity, said:

"The NHS and social care system is vital to our individual and national health and prosperity. Too many people are struggling to get high quality care, when they need it most. As a result, there are growing calls for us to change our 'free at the point of need' system.

“But now is not the time to abandon the principles which underpin the NHS. Instead, we must renew and extend them in order to deliver better health, a stronger economy and a fairer society. This report sets out a plan to achieve this." 

Dr Parth Patel, lead author of the report, IPPR senior fellow, and NHS doctor, said:

“We spend more years in sickness than ever before, yet it has never been harder to access timely healthcare. The NHS, world-leading not so long ago, has now fallen far behind international peers.

“With political will, health services in this country can once again be world-leading. Not by following red herring reforms to the funding model, but through an ambitious plan to move from a reactive 20th century model to a proactive 21st century one that works for public health and public finances. Death and taxes may both be inevitable - but with these reforms to our health and care system, we will face less of both than if we continue as we are.”

Harry Quilter-Pinner, IPPR director of research and engagement, said:

“At their best, health and care services can save lives, transform wellbeing, and support prosperity. But after a decade of austerity, low investment and a pandemic, today's status quo is not meeting the demands of the 21st century.

“If we continue down this path, we risk a status quo of extortionate inadequacy - where we pay ever increasing sums for health and care services that are, at best, mediocre. Our new research shows we can get better by spending better.”

Lord James Bethell, former health minister and commissioner, said:

"Sick Britain is costing us our lives, our livelihoods and harming the UK economy. If we want to change course, we must stop pretending that the answers are always more hospitals and more acute staff. Instead, we must start taking action to reduce demand and need for healthcare, through prevention. A mission for a healthy Britain, that targets the concurrent epidemics of obesity, gambling, addiction and online harm is a precondition for any sustainable, effective National Health Service in the 21st century."

Matthew Taylor, CEO of NHS Confederation and commissioner, said:

"Both the human and economic case for investment in health is inarguable. With record numbers excluded from work by sickness, and high levels of avoidable mortality in the UK, the government must do more to support the NHS.

"That includes doing more to stop people falling ill, as IPPR's research highlights. Health leaders have long advocated for more prevention and will welcome the argument to make this a core principle for reform in this report.

"Investment that keeps people out of hospital and preventing ill health will save money in the long-term, support the economy, and help secure a sustainable, flourishing future for the NHS.”

Oonagh Smith, CEO of Skills for Care, said:

"This report is a useful contribution to the debate. It's good to see that it attempts to tackle some of the biggest issues facing social care, and recognises the importance of both health and social care to enabling people to live healthy, independent and fulfilling lives.

“Social care is not the same as healthcare - while the drivers for improvement are the same, the levers for bringing it about are different. Nonetheless, the two are close cousins and need to work together on an equal footing.

“We believe that, now we have a long-term workforce plan for the NHS, an equivalent plan for social care is crucial for success. We're working with partners across the sector to make this a reality.”

Christina McAnea, UNISON general secretary, said:

“Thirteen years of underfunding has done untold damage to NHS and social care.

“Ambitious care reform to raise standards and give people confidence in the system is long overdue.

"A thriving care service, able to deliver quality care to all who need support and which pays and treats its staff fairly, has never been needed more."

Fiona Carragher, Director of Research and Influencing, Alzheimer's Society said:

“1 in 3 people born today will go on to develop dementia, and this report makes plain the serious consequences of failing to properly invest in health and social care. If the UK had matched the dementia mortality rates of our European counterparts, 180,000 people might not have died of dementia between 2010 and 2020.

“We hugely welcome the IPPR report's pragmatic and constructive recommendations on care reform, from a social care guarantee that will offer free personal care and drive up the quality of providers through ethical commissioning, to a new deal for health and care workers that would see all care workers paid the real living wage and provided with appropriate training and support for their roles. Alzheimer's Society has long called for social care workforce reform to tackle record vacancies and ensure we have a workforce fit for the future that can deliver the high-quality, personalised care people living with dementia need and deserve.

“We also welcome the report's proposals to finance the future fairly through a five-year commitment to increase England's health and social care budget by 3.6% per year. We already know that dementia is the UK's biggest killer, and by 2040, we estimate that 1.6m people will be living with the condition. This means pressure on health and care services is only going to increase. Sustainable, long-term investment is vital to address the biggest health and care challenge we face today, but as the report outlines, there are also smaller reform steps we can take to make a real difference to people's lives now. At Alzheimer's Society, we vow to end the devastation caused by dementia. That's why we'll keep pushing the Government to make dementia the political priority it needs to be.”

Harry Quilter-Pinner, Chris Thomas and Dr Parth Patel - report authors - are available for interview. Carys Roberts (IPPR executive director) and Lord Ara Darzi (IPPR commission co-chair) are also available.

NOTES TO EDITORS

1. The IPPR paper, For public health and public finances: The case for reforming health and social care, by Parth Patel, Harry Quilter-Pinner, Annie Williamson and Chris Thomas, will be published at 0001 on Wednesday September 13. After publication it will be available at: http://www.ippr.org/research/publications/for-public-health-and-public-finances

1. Advance copies of the report are available under embargo on request

1. The analysis to model government healthcare spending in England projections was undertaken by LCP Health Analytics specifically for this report. It is based on analysing age-, sex- and specialty- specific trends in healthcare service utilisation, and unit costs since 2004/5 in England. IPPR worked with LCP to develop three scenarios to model:
   a) repeating history: productivity grows in line with historic trends,
   b) post-pandemic new normal: productivity growth in the health service flatlines c) reform: productivity grows half a per cent faster per year than historic trends and healthy life expectancy begins rising from 2028/29 in line with the gains seen in the 2000s.

1. The chart below projects government healthcare spending in England as a share of GDP over the next decade under each scenario, using OBR forecasts for GDP growth. All projections account for inflation expectations using the GDP deflator. Please note our estimates are not comparable to ONS estimates of health expenditure as a share of GDP, which are UK-wide and include non-governmental healthcare spend, such as out-of-pocket healthcare expenditure and voluntary health insurance, as well as some government-funding social care expenditure.

1. CHART: Government healthcare spending in England as a share of GDP - 10 year projection, based on three different scenarios

1. IPPR's proposed five-year funding settlement for NHS England and adult social care services is as follows:

2. Lane Clarke and Peacock (LCP), an actuarial and data analytics company, worked with IPPR to model projections of government healthcare spending in England (by DHSC) for this report. Carnall Farrar (CF), a healthcare consulting and data services company, worked with IPPR to conduct the audit of health and care services and the international comparisons.

3. The Commission on Health and Prosperity (CHP) is a landmark IPPR initiative, exploring the case that a fairer country is a healthier country, and that a healthier country is a more prosperous country. It is cross-party and is co-chaired by Professor Dame Sally Davies, former chief medical officer for England, and Lord Ara Darzi, former health minister and Paul Hamlyn Chair of Surgery at Imperial College, London.

1. IPPR (the Institute for Public Policy Research) is an independent charity working towards a fairer, greener, and more prosperous society. We are researchers, communicators, and policy experts creating tangible progressive change, and turning bold ideas into common sense realities. Working across the UK, IPPR, IPPR North, and IPPR Scotland are deeply connected to the people of our nations and regions, and the issues our communities face. We have helped shape national conversations and progressive policy change for more than 30 years. From making the early case for the minimum wage and tackling regional inequality, to proposing a windfall tax on energy companies, IPPR's research and policy work has put forward practical solutions for the crises facing society.

Full article