(Bloomberg) -- England’s National Health Service is at breaking point and will need a “great deal more funding” to prevent the system deteriorating further, the National Audit Office warned.
In a report on the financial management and sustainability of NHS England, the spending watchdog called current service levels “unacceptable” as it laid out the chronic problems Prime Minister Keir Starmer’s Labour government inherits after a decade of underinvestment by the Conservatives compared with long-term trends.
Unless a new, preventative approach to ill health is adopted, Britain’s free-at-the-point-of use universal health service will “need to become much bigger and more expensive,” the NAO said. Health and social care already costs £190 billion (£245 billion) a year, almost £1 in every £6 the government spends.
“The scale of challenge facing the NHS today and foreseeable in the years ahead is unprecedented,” the NAO said.
Labour’s immediate challenges will be to address the 7.6 million-long patient waiting list – 3 million more than before the pandemic — and the £11.6 billion maintenance backlog for the hospital estate, including £2.4 billion that is so urgent it risks “catastrophic failure, major disruption to clinical services, or prosecution.” Some performance targets have not been met since 2015, the NAO added.
Longer-term pressures are even more acute. Many “NHS bodies have been unable to break even” in the past year, it said. In 2023-24, £900 million was transferred from infrastructure budgets to day-to-day spending despite maintenance needs because NHS trusts were running out of money.
Without a new approach to health care, the NAO said the situation will only get worse as demand spirals due to an ageing population. It pointed to a Health Foundation report that forecast the number of people with a major illness to rocket to 9.3 million in 2040 from 6.7 million in 2019 – “a 39% increase over a period when the population will only increase by 13.1%.”
Unless demand for care reverses, the NHS will need to increase general and acute bed capacity by almost 30% to 133,000 within 12 years. “When we consider how the health needs of the population look set to increase, we are concerned that the NHS may be working at the limits of a system which might break before it is again able to provide patients with care that meets standards for timeliness and accessibility,” the NAO said.
The watchdog also questioned current plans to tackle the crisis. The last Conservative government struck a deal with the NHS that would see it deliver productivity growth of between 1.5% and 2% between 2025-26 and 2029-30 in return for digital investment. The long-term pre-pandemic average for NHS productivity growth was just 0.6% between 1996-97 and 2018-19, the NAO said.
It urged the government to focus on preventing serious ill health, including by addressing wider social and economic factors. “Either much future demand for health care must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further,” it said.
“The Conservative Party has pushed our NHS to breaking point,” Liberal Democrat Health and Social Care spokesperson Daisy Cooper said. “At the heart of this Labour government’s agenda must be rescuing the NHS and ending the crisis in social care.”
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