Great Expectations: The NHS in 2025

The end of the year is a time to take stock, celebrate what’s been achieved and, with luck, find some downtime to recharge batteries ready for the year ahead. For senior ministers, in a Government only 150 or so days old, festive thoughts may well be dominated by daunting, unresolved challenges that await in 2025. Nowhere can that be more true than in the Department of Health and Social Care.

On many measures, NHS performance is at an all-time low. Waiting times in A&E, elective backlogs, 100% bed occupancy rates, unprecedented winter pressures, staff burnout – these issues and more need to be tackled. They’re stubborn problems, and as Wes Streeting has said, it’s not just a case of flinging more money at them. Productivity improvements will come through smarter ways of working as well as extra cash. But changing ways of working in the NHS is far from easy.

Labour’s three big themes for change in the NHS are widely seen as sensible and right, but they’re not exactly new and it’s not as if others haven’t tried. Moving care from hospital to community, for example, has proved nigh on impossible for this Government’s predecessors – change has been modest at best.

So what can we expect in 2025 on the health and care landscape? 

For a start, the NHS 10-Year Plan is now in gestation and will be delivered by May. A lot rides on that, for the Government as well as the NHS itself. It needs to draw together a range of changes and ideas into a coherent, practical design, it needs to set the NHS on a sustainable long-term path, and it needs to deliver some quick improvements. 

Then there’s the small matter of Phase 2 of the Spending Review, due a short while later, which needs to align with and provide funding for the Plan.

If those two policies are not carefully interlocked, the wheels may come off before the journey has even started.

Before then, Ministers are determining the allocation of the £22billion that flowed to health and social care from the autumn Budget. A generous £126 million will go to the hospice sector, but the list of other competing demands is long, and all are deserving. It’s a perilous balancing act and it seems inevitable that some will be disappointed.  

The impact of the employer’s NI increase will affect organisations and services funded by the NHS. Decisions are pending over whether and how to address that.

Clarity is needed over targets – the current headline targets (18 weeks from referral to treatment, four hours for emergency departments) are not being met, so what should happen to them?

Penny Dash’s review of patient safety organisations will address questions around how best to prevent or detect patient safety issues and who does it, but the fact remains: A service that is ‘broken’ puts patient safety in greater jeopardy.

There are big decisions to take over the way that primary care and public health are funded and who controls those budgets. If the current split between NHS organisations and local councils is to remain, there’s a need for better coordination between the two. 

What’s the future for devolved decision-making in the NHS? Are ICBs proving effective and what lessons can learned from the best – and worst – performers?  

The consultation on the regulation of NHS managers concludes in February. Decisions about the approach to take won’t be easy. Attracting and keeping good NHS leaders is hard enough as it is.

And, crucially, a new approach to social care is needed. However good the 10-Year Plan is, it will be hamstrung without a plan to improve social care. 

You would not be human if, as the responsible minister, you didn’t feel the weight of all this on your shoulders. But perhaps the greatest challenge is us, the public, the people who use the NHS. When people voted for change in the summer, they were voting for a better, faster, more accessible NHS. People will be disinclined to wait until the end of this Parliament to see and experience the improvements they want. This Christmas, ministers will be acutely aware that the clock of public expectation is ticking. And at 39 Victoria Street they know it is going to sound ever louder in 2025.