Conclusion and recommendations

COVID-19 has had a fundamental impact on health and health care in England. The long term plan set out a 10-year strategy for improvement and reform in the NHS. The core principles set out in the plan – of expanded primary and community services, stronger action on prevention and health inequalities, better access to high quality care – remain as relevant now as they were before COVID-19. But implementation of the plan has been derailed by the pandemic and new pressures and priorities have emerged.

The scale of the challenges facing the NHS after the pandemic is enormous – including addressing the growing backlog of unmet health care need, fixing longstanding staffing shortages, boosting action on wide and unjust health inequalities, and more. Resources to address these challenges are constrained. There needs to be an updated strategy for improvement and reform that accounts for the impact of COVID-19. Our analysis points to several priorities for the NHS and government to guide this:

  • Government must recognise the urgency of reducing care backlogs but also the importance of improving health and reducing inequalities across the population. Significant investment will be needed over the long term – including to expand the NHS workforce and improve NHS infrastructure.
  • National NHS bodies must give a realistic assessment of the time and resources needed to address unmet need for NHS services, alongside new demands created by the pandemic. This should include goals for what can be delivered by when, given constraints on the NHS workforce.
  • National NHS bodies must also set out the investment needed in primary, community, mental health, and other services to achieve the plan’s vision for better prevention of ill health, earlier diagnosis, and care for major conditions. Ambitions in the long term plan must be reassessed.
  • Action to address the backlog in elective care must not come at the expense of interventions to prevent disease and reduce health inequalities. A more detailed framework of priorities and interventions for NHS agencies to tackle health inequalities is needed to help ensure progress.
  • Wider government investment is also needed to improve health and reduce health inequalities, not just increased spending on the NHS. This includes investment in social care, public health, and other services that shape health. Continued underinvestment will hold back NHS progress.
  • As new NHS integrated care systems are developed, greater clarity is needed on their objectives and how progress against them will be assessed and publicly reported. Future national plans for the NHS should include clear measures of progress that are transparently tracked and publicly reported each year.
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