Confed Viewpoint blogs

The NHS needs a new social contract

With the NHS celebrating its 75th anniversary, Matthew Taylor reflects on what's needed for it to 'survive and thrive for the next 75 years'.
Matthew Taylor

6 July 2023

While the NHS remains well respected and loved in the UK, there's much to address, a lot of which lies outside the NHS. We need a shared vision of the NHS’s next era and a cross-government strategy to support it.  


This article was first published in The Times Red Box on 5 July 2023.

It’s with good reason that the NHS consistently ranks as one of the most trusted and loved institutions in the UK.

Despite the trauma of COVID-19 and lengthening waiting lists, on the eve of the 75th anniversary of the NHS it’s clear the public continue to place huge faith in the founding principles of the health service.

The public are not blind to the challenges that the NHS faces

In our latest polling with Ipsos, 87 per cent of believe the NHS should provide a comprehensive service available to all and the same number think it should remain free at the point of delivery. In addition, 83 per cent think it should continue to be funded primarily via taxation.

As we prepare to mark this historic occasion, we will celebrate many of the NHS’s notable achievements, but the public are not blind to the challenges that the NHS faces and what it needs to survive and thrive for another 75 years.

We start with our capacity to deliver, which has long been under-resourced. Our polling shows that 69 per cent do not think the NHS receives enough funding.

We need to see sustained and sufficient investment and to acknowledge that we have fallen behind other countries in funding and particularly capital investment, without which it becomes almost impossible to achieve the innovation and productivity gains we all want. Moreover, we need to see that NHS spending is also an investment that is contributing to the national and local economy in ways that include helping more people get back to work.

NHS workforce plan in England offers hope that we will finally get the staff we need

The public also see a lack of staffing as one of the major barriers holding the NHS back. The recent publication of the long-awaited NHS workforce plan in England offers hope that we will finally get the staff we need. This will come through a combination of better retention and increasing supply side reforms, notably through increasing medical and nursing school places and ramping up degree apprenticeships.

The long-term focus of the plan is welcome, but we also have pressing immediate issues and the coming planned industrial action by junior doctors and consultants this month will hit services hard.

We seem a long way from the government and the BMA even finding grounds to talk but the longer industrial action continues the bigger the risk to the prime ministers’ waiting list pledge.

The workforce plan will also rely on achieving ambitious productivity increases shared by NHS leaders, but at between 1.5-2 per cent these are very ambitious targets and well above the long-term average that has been delivered to date. Indeed, ONS data shows that UK healthcare productivity grew by 0.9 per cent on average between 1997-2019. Even to achieve the lower end of the range will require major extra investment in technology, innovation and capital in a relatively short timescale.

Yet, it’s not just about the money, it’s also about changing the way we deliver healthcare. At the heart of this, must be a drive to proportionately shift resources out of acute hospitals and upstream into community-based services, primary care and prevention.

We need a new social contract with the public, one in which we offer more and expect more

Resolving the fundamental question of how we fund our social care system for an ageing population is equally crucial. If we fail to sort this, then the workforce plan is going to have less impact. It’s one of the reasons why we have written to the prime minister calling for an equivalent workforce plan for social care.

All of this needs to be backed up by a cross-government strategy for our national health, not just policies for the NHS. This is vital given that most policy that impacts the health of the nation — from gambling and food regulation to housing and air quality — is made outside the NHS.

Finally, we need a new social contract with the public, one in which we offer more and expect more. The 75th anniversary is an opportunity for a national conversation about a more ambitious relationship between NHS and patients. Our own recent research shows the potential of technology in empowering patients to better manage and monitor their own health.

The challenge before us is to use the historic moment of the 75th to unite behind a shared vision of the NHS’s next and best era. At its heart it must be based on an ambitious and honest partnership between the NHS and those it serves.

Matthew Taylor is chief executive of the NHS Confederation. Follow Matthew on Twitter @FRSAMatthew