The new government has an ambitious ten-year plan to transform the NHS by shifting care closer to home and tackling the UK’s poor record on public health. But with multiple short-term challenges and little money to spend, ministers will need more than goodwill and good intentions if they’re to turn those ambitions into reality, writes Sarah Woolnough.

The government believes the NHS is “broken” and wants to show how it will go about “fixing” it quickly. To that end, I’m pleased to see a welcome urgency about the ministerial team’s early weeks in office.

We’ve seen immediate steps taken to attempt to bring the junior doctors’ industrial action to an end and acceptance of the pay review body’s recommendations for some other healthcare professionals. Lord Darzi has carried out his audit of NHS performance and, more broadly, work has begun to develop a ten-year plan for the NHS and a cross-government ‘mission’ is being formed to transform the nation’s health. The new government’s legislative agenda set out in the King’s Speech includes commitments to introduce much-needed reforms to the Mental Health Act as well as a phased ban on the sale of tobacco products.

Less positively, the new government has indefinitely postponed the introduction of charging reforms for social care, which were developed by the previous Conservative government and due to come into effect next year. In truth, Labour always seemed lukewarm on the plan. The problem with dropping these reforms is that the new government is left with no plan for social care.

Labour did make manifesto commitments to establish a fair pay agreement for care workers and to create a National Care Service, but we are yet to see what these mean in practice. There have been rumblings about a Royal Commission to examine policy solutions in social care. We have been here before, with previous commissions taking time to come up with recommendations that were then not enacted, which is why some in the social care sector responded to the idea with dismay. Fundamentally, our social care system is not sustainable, with people’s need for care outstripping the availability of state support. However ministers decide to approach it, the central challenge is boosting the availability of publicly funded social care and creating a fairer system.

So, what are the other key challenges, priorities, and opportunities facing the new government?

The first, and most visible, is patients struggling to access timely care when they need it. It’s one of the major reasons we have historically low levels of public satisfaction with our health and care system. Many of the constitutional standards to ensure quick access to key services — A&E, ambulance and elective care — have not been met for years. The government has ambitiously promised to fix this within a five-year parliamentary term. Resolving the junior doctors’ dispute should help deliver the 40,000 additional appointments per week Labour promised in their manifesto. There’s a small amount of money for scanners and other kit too, recognising that we have relatively fewer scanners compared to some of our higher performing international neighbours.

Second, in opposition, Labour made positive noises about a greater emphasis on preventing illness. In government, they have taken some promising early steps. A bill banning the sale of tobacco and advertising of vapes to young people will be introduced into parliament shortly. Ministers have also announced plans to restrict the marketing of junk food and high caffeine drinks to children, both of which are relatively easy to do and don’t directly cost taxpayers much to implement.

Beyond these early steps, a child health action plan, implementation of a more comprehensive anti-obesity blueprint, an alcohol harm reduction plan and bolder clean air laws would all be generally popular with the public and should begin to address our poor population health, particularly in more deprived communities. A quarter of 11-year-olds leave primary school obese; life expectancy has stalled — and, in some communities, declined — over the past decade.

Third, ministers will want to do more to support health and care staff. The health secretary has already made welcome statements about the need for honesty in conversations and action to improve a culture that too often doesn’t encourage people to speak up. There has been talk of plans for professional regulation of managers, but nothing was said about this in the King’s Speech. Of course, many managers are already professionally regulated, regulation is relatively costly, and it would not be a panacea to tackle the poor behaviour we have seen in recent high-profile cases.

Managers are central to realising an efficient and productive health service, streamlining processes, and creating environments for clinicians to focus on delivering patient care. The new government can and should partner closely with NHS managers to work through these issues.

The fourth big opportunity for the government, and one of the most exciting aspects of their health agenda, is to move care closer to home. This requires a big shift. It means preventing more disease and re-wiring our health system to provide proactive care in the community when disease is detected, negating the need in many cases for people to be admitted to hospital.

It means different approaches to managing multi-morbidity, including using tech-enabled devices at home, and embracing community rehabilitation to get people the support they need to leave hospital with confidence more swiftly. Successive governments have promised to do this for at least 30 years. They’ve largely failed. It requires a wholesale shifting of the spotlight from acute hospitals to primary and community sectors. We need to value and measure community activity, increase the status of the workforce, and differentially increase investment out of hospitals in the years to come. Put bluntly, part of the answer to overcrowded hospitals is decent investment in primary and community health and care services.  

What will it take to deliver this shift to a health and care system centred on care closer to home?

To stand a chance of success there needs to be a sustained commitment to bolstering primary and community services, which runs through not just the centre of government but out to every system across the country. Integrated Care Systems have clear remits to improve population health and embrace integrated healthcare that is more person and patient centred. The problem is many systems have been under so much pressure to deliver to shorter term, performance related targets, particularly at a time of continued financial constraint in health and care services, that they have not had the time or resource to work on the long-promised shift to more community-based care. Finding the space to deliver on shorter term performance metrics, while not forgetting the longer-term change, will be tough but a major achievement if delivered.

This is a government keen to hit the ground running and to be seen hitting the ground running. They have made many short-term commitments, but also set out ambitious, longer term reform goals. The challenge is how that ambition and pace is affected by harsh financial reality, and the inevitable challenges that crop up along the way. The key opportunity for the incoming government is that all of us across the health and care landscape are also committed to making progress on these important areas and will work alongside them to do so.

Parliament returned at the beginning of September, the Budget is due on 30 October and demand for health and care services will soon start to rise as winter bites. It will be an important few months for health and care in this country.

• Sarah Woolnough is chief executive of the King’s Fund (kingsfund.org.uk)