NHS reform fact check: Rishi Sunak to announce ‘historic plan’ but have past Tory reforms worked?

Prime Minister Rishi Sunak, along with NHS England chief executive Amanda Pritchard, will unveil their new “historic” 15-year plan to fill NHS staffing shortages today (30 June). There will be a major expansion in training places for health staff in England, which will see more university places for medical and nursing students - as well as a first-time scheme of apprenticeships for doctors. 

A consultation looking at whether five-year medical degrees could be shortened by a year will also be launched. Currently, the UK is facing a shortage of doctors and nurses with one out of every 10 posts remaining unfilled, and half of new doctors and nurses being recruited from abroad. 

There are more than 110,000 vacancies, and without action, modelling suggests this could rise to 360,000 by 2037. To help achieve this new goal, the government has promised £2.4 billion with targets already set out for 2031. As the new plans are revealed, NationalWorld looks back at previous NHS reform promises made by the Conservative government, and what happened to them. 

Boris Johnson’s 40 hospitals

Boris Johnson promised a myriad of improvements to the NHS in his 2019 general election manifesto. This included increasing spending on the NHS by £34bn a year, enshrining a long-term funding plan for the NHS, delivering 50,000 more nurses - with maintenance grants - creating 50 million more GP appointments each year, and of course, building and fund 40 new hospitals by 2030.

Four years and one pandemic later, The Guardian revealed that only a quarter of the 40 hospitals promised by Johnson have secured full planning permission, required for building work to start. A boss of one of the NHS trusts awaiting a new hospital told them: “There’s a 0% chance there’s going to be 40 new hospitals by 2030. We’ll be moderately lucky to have eight. At the moment we’re doing loads of maintenance work on an ongoing basis, trying to sort out roofs and theatres and all those things. Some hospitals are literally falling down.”

An ongoing investigation by the independent National Audit Office has brought to light how many of the supposedly-new hospitals are just extensions or refurbishments.

The NHS Long-Term Plan 

Under Theresa May’s Conservative government in January 2019, the NHS Long Term Plan, or the NHS 10-year plan, was published in conjunction with NHS England chief executive Simon Stevens. The plan marked the official abandonment of the policy of competition in the English NHS created by the Health and Social Care Act 2012.

The plan proposed to shift resources out of hospitals and into community services and primary care. There was a huge focus on improving mental health support in schools and 24-hour access to mental health crisis teams. The idea was to also increase the NHS budget by £20 billion a year by 2023.

There was also a focus on shifting to digital health services, to make them a mainstream part of the NHS so that in five years (2024) patients in England will be able to access a digital GP offer. The plan also included ways to measure and prevent 150,000 heart attacks, strokes and dementia cases.

However, parts of the plan have been derailed to the pandemic, as the NHS was pushed to breaking point, with wait lists growing reaching historic highs. Data from NHS digital reveals that 69.8% of all appointments in May 2023 were carried out face-to-face. In the previous years of 2023, there was a stronger focus on face-to-face appointments, averaging around 70% according to NHS Digital, despite the want to move to more digital appointments.

However, what is on target is patients using the NHS app, as signups hit 30 million in January 2023. The government has reached its target to have 68% of people in England with the app by March 2023, and is on track for its second target of having 75% of people registered by 2024.

Health and Social Care Act 2012

In 2012, the UK passed the Health and Social Care Act which enforced one of the most extensive reorganisations of the NHS to date. The act removed responsibility for the health of citizens from the Secretary of State for Health - a role which had been in place since the NHS’ conception in 1948.

The act also saw the removal of primary care trusts (PCTs) and strategic health authorities whilst between £60 billion and £80 billion in healthcare funds from the abolished PCTs to clinical commissioning groups. This was all done under the then Secretary of State for Health, Andrew Lansley. 

These changes were one of the most controversial points in the coalition government, with a white paper set out in 2012 to establish an independent NHS Commissioning Board, establish new local authority health and well-being boards and develop Monitor as an economic regulator.

The reform saw an uproar and ignited a host of protests up until 2013. In 2015, a review from Chris Ham of the King’s Fund called the act “distracting and damaging” with the changes in governance complex and confusing with no system leadership.