The future of the NHS will be shaped by its ability to moderate demand for care and support, to invest more in primary care and community services, and to recognise the role of patients and the public in improving health and care.

That is the conclusion of a report published by the King’s Fund, The rise and decline of the NHS in England 2000–20

The report calls for greater investment in primary care and community services (including social care) and a sustained commitment to prevention.

Written by former King’s Fund chief executive, Professor Chris Ham, the article notes that the case for change in the NHS has been set out in various policy documents and reports in the past decade, including the Forward View and the NHS Long Term Plan.  Despite this, the share of NHS expenditure accounted for by hospitals increased from 62.7 per cent to 65.2 per cent, and the share accounted for by primary and community services fell from 20 per cent to 19.4 per cent, between 2015/16 and 2018/19.

The report finds that failure to invest more in services in the community hindered efforts to reduce demand for hospital care and respond to the changing burden of disease. One study noted that growth in the workforce was greater in hospitals than in general practice, resulting in ‘more capacity for doctors to refer patients and to undertake outpatient procedures as technology advanced’. During 2000/1 and 2017/18, elective procedures grew by 9.6 per cent each year whereas GP consultations grew only 0.7 per cent per year.

Looking to the future, Ham believes that the difficulty facing ICSs is that they have inherited financial challenges, which will “undoubtedly constrain the ability of ICSs to increase investment in primary care, community services and prevention”..

Rather than attributing the current situation to some inevitable built-in decay, the report draws out the decisions (or lack of them) that have led to the current crisis. A mix of reform and investment could enable the same scale of recovery seen through the decade following 2000, he suggests.

He concludes: “The next government must adopt a long-term perspective to avoid repeating the mistakes of the past decade.”