Victoria Stratford is a student at the University of Essex.
In recent years, the NHS has been under increased pressure. Budget constraints are leading to long waiting times, staff shortages, and latterly strikes and walkouts from nurses and doctors. Even Sir Keir Starmer’s recent proposal of a 22 per cent pay rise for junior doctors has not been enough to bring an end to the strikes.
Yet these pressures have arisen despite the Health Service’s vast (and growing) budget. In the year 2022/2023, the Department for Health and Social Care spent £182 billion to fund a wide range of health and care services including GP appointments, ambulance and mental health services and community and hospital services which are all commissioned by the NHS.
The Department for Health and Social Care also funded some services that are commissioned by local authorities. However, in 2024/2025, the total budget is set to increase to £192 billion, an increase of £1.1 billion on 2023/2024 when the budget was adjusted for inflation.
Where is all of this money going? The issues lie not just in the overall funding but in how this funding is allocated and spent.
Clinician involvement in management and spending decisions, for example, has been recognised since the 1983 Griffiths Report, and again in the 2008 NHS Next Stage Review. Despite this, today frontline medical staff have less say in management than in the past; instead there is a class of super-earning managers (being paid up to £240,000 per year), and managers being recruited at a faster rate than nurses and doctors.
Physician involvement in hospital management leads to more clinically aligned decision-making, improved quality and patient outcomes, operational efficiency, and stronger staff engagement all of which enhance the overall performance of the hospital.
This pay disparity between management and clinicians is also surely a factor in the latest round of strikes. Giving front-line staff a larger role in management – and fairly compensating them for the extra responsibility – would not only lead to better decisions, but mitigate one of the factors driving wage demands in the Health Service.
At present, the NHS is also locked into a reactionary approach, dealing with medical problems once they arise rather than preventing them, which is very often much more cost-effective. This has created a negative feedback loop, with more resources diverted to hospitals and away from GPs, are the first line of detection and defence – and are now taking industrial action themselves.
When the Health Service does invest, it too often favours high-visibility projects with immediate results over less eye-catching initiatives which could unlock greater long-term benefits, and improving access to high-profile services is prioritised over both workforce development and public health programmes which would reduce demand on scarce healthcare resources.
There are exceptions: the NHS Long Term Workforce Plan has been commissioned as a once-in-a-generation opportunity to put staffing on a sustainable footing and improve patient care, accompanying the biggest recruitment drive in health service history with a focus on retaining existing talent and making best use of new technology.
But given the current pressures and decision-making architecture of the NHS – which results in a continuous cycle of crisis management where funding is continually redirected to address immediate pressures – there is no guarantee it will deliver on its big promises in the face of year-on-year budgetary pressure.
The Tory leadership contenders have a unique opportunity to present bold, forward-thinking policies that resonate with the electorate. They have the opportunity to present immediate and long-term solutions for the challenges facing the Health Service, including workforce and retention and mental health services.
If our party is to win a hearing from the voters in 2029, is vital that the next Conservative Party leader prioritises the NHS.
