Press Story

  • First annual ‘State of Health and Care’ report finds Covid-19 has undone years of progress and threatens ‘decade of health disruption’
  • IPPR sets out blueprint to ‘build back better’ and deliver a world-leading service in NHS and social care

An extra £12 billion a year is needed to invest in the NHS and care system, to recover the damage done by Covid-19 and ensure the health service can guarantee world-leading outcomes and care for generations to come.

In a landmark State of Health and Care report, the Institute for Public Policy Research (IPPR) has carried out the most extensive review of the toll the Covid-19 pandemic has inflicted on health and care service in England since the crisis began. Among a range of stark findings, new IPPR reveals:

  • GP appointments - There have been 31 million fewer GP appointments since the pandemic began. An issue falling hardest on people with long term conditions.
  • Avoidable cancer deaths - An additional 4,500 avoidable cancer deaths are expected this year because of pandemic disruptions. Undoing at least eight years of colorectal cancer survival rate progress, six years in breast cancer survival rates, and two years in lung cancer survival progress. The proportion of cancers diagnosed while still highly curable has dropped from 44 to 41 per cent.
  • Mental health - Checks on people with severe mental illnesses have fallen below a third of their target levels. 235,000 fewer people have been referred for psychological therapies. Eating disorder referrals for children have doubled and waiting lists have reached five year high. Children’s rates of common and severe mental illness have risen sharply during the pandemic.
  • Care homes - The low care home death toll during the second wave suggests most of the 30,000 care home deaths in the first wave were largely avoidable.
  • Avoidable severe illness – An additional 12,000 avoidable heart attacks and strokes are expected in the next five years due to Covid-19 disruptions to routine health services.

The report shows that the Covid-19 pandemic has undone years of progress tackling other major illnesses and if left unaddressed threatens to cause a decade of health disruption to prevention, diagnosis and treatments.

IPPR says that the strain the pandemic has put on the NHS in England is severe, but manageable if urgent action is taken by the government. The think tank calculates that just to recover the elective backlog and manage the mental health surge caused by the pandemic, the NHS budget needs an extra £2.2 billion per year for next five years.

However, the report urges the government to go further than just restoring the NHS to its already dangerously overstretched pre-pandemic level. The researchers instead set out a blueprint for ambitious reform across the health and caresector in England, defining what the government’s ‘build back better’ mantra should look like in reality.

The think tank calculates that a further £10.1 billion of investment would be needed annually, on top of the £2.2 billion Covid-19 catch-up funding, to realise this vision of a truly world-leading service and to get the NHS in England back on course to meet its own NHSLong Term Plan objectives. In the immediate term, this spending should be funded by borrowing but in the long term taxes will need to rise to fund the higher spending permanently.

Immediate policy priorities outlined in the report to tackle the pressing healthcare workforce crisis, overcome the social care deadlock and ensure access to NHS digital services include:

  • NHS staff pay – Set aside at least £1.4 billion to enable an average pay rise of 5 per cent for NHS staff.
  • Care workers’ pay - Guarantee a living wage for all care workers through government wage subsidy, similar to the furlough scheme, at a cost of £1 billion.
  • Migration – Scrapping the skills requirement and salary threshold for care workers to ensure all kinds of vacancies can be filled.
  • Social care - Making social care free at the point of need, just like the NHS.
  • Digital - Creating a universal entitlement to internet access by reimbursing internet costs for those most in need.

Longer term reform proposals include:

  • Education - Reforming health education, training and progression to develop a workforce with the right skills mix to meet future health needs.
  • Capital - Raising spending on NHS infrastructure, matching at least OECD levels, to upgrade ageing buildings and create more capacity across the health and care.
  • Legislation – IPPR support the government’s proposed legal reforms to NHS. But warn against greater ministerial control, suggesting instead NHS accountability to the public is strengthened by a more direct relationship between top NHS officials and Parliament.
  • Integration – Increasing integrated working between health, care and public health services is key to improving outcomes. But legislative change is just one piece of the puzzle – regulatory bodies must encourage collaborative working and financial incentives should reward improving health outcomes, not performing more healthcare activity.
  • Social care - Creating a ‘long term plan’ for social care that drives low quality providers out of the market, puts a cap on accommodation costs, shifts ownership back to public and voluntary sectors and brings care worker pay in line with NHS pay scales.
  • Digital - Upgrading digital infrastructure across the NHS and care to vastly improve productivity, care quality and drive further integration.

IPPR also commissioned Savanta ComRes to carry out polling of 172 senior leaders in NHS agencies and local government. This found:

  • Four in five NHS leaders say the current NHS funding deal, including the top ups announced in 2020, is no longer sufficient to deliver the NHS Long Term Plan
  • An overwhelming 80 per cent of health leaders believe social care reform will be ‘very important’ if the NHS is to achieve the targets set out in the NHS Long Term Plan.
  • Staff burnout and a surge in mental illness are the post-pandemic challenges that most worry health leaders (44 per cent for both).
  • Changes to immigration rules are important to meet workforce needs, according to 87 per cent of health leaders. Polling also showed that flexible working, progression opportunities and better pay were also key to tackling severe healthcare workforce challenges.

IPPR argues that the impact of Covid-19 has been compounded by the preceding decade of austerity and efficiency drives that pushed healthcare to the top of its capacity, but not the top of its game. Researchers urge the government to reject a ‘new era of austerity’ and instead re-invest in vital public services and the health of the nation.

Dr Parth Patel, IPPR Research fellow and lead author, said:

“The NHS has been there for us, from outbreak to vaccine. Our blueprint for reform is the booster shot it now dearly needs.

“A decade of austerity left our NHS running at the top of its capacity, rather than the top of its game. As a result, the consequences of the pandemic on people suffering with illnesses such as cancer and depression have been huge. There is a real risk now that this damage embeds and the NHS falls further down international rankings.

“The government wants to ‘build back better’ in health and care. This landmark report provides a costed and comprehensive plan on how to do that. It offers implementable solutions to the shrinking workforce, the crisis in care and fragmented health services.”

Chris Thomas, IPPR Senior Research Fellow, said:

“It is high time this government backed its build back better rhetoric with tangible policy and new funding.

“We have among the lowest numbers of nurses, doctors and long term care workers per capita. We face thousands more cancer deaths and 12,000 more heart attacks and strokes in the coming years. The number of people with mental ill health or multiple, chronic conditions is rising sharply. We are on the very edge of a precipice of a whole decade of severe health disruption.

“Now is no time to be timid. We urge the government to give the NHS the boost it so desperately needs, and to protect the nation’s health in the decade to come.”


Available for interview: Report authors Dr Parth Patel (who is also a hospital doctor), Chris Thomas and Harry Quilter-Pinner.


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A case studies available via third parties on request


  1. The IPPR paper, State of Health and Care: The NHS long term plan after Covid-19 by Dr Parth Patel, Chris Thomas and Harry Quilter-Pinner, will be published at 1900 on Tuesday 16 March 2021. It will be available for download at:
  2. Advance copies of the report are available under embargo on request.
  3. Sources for analysis include NHS Digital, Hospital Episode Statistics, Office for National Statistics and Public Health England.
  4. Savanta ComRes interviewed 172 health and care system leaders (director and executive level) online between 11 December 2020 and 15 January 2021. Data were unweighted. It is a sample with good representation across NHS agencies and local government, and good geographical representation across England.
  5. Table A1.1: Summary of the investment required to ‘build back better’ health and care.

  1. Figure 2.4: The pandemic has reversed improvements in cancer survival

  1. Figure 2.7 Children’s mental health has declined sharply during the pandemic.

IPPR is the UK’s pre-eminent progressive think tank. With more than 40 staff in offices in London, Manchester, Newcastle and Edinburgh, IPPR is Britain’s only national think tank with a truly national presence.