The Prime Minister's focus on cutting waiting lists means the NHS is in an "endless hamster wheel" with the main focus on hospital care instead of preventing ill health in the first place, an NHS leader has suggested.
Matthew Taylor, chief executive of the NHS Confederation, which represents NHS trusts, said more investment needs to be put into GP surgeries, public health and community-based services One of Rishi Sunak's key commitments is to "cut NHS waiting lists", but Mr Taylor said that this means the focus is on the "end of the process".
Speaking ahead of the annual Edwin Stevens Lecture at the Royal Society of Medicine, which Mr Taylor was due to give later on Monday, he told BBC Radio 4's Today programme: "When money is short there's a sense of crisis and this leads to a short-termism where the department, the centre of government, is continuously firing out targets. It also leads to a kind of focus on particular issues.
"So the Prime Minister's 'objective health' isn't to improve health outcomes or tackle health inequalities or improve prevention, it's to cut waiting lists. Now waiting lists are extremely important but if you only focus on what happens in hospitals at the end of the process, and you're kind of caught on an endless hamster wheel because what you're not addressing is investment upstream in prevention and in primary care."
He added: "We need a health policy, we don't have a health policy at the moment. We have NHS policy even though actually what the health service does only contributes about 10% to 15% of our health outcomes - the rest is determined by a range of other factors, particularly including what are called the social determinants of health."
He will later say in his speech that the NHS struggles to find time, money and commitment to innovate because it "lurches from crisis to crisis". He will also set out an "urgent demand for investment - not just the amount, but also where we invest".
Mr Taylor will add: "In a service that lurches from crisis to crisis finding the time, money and commitment to innovate is hard. The investment case for intervention requires evidence that it can reduce costs but when demand exceeds capacity it is difficult to show that preventative interventions are having an effect. It is like trying to use a spoon to bail out an overflowing bath while the taps are still running."
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He will also call for a new "social contract" to mark the NHS's 75th anniversary. "(There is a) need to reset relationships between the public and our own health; between the centre and the NHS; and between all organisations involved in health and care," he is expected to say.
"The NHS's relationship with patients and the public has become mission critical," he will say. "Our health choices have implications not just for us but for everyone else.
"Compelling people to monitor their health, to follow health advice or adhere to treatment programmes would be counter-productive and unworkable. But social norms and expectations make a difference. Look at drink driving, smoking, and attitudes to sexuality - all areas where law has played a role, but the main driver has been a shift in the public sense of what is right; right for ourselves and right for each other."
He said that any conversation about empowering people to take control of their health should be about "shared responsibility, not blame". "The NHS needs the support of people just as much as the people need the support of the NHS," he will conclude.
