The Labour government has declared the NHS ‘broken’ and set-up a review that will feed into a ten-year plan to fix it. It’s going to be a big job…
The polls weren’t wrong. As soon as voting closed on 4 July, it was obvious the general election had delivered a huge majority to the Labour Party and its leader, Sir Keir Starmer, would form the next government.
By the end of the following day, he had unveiled a Cabinet built around his shadow team, with Wes Streeting in place as health and social care secretary.
‘The NHS is broken’
Streeting lost no time putting distance between himself and the previous regime. Pretty much his first act was to declare that: “The policy of this department is that the NHS is broken” and the job in hand is to “save” it.
“It will take time,” he warned. “We never pretended that the NHS could be fixed overnight. And it will take a team effort… [But] when we were last in office, we worked hand in hand with NHS staff to deliver the shortest waits and the highest patient satisfaction in history… and together we can do it again.”
A couple of days later, the Health Service Journal reported that Streeting had returned to the “team effort” theme in his first call to civil servants working in his department and at NHS England, telling the two organisations to work “collaboratively” and to surface any disagreements with him.
Getting the old (New Labour) team back together
Streeting has resisted the urge to announce another shake-up of the NHS, so NHS England, its regional bodies, and integrated care systems look safe for the moment. However, it doesn’t look as though the commissioning board will have the policy driving role it had assumed until Covid arrived.
Instead, Streeting has brought in a suite of New Labour-era advisors to “diagnose” how the NHS is broken and how to fix it. Lord Ara Darzi, a health minister in Gordon Brown’s government, has been asked to lead an independent review of NHS performance.
This will feed into a new, ten-year plan that will be put together by Sally Warren, a former civil servant and, latterly, policy director at the King’s Fund, with input from Blair-era special advisor Paul Corrigan, who has been brought in as a strategy advisor (HSJ).
Former health secretary Alan Milburn is also on the scene, with a report calling for health and job services to work together, to help make the NHS one of the engines for Labour’s “mission” for growth (The Guardian).
The King’s Speech and a reality check
With this activity underway, there was relatively little mention of the NHS in The King’s Speech, which simply said the government will “improve” it “as a service for all, providing care on the basis of need, rather than ability to pay.”
There were references to Labour’s campaign pledge to get waiting lists down (by creating an extra 40,000 appointments per week through overtime and use of the private sector) and its ambition to give mental health the same “attention and focus” as physical health.
And there were two public health bills. One to take forward ex-prime minister Rishi Sunak’s project to phase out smoking by progressively increasing the age at which people can legally buy tobacco, and one to restrict junk-food advertising and the sale of high-caffeine drinks to children.
Meanwhile, the NHS has carried on with what has become business as usual. Very high demand, particularly for ambulance services and ED. Waiting lists stuck around 7.5 million pathways. A crumbling estate. A financial ‘black hole’ so deep the National Audit Office is warning the service faces “unprecedented” challenges and could collapse. More strikes, as junior doctors talk (ITV) but GPs ballot on strike action.
Clever politics: big questions
So far, Labour has played some clever politics with its NHS announcements. Streeting has played up his willingness to use the private sector to show-off his “reform” credentials. Traditionalists got a King’s Speech commitment to the NHS’ founding principles.
Right-wing papers welcomed Milburn’s report as a plan to crack-down on “sick note Britain” (Daily Mail). Left-leaning publications welcomed the King’s Speech’s mental health and public health commitments (The Guardian).
However, the big-picture challenges haven’t gone away, and the decision to set-up a review to address them has benefits and risks. The obvious benefit is that it buys time. First, for new chancellor Rachel Reeves to get a handle on the mess she has inherited (The Guardian).
Second for spending departments, like health, to pin down problems they can address. A review can also build consensus for change. The NHS Plan, which New Labour launched in 2000 after promising to raise healthcare funding to European levels, was signed by 25 think-tank, union, and professional leaders.
The terms of the Darzi review say it will “stimulate and support an honest conversation with the public and staff about the level of improvement that is required, what is realistic and when.” Although “wide ranging public engagement” – that will, presumably, include suppliers – will have to wait for the ten-year plan.
The obvious risks are that a review ends up stating issues that are well known, while holding up action to address them at just the moment when a government has the momentum and political capital to get things done.
History rhymes, it doesn’t repeat
Plus, there is a debate about whether Streeting has picked the right advisors for the job. Corrigan and Milburn recovered waiting lists and built capacity in the early 2000s.
But some of the policies they championed – from the private finance initiative to competition-based reforms and target-based performance management – were expensive and delivered diminishing returns over time.
Later in the decade, Lord Darzi sharpened the government’s focus on community and primary care, which Streeting’s October “missions” paper suggests he also wants to fund and reform. But Darzi’s polyclinics were unpopular and short-lived (lowdownNHS).
Also, New Labour’s NHS successes were underpinned by that big increase in funding and on the money being enough to meet demand that was growing but not out of control. For the moment, Reeves is holding the line on that kind of money not being on offer.
Meanwhile, demand has spiralled, as the aging population and austerity-driven inequality have increased the number of people living with long-term conditions and mental health problems. Some important, supporting services, such as local government and social care, face crises of their own.
In its report on the financial management and sustainability of the NHS, the NAO says there are things that could be done to improve financial management – the Treasury and DHSC could plan better, productivity could be higher, integrated care systems could get more support.
But, in the end, long-term sustainability “depends on how elective governments decide to address steeply increasing demand for healthcare” and “on what happens in other parts of government and wider society.”
New Labour loved health tech
There has been very little mention of technology from the new health team. In some ways, this is not surprising, as its immediate priorities are not tech-focused (Streeting’s waiting list initiative depends on good, old-fashioned overtime, even if a growing number of trusts are running SMS waiting list validation projects).
However, it would be surprising if health and med tech didn’t feature in the new ten-year plan. New Labour was very keen on IT. It launched the NHS data spine, national programmes such as Choose and Book and the Electronic Prescription Service, and the National Programme for IT to implement electronic patient records at trusts.
It also experimented with patient advice and treatment services based on exciting new ideas like the ‘information superhighway’ and ‘telemedicine’. Some of these initiatives have also proved harder to implement, more expensive, and less effective than hoped.
The frontline digitisation programme, after all, was set up to complete the roll-out of EPRs, which are still missing from around 20 acute trusts. While decaying infrastructure, old devices, and poor integration have been blamed for costing millions of hours of productivity every year (British Medical Association).
Will a new ten-year plan do the same?
Still, these issues need to be dealt with, alongside work to re-platform some of those national programmes and advice services into the NHS App, which Streeting has said could “transform how the NHS interacts with patients and promote better public health” (Wired).
Streeting is also keen for the NHS to use the Federated Data Platform procured from Palantir (digitalhealth.net) and, like other politicians, puts great store in the potential of AI (Healthcare Leader). Former health and social care secretary Jeremy Hunt put aside £3.4 billion for IT in his Spring Budget, with £2 billion for infrastructure and records, £1 billion for the FDP, data and AI, and £400,000 for the app, portals, and digital services.
However, this was supposed to be tied to a new productivity plan for the NHS, which hasn’t emerged, and will presumably be incorporated into the Darzi review. And Labour could have its own ideas on what is needed to support the ten-year plan, when it’s published next spring.
Government’s back: but it has a lot to do
A month on from the landslide, the new government has taken power smoothly. Its shadow team has stepped up with little drama. Its manifesto has been a good guide to its immediate priorities. Last October’s “mission” papers look to be shaping medium-term thinking.
However, in health, as in other spending departments that are subject to reviews and dependent on Treasury funding, Labour’s long-term plans are not yet clear. This may be disappointing for health and med tech suppliers keen to get on with pitching their ideas and selling their solutions into an NHS that needs them.
But, for the moment, they can only keep making the case as ministers assess the task in hand; and work out how on earth to address the “unprecedented” challenges they’ve inherited.
