Can Labour Fix the NHS?

Labour strategists believe two things have to happen if they’re to win a second term. Voters have to feel at least a little better off than they do now and they have to see a noticeable improvement in the NHS. That might not be enough but it’s the minimum necessary.

At the moment they’re mainly worrying about how to achieve the first goal and feeling somewhat shaken by the negative reaction to the budget. Thus the speeches on growth and constant attempts to convince to businesses that they should be investing in Britain. If the economy continues stagnating, and per capita GDP keeps falling, they know it’s game over.

The second goal – fixing the NHS – is seen as more in hand. After all they’ve increased the health budget by £22.6 billion over two years. Wes Streeting is considered one of their more capable and dynamic ministers. The doctors’ strike was quickly resolved. Several key advisers from the Blair era, who helped slash waiting lists and boost patient satisfaction back then, are helping out. An ambitious “10 year plan” is in the works.

But this is not 2001. The NHS is in a bigger mess than it was back then and operating through a much more convoluted and complex structure. We have an older and sicker population. The workforce is more demoralised than ever, and leadership is weaker. Whatever one thinks of Streeting’s capabilities this is a much bigger challenge than I fear is widely realised.

In the whole of last year there was almost no reduction in waiting lists. In January 2024 there were 7.58 million referrals waiting for treatment, in November it was 7.48 million, despite the end of industrial action and a substantial increase in appointments.

Accident and Emergency stats are actually getting worse. In December 2023, 44,000 people had to wait more than 12 hours from a decision to admit to admission, in December 2024 it was 54,000. These numbers are dire by historical standards. GPs are finding it increasingly difficult to make referrals. Multiple trusts declared critical incidents over the past month, something that it supposed to be rare but has become normalised.

It is, of course, early days in the life of the government but a brutal report from the Public Accounts Committee, published last week, suggests improvement is a long way off. The Committee – which has a Labour majority – accused NHS England of “remarkable complacency” and expressed concern:

“about the lack of fresh thinking and decisive action we heard from DHSC [Department of Health and Social Care] and NHSE [NHS England]. The scale of government’s ambitions is great, but senior officials do not seem to have ideas, or the drive, to match the level of change required, despite this being precisely the moment where such thinking is vital.”

NHS England put out a defensive and unconvincing response, which has only added to concerns about whether they can take on this challenge. The Committee also pointed out that the government seems trapped between their plans for long-term reform and the urgent demands of the short-term – the perennial problem of health policy.

Streeting has set out three “big shifts” he wants to see – from treatment to prevention, from hospitals to primary and community care, and from “analogue to digital”. Most people in the health world agree with these. But they also agreed the last half dozen times these shifts were proposed in a government strategy.

As Lord Darzi noted in his report on the state of healthcare last year, for a long time now “the NHS has implemented the inverse of its stated strategy.” Despite promises to the contrary spending on hospitals has increased relative to primary and community care. Grants for prevention have been slashed. Money set aside for technology has been raided to deal with short-term funding pressures.

While acknowledging this, the government has nevertheless decided to make its key target for health a substantial reduction in hospital waiting lists. Which is politically understandable but seems contradictory to their supposed aims.

In the rest of the post I’ll explore the NHS’s financial position; what Labour have announced so far and why they’re falling into the same trap as previous governments (in implementing the inverse of their stated strategy); why this trap has got harder to escape; and what options ministers have to try and find a way out.