Thursday briefing: Labour ​is bet​ting on ​an NHS overhaul to ​deliver ​real ​change​, but can they pull it off?

The Guardian

2 days ago

Good morning. Wes Streeting's first statement as health secretary was a startling one. Just a day after Labour's historic election triumph, he declared that 'the NHS is broken'. Now, almost exactly a year later, he returns with a 10-year plan to fix it, in what's been billed as the most ambitious health reform agenda in a generation.
It's hard to overstate the significance of this moment. Reforming the NHS was central to Labour's election manifesto, and last year prime minister Keir Starmer made the consequences clear: 'Reform or die,' he warned, and with it, staked the next election on his government's ability to deliver meaningful change.
NHS leaders, unions, thinktanks, patient groups and other key stakeholders may not agree on every detail, but they are united on one thing: the NHS is in crisis and change is urgently needed.
But what exactly is in this plan and will it make a difference? To find out, I spoke to health policy editor Denis Campbell, who has been covering the NHS for two decades. That's after the headlines.
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At its most basic, the 10-year plan is the Labour government's detailed 150-page blueprint to get the NHS back on its feet after nearly 15 years of serious neglect, Denis Campbell told me. 'It aims to address the fact that the NHS is sadly no longer able to perform its most essential function, which is to give people who need care the care they need, when they need it.'
Waiting times are too long for many of the NHS's most vital services, including GP appointments, ambulances, mental health support and surgery.
'The 10-year plan is meant to get the NHS back on its feet in a way that we as patients, voters and taxpayers will appreciate and notice, but crucially, to also modernise the health service, to make it work better and more efficiently to help deal with the fact that we live in a tech-driven age, with an ageing population and the fact that people expect health care to be much more convenient in the way that so many things in life are now,' Denis added.
How will it do this?
The 10-year plan proposes to do this with three big 'shifts':
From hospital-based to community-based care: Services are moved out of hospitals and into community settings like GP surgeries, clinics and the promised new neighbourhood health centres.
From analogue to digital: Rely more on digital tools like AI to spot problems early, speed up diagnoses and improve efficiency.
From treating illness to preventing it: Focus more on keeping people healthy – by tackling smoking, obesity and misuse of alcohol – instead of just treating illness when it occurs.
But, Denis told me, there are many practical questions, particularly on the first shift: 'What will these new centres actually look like? Will they be new places or expansions of existing GP practices? Who will staff them? Is there any money behind this bold vision to make it a reality?'
On staffing, the NHS workforce continues to grow in England. 'There are 1.5 million people, but the NHS in England has for many years had roughly about 100,000 vacancies at any one time. So we know the NHS in England does not have the staff it needs already.
'The government is unveiling an ambitious and potentially voter-friendly plan to make the NHS more accessible, responsive, convenient and patient-friendly, with lots of consumer friendly positive language like this,' Denis said. 'But we do have to ask the hard question: if there isn't enough people hired to do what the NHS already does, where will the extra people come from to provide these extra services?'
Denis added that while there has been some progress that the 10-year plan can build on, there's still a crisis to accessing care. 'Too many people wait too long. So there's clearly a big job to be done here to make the NHS as accessible as the government is saying,' he said.
What has the reception been so far?
Denis was being inundated with responses from thinktanks, unions, patient groups, and other stakeholders when I spoke to him. 'Many are welcoming the boldness of the government's vision, but they're questioning the practicality of delivering all of this and the timescale, what will it take to do this?'
For many of these stakeholders, much of the plan is appealing, Denis added – who wouldn't want a local neighbourhood health centre where you can get an X-ray or scans, mental health support, pharmacist services and GP appointments? But there is scepticism.
Denis groups the criticism into three main concerns: it will take a long time, there's no extra money for new buildings or services and there's not enough bold action on public health.
'This is billed as a 10-year health plan, not just the 10-year NHS plan. The government says it will improve the nation's health. But several thinktanks like the King's Fund are saying it doesn't include enough bold action to tackle the drivers of ill health and the fact we've got an increasingly sick population, particularly through diet and obesity and misuse of alcohol,' Campbell said.
He added that the criticism is that there's no equivalent in this plan to past transformative policies like the sugar tax or indoor smoking ban. 'The NHS at the moment is not able to outrun a growing tidal wave of preventable illness that has been lapping at its shores for some years now. We have an ageing population and an increasingly sick population, will this plan make it any more able to cope with this growing burden of illness? At the moment, unfortunately the answer to that question is, 'No'.'
Is this the last chance to save the NHS?
The prime minister's positing that this is 'reform or die' certainly makes it seem that way, but Campbell suggested that it's a bit hyperbolic.
'The NHS is so deeply embedded in British life that no one is going to replace it with something else. But there is enormous pressure on this government to deliver. Keir Starmer promised transformative change into something people would notice and value,' he said.
'We're a year into this government, and England doesn't yet look much improved. So the pressure on this plan to deliver real, visible improvements quickly is intense. By framing it as 'reform or die' the prime minister is setting a very high bar for success.'
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