Labour's 10-year health plan for the NHS is bold, radical

The Guardian

3 days ago

The government's 10 Year health plan to revive, modernise and future-proof the NHS in England – has arrived as the service is facing a dual crisis. It has been unable for a decade now to provide the rapid access – to GPs, A&E care, surgery, ambulances and mental health support – which people need and used to get.
Normalisation of anxiety-inducing, frightening and sometimes fatal delay has produced a less tangible, but also dangerous, crisis – of public satisfaction, born of a profound loss of trust that the NHS will be there for them or their loved ones when they need it.
Barely one in five people in Britain are happy with the NHS. Polling by Ipsos this week, ahead of the NHS's 77th birthday on Saturday, found that about 60% of voters have seen little improvement in it during Labour's first year in office.
About the same proportion do not expect things to be much better by the time of the next election in 2029. It is hyperbole to say, as the plan does, that 'the NHS now stands at an existential brink'. The dissatisfaction with access problems is acute – but behind it lies enduring public support for the service itself.
However, it is no wonder Keir Starmer and Wes Streeting have acknowledged the seriousness of the patient's condition and diagnosed radical surgery. It is blindingly obvious that, as the plan says: 'The status quo is no longer an option.'
The authors of the 168-page document have produced a serious, detailed and impressive piece of work.
It is unsparing in describing the many failings that mean the NHS is not just often frustrating for patients to use but also ill equipped to deal with the relentless demand for care created by an ageing, growing and increasingly unhealthy population, which is unlikely to fall soon. It also charts a new course for a service so indispensable that it is part of the nation's DNA.
Labour's repeated claim that the Conservatives had left the NHS 'broken' helped win them last year's general election. And it has allowed the party during its time in government to blame the service's every dysfunction – staff shortages, overcrowded hospitals, inadequate mental health care – on its predecessors.
But that time is over. The plan implicitly acknowledges that this narrative, a frequent refrain by Streeting, is no longer enough. After a year in power, this is Labour's prescription for how it will nurse the patient back to health.
This – progress on delivering the planned transformation – is now a legitimate yardstick by which to judge Labour's stewardship of the nation's most treasured institution.
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The plan is as bold and radical as Streeting insists. But its key objectives – 'three big shifts' in the NHS's modus operandi from analogue to digital, treatment to prevention and hospital to community-based care – are familiar.
They have been the stuff of previous NHS plans, and multiple inquiries, for decades – much promised, but rarely delivered.
For example, the planned network of new 'neighbourhood health centres', with teams of health professionals and patient-friendly long opening hours, are very similar to the 'Darzi centres' proposed by the last Labour administration, of which few actually opened.
Streeting does not pretend that the job of transformation will be easy. But there is a daunting array of obstacles to overcome.
Will money needed to temporarily 'double run' old and new services during the transition be found? Will staff used to working in hospitals prove willing to switch to community settings?
Will the gamble on technology pay off? Will the plan's failure to include big shifts to improve public health – such as mandatory reformulation of food or minimum unit pricing of alcohol – mean that the tidal wave of often-avoidable illness continues to outrun the NHS's ability to treat it?
And will the decision to shed half of NHS England's 15,300 staff during its merger with the Department of Health and Social Care mean that Streeting does not have enough progress-chasers to ensure his tablets of stone are yielding real change?
But the greatest risk Streeting faces is time. Alan Milburn, health secretary under Tony Blair and now Streeting's chief adviser, admitted later that the 2000 NHS plan bought him time to rescue the service from the derelict state his predecessors had left it in.
But the often snail-like pace of previous NHS reforms suggests that, despite Labour having four more years in power, even that may not be enough for this plan to produce real, tangible benefits – changes to waiting times and the convenience of interacting with the NHS that patients notice.
Voters keen to see 'our NHS' restored and improved may need to temper their expectations of rapid change, and ministers may have to do so too.