The NHS is in crisis after a decade of austerity and COVID-19. Political failures since 2010 have weakened the health service and constrained what it could deliver. Patients are suffering, for instance, as they wait too long for hospital care. The new government has promised to restore services and transform the NHS. They are producing a 10-year plan for how this will be done.
The Prime Minister said the NHS must ‘reform or die.’ So far, the details of what ‘reform’ means are limited, but three significant shifts exist. There are analogues to digital, hospitals to communities, and sickness to prevention. Guiding principles for a new NHS 10-year plan are expected in spring 2025. And the Secretary of State has pledged to increase the share of NHS resources going to primary care. Labour’s manifesto promised to ‘tackle the social determinants of health.’ It acknowledges that the UK’s health is shaped mainly by factors outside of health and care services. The Labour government’s health policy wants to tackle these factors.
Labour government’s health policy, Starmer Version
Labour plans three significant shifts in health. They want to move care from hospitals to the community, switch treatment and administration technology to digital methods, and work on prevention methods rather than just treatment—hence the publicity focus on scanners. Labour wants to cut NHS waiting times by 40,000 more appointments every week.
This is part of Labour’s plan to build an NHS ready for the future. Labour said we are not increasing income tax, national insurance, or VAT. Labour will:
- Decrease NHS waiting times by 40,000 more appointments every week
- Increase the number of cancer scanners by two times
- A New Dentistry Rescue Plan
- 8,500 more mental health staff
- Retrieval of the family doctor
The NHS has a long history of producing long-term plans. For example, a national 10-year hospital plan for the NHS was developed in 1962 alongside plans for community care. The government’s objectives – such as shifting more care out of hospitals – are nothing new. Consider the context facing health services in England to identify priorities for the latest NHS plan due in spring 2025. Keir Starmer has brought the health service back under the control of ministers by abolishing NHS England as part of the Labour government’s health policy. The prime minister said politicians should oversee the NHS rather than an arms-length body, which would bring greater accountability.
Health Spending in the UK
Over this parliament, real-term UK health spending (i.e., spending revised for economy-wide inflation) has grown below the long-term average rate (2.4% per year over this parliament versus an average of 3.6% over the longer term). However, the UK’s poor economic performance indicates that health spending as a percentage of national income has risen by more than the long-term average (by an average of 0.13 percentage points per year, reaching an average of 0.06). Health spending per person has increased more in Scotland, Wales, and Northern Ireland than in England since devolution, though the price gap has tightened. In 1999–2000, Scotland spent 22% more per person than England, Wales spent 12% more, and Northern Ireland spent 15% more. However, in 2019–20, Scotland spent just 3% more due to the pandemic, while Wales and Northern Ireland each paid 7% more.
Within England, NHS spending this year is expected to be 32% higher per person in the area with the highest budget. The NHS’s extent means any health spending boosts will force tough fiscal trade-offs elsewhere. Under the government’s current plans for public service spending from next year ahead, providing the NHS workforce plan in England suggests flat real-terms budgets for all other government departments. Taking into account other expenditure responsibilities on childcare, defence, and elsewhere implies large real-terms cuts to remaining departments. To avoid these cuts to other units would require a higher overall spending envelope. Without a significant improvement in economic growth, some combination of increased borrowing or higher taxes would be necessary. There were frequent failures by the NHS and care organisations in coordinating care for people with long-term health conditions. This is important for the Labour government’s health policy. Figures show that 41% of adults and 17% of children have at least one long-term health issue.
The Health Foundation argues that the NHS was “in distress” this winter.
The group says it would be wrong to blame relatively high levels of flu. The government is due to issue an urgent emergency care plan shortly. The Department for Health and Social Care said hospitals were “feeling the strain” but taking “decisive action” to prevent winter crises. The Health Foundation report on the recent winter says that the number of people waiting 12 hours or more in A&E after a decision to admit to a ward was the highest since modern records began. It topped 60,000 in January, or 11% of emergency admissions.
The Department of Health and Social Care said a target is to increase the number of hospitals in England. The Labour government’s health policy allowing patients to view appointments through the NHS app had exceeded. The target was 85% by March, and the outcome was 87%, up from 68% last July. The department also noted that because more patients could get access to correspondence via the app, 12 million fewer letters had been sent since July. It noted that there were 1.5 million fewer missed appointments. Ministers said this was helping cut waiting lists and saving taxpayers money.
The NHS has often attempted to deal with financial and workforce challenges.
Criticisms of long waiting times or relatively poor health outcomes due to engaging in reorganisation are significant. A new poll has revealed a dramatic collapse in public satisfaction with the NHS. Almost two-thirds of people across England, Scotland, and Wales expressed dissatisfaction. The Labour government’s health policy is going to address it.
The British Social Attitudes (BSA) survey found that 59 per cent of respondents were “quite” or “very” dissatisfied with how the health service is run—the highest level recorded since the survey began in 1983. Concerns over access to care, long waiting times, and staffing shortages have contributed to this growing frustration. Worryingly, nearly one in ten people also reported experiencing harm due to NHS treatment or lack of access to care, with many suffering severe impacts.
