Labour says the NHS must ‘change or die’

Earlier this month, in Liverpool, Shadow Secretary of State for Health and Social Care, Wes Streeting, outlined Labour’s ambitions for the sector in his 2023 conference speech. Steve Davidson, Account Director in our Healthcare team, takes a look at what Labour had to offer.

This year’s Labour Party Conference followed a Tory conference which offered some provocative-by-design gender politics, with solutions to problems few have identified, and bold £5 billion spending commitments from the Liberal Democrats for social care and mental health.

While Keir Starmer urged restraint on Labour’s supporter base, despite their significant poll leads, health sector leaders were probably most eager to hear Labour’s plans, as the most likely future reality.

Perhaps to be expected at a pre-election conference after 13 years of Tory rule, Streeting was heavy on criticising the government’s record while setting out aspirations for a better future. Announcements were bold but arguably lacked detail. The defining tone was that significant changes were on the way, but not in the form of new investment.

The NHS must ‘change or die’ was the mantra that rang loud in the conference hall while Streeting also repeated his commitment that Labour will never abandon the founding principles of the NHS. “I make the case for reform not in opposition of these principles, but in defence of them.”, he said.

“Reform is even more important than investment.”, Streeting explained, urging a future Labour government to avoid wasting money on a system that isn’t working. Describing the NHS as “a hospital-based system geared towards late diagnosis and treatment” he went on to say that today’s NHS is more of a ‘sickness service’ than a ‘health service’. He claimed that the near future threats of rising chronic disease and an ageing population risk “bankrupting” our NHS.

Streeting’s answer, Labour’s programme of reform, has three core pillars.

Reforming the NHS

From hospital to community

Since Covid, in particular, access to GPs has been a sensitive voter issue, with public perceptions often not mirroring on-the-ground reality. Streeting, however, chose to describe the NHS ‘front door’ as being broken. His fix is to train thousands more GPs, cut red tape, bring back the family doctor and give patients more choice about how and when they access primary care. Indeed ‘patient choice’ was often repeated.

Labour’s plan to prevent people from needing hospital care in the first place also included an expanded role for community pharmacy, 8,500 more mental health professionals and mental health hubs in every community. Streeting also promised 700,000 extra annual dental appointments and to provide NHS dentistry to everyone who needs it.

 

From sickness to prevention

Concern for the health and wellbeing of children and young people was certainly on show in Liverpool as Streeting made his pitch to produce the healthiest ever generation. To get there, he said Labour will provide school breakfast clubs for all primary pupils, introduce supervised tooth brushing in schools in an effort to tackle what Labour says is the number one cause of hospital admission for children – tooth decay – and provide mental health support in every school. And he announced a set of public health regulations aimed at preventing ill health in young people:

• Tackling childhood obesity with a ban on junk food adverts that target children, a move welcomed by the Royal College of Physicians as the “bold action that is needed”.
• The message to the vaping industry was that Labour would ‘come down on you like a tonne of bricks’, an announcement followed a day later by the publication of a Department of Health consultation on vaping.
• And a pledge to follow through with Rishi Sunak’s phased smoking ban, an idea that Streeting made a point of having come up with first.

 

From analogue to cutting edge technology

At Labour’s 2022 conference, Streeting announced the party’s £171 million Fit for the Future fund, with a pledge to double the number of NHS scanners. Tech solutions were a theme that cut through this year too with technology being presented as a way to improve outcomes without turning to heavy investment.

Apart from scanners, however, Labour’s tech revolution was light on detail, mentioning more virtual wards, harnessing the opportunities of artificial intelligence to offer faster, more effective, targeted treatments, and breakthroughs in genomics to shift the focus from treatment to prevention.

Tackling the backlog

Aside from its reform programme, the party laid out its aspirations on social care and tackling the record backlogs, which recent data shows are continuing to rise.

Labour had previously committed to a £1.1bn fund to tackle the NHS backlog with extra clinics at evenings and weekends, providing two million new appointments per year.

At the start of this year’s conference, Keir Starmer suggested Labour would be able to clear the backlog in its first term in office, a claim which drew criticism from some health sector leaders. Chief Executive of NHS Confederation, Mathew Taylor, described the plans as ‘admirable’ but said: “where health leaders may differ in opinion from the Labour Party is reform being more important than investment.” He went on to say that “any incoming government should resist wholesale restructuring.”

A National Care Service

Underfunded, under resourced and under skilled; the social care sector has long been seen as the bottleneck that needs unclogging before NHS backlogs can be tackled.

Healthcare leaders across the sector welcomed the announcement for a new deal for care workers – a workforce plan for recruitment, retention and professional accreditation, and their first ever fair pay agreement.

Sally Warren, Director of Policy at The King’s Fund, said: “while Labour has committed to boost the pay of social care staff, it has yet to set out how it would introduce long overdue reform of the sector.”

Streeting said that this would be one of the first steps of Labour’s 12-year plan to develop a national care service.

A workforce plan?

Last year, Labour said a workforce plan was needed and pledged to double the number of medical training places and create an extra 10,000 nursing and midwifery clinical placements every year. On top of this they would double the number of qualifying district nurses every year and train 5,000 new health visitors.

Last week, Streeting added a commitment to train ‘thousands more GPs’ and set out the social care workforce plan. But Labour hasn’t said how it will tackle staff morale and make the NHS an attractive place to work so that people will want to take up those training places.

And amid ongoing industrial action across the NHS, there was barely anything on pay other than to say it would be ‘better’. Streeting did say “there is a window of opportunity for negotiations before the next round of strikes take place that any serious Prime Minister would take.” But he didn’t say what Keir Starmer might do.

Unison General Secretary, Christina McAnea said “Labour plans to boost the workforce and provide extra equipment would kickstart the recovery process”. However, other health sector leaders from the Royal College of Nursing, NHS Providers and Unite the Union struck a more cautious tone, and Sarah Scobie, Acting Director of Research at the Nuffield Trust said that “spreading existing staff across more days is not going to address the reality that many staff are overstretched, burnt out and, as we recently showed, increasingly quitting the NHS.”

How will Labour fund its proposals?

Labour’s plans would be funded through fiscal reform such as scrapping non-dom status and closing tax loopholes for private equity. The party would also scrap tax benefits for private schools, estimated to raise £1.6bn for the public purse by the Institute for Fiscal Studies.

Labour didn’t say, however, if this increased tax revenue would be ringfenced for the NHS. Nor did the party provide data at conference on what their reform package would cost.

Labour could make the case that investment in health and care can pay for itself. Research published last month from NHS Confederation sought to challenge the well-worn narrative of funds given to the NHS being a ‘drain’ on the public purse. It showed that for every “£1 that is put into upstream NHS services in places with historically poor funding …/… there is a return of up to £14”.

For the time being, however, Labour is pinning its narrative to the message of ‘reform first’ as they aim to stay light on spending pledges and project a sense of prudent economic housekeeping. It remains to be seen how the reality will differ significantly from the kind of fiscal conservatism that has guided health sector policy for the past 13 years.

Freshwater’s specialist healthcare team has supported hundreds of NHS and health and care clients to manage and communicate change, deal with crises, or promote positive awareness. We enable patients, carers, staff, stakeholders, and communities to be engaged, involved, and contribute to their healthcare, the NHS and improving the health of their communities.

 

This article was written by our Account Director, Steven Davidson.