As Labour gears up for the election later this year, its health policy reforms are starting to take shape. The need to improve the nation’s health as an integral part to delivering economic growth features prominently in the party’s health mission. The leader of the opposition, Sir Keir Starmer, has cited his work at the Crown Prosecution Service (CPS) as central to his belief in a prevention-first approach to health and wider social policy. Last month the party published a Child Health Plan, which sought to reframe the argument about the “nanny state”.
Such activism and energy are rooted both in belief and necessity. A recent Future Health report – commissioned by AbbVie – found that more than half of adults in England, 25 million, now have a long-term condition such as arthritis, high Labour’s health reforms can put patients first blood pressure or poor mental health.
Perhaps the biggest challenge, though, is the growing number of people – one in four – with multiple conditions. Once a patient develops multiple conditions, it becomes costlier to treat them. When added together, the cost of managing long-term conditions and multiple long-term conditions for health and social care is a staggering £115.2bn a year.
The wider costs and impacts are also starting to be noticed. The number of people out of work for health reasons has risen by more than 400,000 since the start of the pandemic. According to the ONS, among those economically inactive because of long-term sickness, 38 per cent reported having five or more health conditions.
While intrinsic to addressing the challenge, the NHS cannot tackle this problem alone. When last in office, Labour created a series of national service frameworks and plans for major conditions. Backed by the National Institute for Health and Care Excellence (NICE) and evidence-based approaches, they improved care in important clinical areas such as cancer and cardiovascular disease. But for patients with other long-term conditions progress was more mixed. While more patients said they were getting the support they needed, over time, fewer reported that they were in good health.
Since 2010 the situation has slipped further. Fewer patients now feel supported to manage their condition and health-related quality of life has also fallen. Data from the Patients Association in 2023 indicated that only a third of patients said their care had been well coordinated, with a third disagreeing. Two out of five felt they had been kept informed about what was happening to their care, a third did not. Two in three patients struggled to access at least one of the services they needed.
While the NHS continues to step up its efforts to tackle health inequalities, the government has discarded its Health Disparities White Paper, and its Levelling Up White Paper commitment to extend healthy life expectancy by five years is well off track. A forthcoming Major Conditions Strategy gives some hope. However, the elevation of a select number of conditions in the strategy jars with a genuinely patient-centred approach to care, such as that adopted elsewhere, in countries such as Denmark.
By focusing on improved health as one of its five missions for government, Labour has a chance to make new progress on improving care for patients with long-term conditions. To do so, though, will require a shift in approach and emphasis away from what has happened before at multiple levels.
At the cross-government level – and as it builds its Mission Delivery Board for Health – Labour will need to tackle the siloed short-termism of Whitehall that focuses disproportionate attention on the NHS and clinical care at the expense of the wider determinants of poor health. Including action here on how patients with long-term conditions and multiple conditions can be better supported with their care through more joined-up working and policy – such as between the NHS, social care, the welfare system and the voluntary sector – should be a priority.
Within the NHS, the Major Conditions Strategy can be evolved into a multiple long-term conditions strategy that places patients rather than conditions at the centre of the policymaking process. In adopting this approach Labour will find allies in the chief medical officer and those within the NHS who are looking to make care more integrated around patient needs, particularly in primary care and within Integrated Care Systems.
Finally, and perhaps most importantly, will be how Labour engages with the public on its health mission. The party is clear that it will take time to deliver the improvements it wants. But to get the time it needs will require a far higher level of engagement than has been seen before.
When last in government, Labour introduced the NHS Constitution, but as performance has deteriorated, the rights and duties within it have withered away. The party should commit to a full update to the constitution and use it to build a new consensus about what patients should expect and what the system should be delivering.
As part of this, Labour’s health team should push the NHS to be much more open about collecting and acting on patient feedback as part of its investment and reform programme for the service. The strong progress made on the NHS App from the current government during and beyond the pandemic provides a platform that can be used to support this.
Labour’s health mission and associated ambitions will face familiar layers of resistance to being implemented. Only by adopting a patient-centred approach – embedded at different levels of government and across the health and care system – will the party be able to truly deliver it.
Editorial control sits with the authors.
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