Gordon Brown’s April 2002 Budget speech remains one of the few memorable political moments of my lifetime. I can still recall how I felt hearing him announce what he described as a “kiss of life” for the NHS – £40bn additional funding over five years, paid for by hikes in National Insurance. I qualified as a doctor in 1990 and my entire 12-year career to that point had been spent in a service blighted by years of Conservative government. Much like today, patients languished for years on waiting lists, a situation that New Labour had failed to improve during their first term (1997-2001). Here, at long last, was a clear signal from the government that it was serious about delivering an excellent NHS – something it went on to do (public satisfaction with the health service hit an all-time high of 70 per cent in 2010).
The recent choreographed announcements by Keir Starmer’s government ought to have caused a comparable surge of optimism in my breast. There’s been the big cash injection – Rachel Reeves has conjured £22bn additional funding over the next two years. Meanwhile, Starmer, his health secretary, Wes Streeting, and health minister Karin Smyth have all been in print and on the airwaves outlining impending reforms. (Gordon Brown’s £40bn “kiss of life” was also accompanied by a rigorous reform programme.) Yet, despite the parallels, I am gloomy about the prospect of returning to the NHS’s heyday, achieved by New Labour by 2010.
Superficially, the problems the NHS faces might seem the same as in 2002: not enough hospital capacity, leading to lengthy waiting lists. The Blair/Brown government addressed this by commissioning extra capacity to burn through the backlog, much the same as Streeting is proposing now. But the challenges we’re facing today won’t be solved by the same approach.
There are three additional issues. First is the crisis in social care, which can both cause people to be admitted to hospital unnecessarily and prevent their timely discharge once medically fit. Streeting himself has said, “There is no solution to the crisis in the NHS that doesn’t include a solution for social care.” Yet the government has deferred action on this critical node: on Friday Streeting announced the Casey Review into Britain’s social care crisis, due to deliver its final report in 2028. The argument for the review – far from kicking the problem into the long grass, says Streeting – is to achieve political consensus for necessary reform. Whether consensus can be achieved is a moot point. The years spent trying to get there will be time lost. The point of Labour’s 2024 mandate was to lead, not to conduct political Doodle-polling in the hope of finding common ground.
The second problem faced by today’s NHS is the hollowing out of its community capacity. GPs and district nurses can meet most patients’ healthcare needs. But their numbers have collapsed over the past decade. Some of the reforms Streeting has announced are a small step in the right direction: UK-trained GPs are among the most capable medical generalists in the world, and giving us access to specialised tests enables us to diagnose many patients without referral. But making good on this reform will require 30-40 per cent more doctors in general practice. And yet retention continues to freefall, with no plans to reverse the declining trend.
The third problem is the least understood. The NHS consumes huge amounts of resources on low- or no-value activities. Streeting has singled out routine out-patient follow-up appointments as a particular drain, but these are just the tip of an iceberg. The political obsession with providing ever more “scans and checks”, for example, is the healthcare equivalent of building extra roads to ease congestion: it simply generates more traffic. Medical investigations frequently return false positives and incidental findings that go on to require further tests, sometimes repeatedly over years. And the NHS has somehow become charged with the chimeric task of preventing disease, when the only cost-effective way of doing so is by improving the socio-economic conditions in which people live. A wholesale reappraisal of all areas of NHS activity is needed, not this tinkering at the margins.
Critics say Labour has had years in opposition to come up with answers to these questions. And, given the tax straitjacket Labour committed to pre-election, the funding for social care reform presumably isn’t there. (Maybe it will be in a few years, if economic growth can be achieved, and perhaps that is the real reason for the Casey Review.) Meanwhile, a renewal of general practice will require a radical new contract that will take time to negotiate with the profession. But Rome continues to burn, and what we’re seeing feels more like fiddling than firefighting.
[See also: Can Labour escape decline in 2025?]
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