At the start of the year, Lowdown was critical of the self-congratulatory tone of a Wes Streeting speech to Labour Party members just before Christmas, in which he also (correctly) insisted that ministers should be judged by what they deliver.
Perhaps because of this, Mr Streeting was rather less triumphalist in his recent speech to UNISON’s Health Conference. In it, he stressed the scale of the challenges left behind by 14 years of Tory underinvestment and resorted to the tried-and-tested trick of yet again promising a ‘zero tolerance’ crackdown on violence against NHS staff—a ruse first used back in 1999 by then Health Secretary Frank Dobson.
But Labour councillor and ex-political journalist Sebastian Salek has had a go at banging the drum for Labour’s achievements in a thread on X/Twitter, which begins:
“Nine months ago, the NHS was at breaking point. The turnaround under Labour has been remarkable – and barely anyone’s talking about it.”
He then lists “five seriously impressive stats”:
- Waiting list down for a sixth month
- Waiting times slashed
- Millions of extra appointments
- Record cancer turnaround times
- Less time spent in A&E
Indeed, these statistics, which appear to have been taken directly from an April 10 release by NHS England, do show some improvement, although perhaps less dramatic and game-changing than Mr Salek would have us believe.
The waiting list is down by almost 148,000 (2%) in the 12 months to January and has fallen for the last few months. But even after that fall, 5 per cent more patients were waiting in January 2025 than in January 2023. If it continues falling at the same rate, it would take almost 34 years to reduce the waiting list to 2.5 million, so patience is required before we see any “seriously impressive” results.
On waiting times, too, Mr Salek’s claims are overegging the pudding: the “two-year low” in the number of people waiting over 18 weeks for treatment is in comparison with the (then record) high, when the numbers topped 3 million for the first time in January 2023. After that, they peaked at 3.3 million in December 2023, and since then, they have been generally falling. It’s not obvious that this is (or could be) linked to the change of government last July.
Of course, it is also good to see that the number of patients waiting over a year is continuing to fall—as they were before Labour was elected.
There have also been, according to Mr Salek and NHS England figures, 3.1 million additional “appointments” (elective operations, outpatient appointments and diagnostic tests) between last July and January. Again there has been no magic wand involved: these plans (and the diagnostic centres that have helped deliver them) were all in place before Labour was elected.
It’s also good news that access to cancer treatment has improved, with performance against the 28 day faster diagnosis standard (to reduce the time between referral and diagnosis of cancer) at 80.2% in February 2025 – above the NHS constitutional standard of 75%. NHS England points out that this represents a 6.8 percentage point increase from January 2025 – but also admits that (as can be seen from the graph) “it conforms to seasonal improvements in performance that are commonly observed each February.”
2025 was the busiest March ever for A&E. Despite that, A&E waits of 4+ hours fell fractionally year-on-year, although the percentage of the most serious Type 1 patients kept waiting over 4 hours was unchanged from March 2024.
Perhaps more worrying is that the numbers and percentage of Type 1 patients left waiting over 12 hours on trolleys waiting for beds have both increased in March 2025 compared with March 2024, underlining the unresolved shortage of beds, and the unresolved problems discharging patients after treatment.
It’s also obviously good news that Category 1 ambulance response times are now the fastest in almost four years, although the speed of delivering patients to hospital is clearly not yet matched by prompt admission and treatment when they get there.
Mr Salek admits “Of course, this is just the start. You can’t fix the NHS overnight” (although that does seem to be the implication of citing the changes since July, and his claim “What a difference it makes putting the health service in Labour’s hands.”)
But rather than trumpeting the achievements, many health workers, campaigners and patients will be rather wondering why there is not more evidence of fundamental change since July.
Outsourcing of NHS support services and community health services have proceeded with no attempt by Wes Streeting to prevent them, despite being in direct conflict with Labour’s manifesto promises. NHS England has adopted a policy of pressing trusts to hive off non-clinical staff to wholly-owned companies, subcos, outside the NHS – a policy hatched up under the Tories and directly contradicting Labour’s manifesto promise of the biggest-ever wave of insourcing – again with connivance of Wes Streeting.
Other promises also seem to be receding into the background rather than focusing government policy. The pledge to “bring back the family doctor” stands in stark contrast to the inadequate numbers of GPs to cover a growing population with increasing needs – while increasing numbers of would-be locum GPs are resorting to driving taxis or other gig economy jobs because GP practices lack the funding to employ them, and bottlenecks in the training system are frustrating thousands of resident doctors.
But even when people do get to see a GP, the emphasis now is not on speeding patients through the treatment they need, but on offering £20 incentive payments for GPs NOT to refer patients for hospital care.
The Health Service Journal reports Integrated Care Boards have been told to take steps to ensure that potential GP referrals are first scrutinised by hospital consultants, under a system known as “advice and guidance”. GPs are expected to discuss cases with specialist consultants, which the HSJ explains “can lead to the patient being triaged to alternative services, or the GP continuing to be responsible for their management, rather than being placed on a waiting list to see a consultant.”
This cunning plan to reduce referrals is now apparently “a key plank of NHS England’s plan to deal with the elective care backlog.”
But while a £20 bonus for not referring a patient seems feeble enough, the reality of this plan is actually even worse for both GPs and consultants – as well as patients. The consequence of each non-referral is an extra patient with significant needs for GPs and already under-funded community health services to care for: meanwhile the hospital specialists are offered no similar financial incentive to find the time for these additional conversations with GPs – but expected to facilitate the diversion of patients (and income)away from their department and their trust.
Nor does it seem NHS bosses or ministers have really considered the way this policy will look to patients, who once they have secured an appointment to see their GP may well be expecting them to refer them for hospital care – only to find out that the doctor can pick up a cash reward for fobbing them off with something else.
But for mental health patients things are even worse. Labour’s promise to tackle long delays in accessing mental health services also seems to have been abandoned, with spending reducing in real terms this year and little sign of improvement since July in access to services.
Perhaps worst of all is the access to emergency mental health care. Analysis by the Royal College of Emergency Medicine has found that, despite the standard of care mental health patients received improving, the average time a person in mental health crisis spent in A&E last year (2024) was almost 11 hours – an hour more than in 2023.
In 2024, 65,881 patients with a primary diagnosis of mental health waited 12 hours or longer in ED to be admitted, discharged or transferred, almost four times the number in 2019.
An average of just 43% of patients considered to be ‘medium’ or ‘high-risk’ received an appropriate level of observation during their stay in ED – but this was a significant improvement compared to last year’s average of 29%. And for just over a third (38%) of patients is there evidence they received compassionate care while in A&E (with 62% apparently missing out): this is after an 8% improvement on previous performance.
RCEM President Elect, Dr Ian Higginson, who leads on Clinical Quality for the College said: “Emergency Medicine teams will keep going, but ultimately there is only so much they can do until those with responsibility for designing and resourcing systems to care for these patients give this issue the priority it deserves.”
Nor is it just a problem for A&E: the latest NHS data analysed by Rethink Mental Illness show people are eight times more likely to wait over 18 months for mental health treatment than physical health treatment.
Rethink points out that the government’s Plan for Change includes an optimistic target for 92% of elective patients to start treatment within eighteen weeks – but it doesn’t include any commitment to tackling waiting times for mental health services.
Moreover with ministers endlessly complaining at the numbers of working age people not in work, Rethink warns that lack of access to mental health care risks undermining the government’s ambition for economic growth:
“With record and increasing numbers of people out of work due to poor mental health, ensuring prompt treatment can help improve lives, support people who are well enough to enter or remain in work, and boost productivity.”
What are the chances this grim situation will improve in the near future? The promise of shifting more care into community health services is held back by the chronic and continuing lack of investment and available funding to expand historically neglected services.
The same funding squeeze is forcing Integrated Care Boards (ICBs) and Trusts to make drastic cuts in their costs – and many are seeking to make savings by axing jobs.
While we have heard of the 50% cuts required by the end of the year in staffing costs for NHS England and ICBs, there is less information on the scale of cuts likely to take place in hospital trusts.
The Guardian has estimated up to 100,000 jobs could be axed by trusts, while the NHS Confederation, representing trusts and foundation trusts has expressed concern over the potential cost of large scale redundancies as trusts cut staff numbers by varying amounts between 3 per cent and over 11 per cent:
“Some leaders of NHS trusts have said they are each looking to cut between 200 and 500 roles, while some ICB leaders have said they are likely to remove anywhere between 300 and 400. Several trust leaders said that they were budgeting for around £12m worth of redundancy payouts and associated costs.”
Already plans have been revealed to cut almost 800 jobs from trusts in Portsmouth and the Isle of Wight, to save £39m towards a “savings” target of £82m in 2025/26, and there are reports of plans to axe 500 jobs in two Bristol trusts.
Although it is claimed that the focus is on cutting “non-clinical” staff, the knock-on effect on front line services is likely to be significant as admin and other non-clinical tasks are dumped on to already hard-pressed clinical staff. This is in turn could be the final straw that persuades demoralised medical and other professional staff to seek work elsewhere.
But while the NHS is being cut back in the hopes of delivering savings targets, other government policies seem certain to pile more pressure on NHS and social care – especially if savage cash-driven cuts in sickness and disability benefits take effect.
Here it is most obvious that far from bringing any change, Labour ministers have simply had another go at implementing policies that failed under the Tories: they plan to introduce a rule stripping claimants of the daily living component of Personal Independence Payments (PIP) from November 2026, for anyone who does not score at least four points in a single activity.
Labour’s quotes Office for Budget Responsibility projections that “only” 800,000 will actually lose their entitlement, but figures released under a Freedom of Information request reveal that a massive 87 per cent — more than 1.1 million people — of the 1.28 million currently receiving the standard daily living rate would no longer qualify under the new rule.
Analysis by the Disability Policy Centre (DPC) has pointed out that plans to cut £18bn in disability benefits between 2016 and 2021 resulted in savings of £800m, just 8% of what was initially claimed.
Labour’s attempt to follow suit with cuts of at least £5bn by 2030 are likely to suffer a similar fate: the DPC predicts the proposals will save as little as £100m – just 2% of the estimated savings.
But the DPC estimates the cuts will also leave local authority social care services and the NHS facing extra costs of £1.2bn, and lead to “unintended costs” as some disabled people seek alternative support from the NHS.
It will also increase poverty and reduce economic growth as disabled people are denied the support to enable them to work and disabled households reduce their spending amid rising legal and administrative costs of appeals against the cuts.
With all of this policy’s knock-on problems looming in the near future, capital-starved hospitals crumbling, clapped-out equipment failing, and no serious attempts to repair or reform the broken, privatised social care system until at least 2028, there is precious little light, if any, at the end of the tunnel for NHS staff.
This state of play leaves Labour’s much-vaunted 10-year plan for the NHS, promised for the summer, as a massive irrelevance. The NHS leaders at national and local level who are supposed to lead on this Plan when it appears are now busy scouring job adverts, polishing up their CVs and calculating their redundancy pay-offs, while trust bosses are once more seeking to make huge savings to balance the books, and short-staffed health staff are left struggling to prevent any further decline in the quality and availability of services.
Switching resources out of the hospital sector to help boost community services, as Streeting has hinted will be at the core of the Plan, would most likely kill off what small improvements have been made to waiting lists and waiting times—and ditch yet another Labour promise to clear the backlog of patients waiting over 18 weeks within five years—as well as obstruct any further progress on emergency treatment.
So while it’s always nice to be able to report on NHS achievements and successes, it’s also important to recognise that unless there is a change of course Labour will be remembered not as the party that rode for a second time to the rescue of the NHS, but as the party that failed to learn from recent and past policy failures – and continued the austerity regime so many people thought they were voting to reject.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
At the start of the year, Lowdown was critical of the self-congratulatory tone of a Wes Streeting speech to Labour Party members just before Christmas, in which he also (correctly) insisted that ministers should be judged by what they deliver.
Perhaps because of this, Mr Streeting was rather less triumphalist in his recent speech to UNISON’s Health Conference. In it, he stressed the scale of the challenges left behind by 14 years of Tory underinvestment and resorted to the tried-and-tested trick of yet again promising a ‘zero tolerance’ crackdown on violence against NHS staff—a ruse first used back in 1999 by then Health Secretary Frank Dobson.
But Labour councillor and ex-political journalist Sebastian Salek has had a go at banging the drum for Labour’s achievements in a thread on X/Twitter, which begins:
“Nine months ago, the NHS was at breaking point. The turnaround under Labour has been remarkable – and barely anyone’s talking about it.”
He then lists “five seriously impressive stats”:
Indeed, these statistics, which appear to have been taken directly from an April 10 release by NHS England, do show some improvement, although perhaps less dramatic and game-changing than Mr Salek would have us believe.
The waiting list is down by almost 148,000 (2%) in the 12 months to January and has fallen for the last few months. But even after that fall, 5 per cent more patients were waiting in January 2025 than in January 2023. If it continues falling at the same rate, it would take almost 34 years to reduce the waiting list to 2.5 million, so patience is required before we see any “seriously impressive” results.
On waiting times, too, Mr Salek’s claims are overegging the pudding: the “two-year low” in the number of people waiting over 18 weeks for treatment is in comparison with the (then record) high, when the numbers topped 3 million for the first time in January 2023. After that, they peaked at 3.3 million in December 2023, and since then, they have been generally falling. It’s not obvious that this is (or could be) linked to the change of government last July.
Of course, it is also good to see that the number of patients waiting over a year is continuing to fall—as they were before Labour was elected.
There have also been, according to Mr Salek and NHS England figures, 3.1 million additional “appointments” (elective operations, outpatient appointments and diagnostic tests) between last July and January. Again there has been no magic wand involved: these plans (and the diagnostic centres that have helped deliver them) were all in place before Labour was elected.
It’s also good news that access to cancer treatment has improved, with performance against the 28 day faster diagnosis standard (to reduce the time between referral and diagnosis of cancer) at 80.2% in February 2025 – above the NHS constitutional standard of 75%. NHS England points out that this represents a 6.8 percentage point increase from January 2025 – but also admits that (as can be seen from the graph) “it conforms to seasonal improvements in performance that are commonly observed each February.”
2025 was the busiest March ever for A&E. Despite that, A&E waits of 4+ hours fell fractionally year-on-year, although the percentage of the most serious Type 1 patients kept waiting over 4 hours was unchanged from March 2024.
Perhaps more worrying is that the numbers and percentage of Type 1 patients left waiting over 12 hours on trolleys waiting for beds have both increased in March 2025 compared with March 2024, underlining the unresolved shortage of beds, and the unresolved problems discharging patients after treatment.
It’s also obviously good news that Category 1 ambulance response times are now the fastest in almost four years, although the speed of delivering patients to hospital is clearly not yet matched by prompt admission and treatment when they get there.
Mr Salek admits “Of course, this is just the start. You can’t fix the NHS overnight” (although that does seem to be the implication of citing the changes since July, and his claim “What a difference it makes putting the health service in Labour’s hands.”)
But rather than trumpeting the achievements, many health workers, campaigners and patients will be rather wondering why there is not more evidence of fundamental change since July.
Outsourcing of NHS support services and community health services have proceeded with no attempt by Wes Streeting to prevent them, despite being in direct conflict with Labour’s manifesto promises. NHS England has adopted a policy of pressing trusts to hive off non-clinical staff to wholly-owned companies, subcos, outside the NHS – a policy hatched up under the Tories and directly contradicting Labour’s manifesto promise of the biggest-ever wave of insourcing – again with connivance of Wes Streeting.
Other promises also seem to be receding into the background rather than focusing government policy. The pledge to “bring back the family doctor” stands in stark contrast to the inadequate numbers of GPs to cover a growing population with increasing needs – while increasing numbers of would-be locum GPs are resorting to driving taxis or other gig economy jobs because GP practices lack the funding to employ them, and bottlenecks in the training system are frustrating thousands of resident doctors.
But even when people do get to see a GP, the emphasis now is not on speeding patients through the treatment they need, but on offering £20 incentive payments for GPs NOT to refer patients for hospital care.
The Health Service Journal reports Integrated Care Boards have been told to take steps to ensure that potential GP referrals are first scrutinised by hospital consultants, under a system known as “advice and guidance”. GPs are expected to discuss cases with specialist consultants, which the HSJ explains “can lead to the patient being triaged to alternative services, or the GP continuing to be responsible for their management, rather than being placed on a waiting list to see a consultant.”
This cunning plan to reduce referrals is now apparently “a key plank of NHS England’s plan to deal with the elective care backlog.”
But while a £20 bonus for not referring a patient seems feeble enough, the reality of this plan is actually even worse for both GPs and consultants – as well as patients. The consequence of each non-referral is an extra patient with significant needs for GPs and already under-funded community health services to care for: meanwhile the hospital specialists are offered no similar financial incentive to find the time for these additional conversations with GPs – but expected to facilitate the diversion of patients (and income)away from their department and their trust.
Nor does it seem NHS bosses or ministers have really considered the way this policy will look to patients, who once they have secured an appointment to see their GP may well be expecting them to refer them for hospital care – only to find out that the doctor can pick up a cash reward for fobbing them off with something else.
But for mental health patients things are even worse. Labour’s promise to tackle long delays in accessing mental health services also seems to have been abandoned, with spending reducing in real terms this year and little sign of improvement since July in access to services.
Perhaps worst of all is the access to emergency mental health care. Analysis by the Royal College of Emergency Medicine has found that, despite the standard of care mental health patients received improving, the average time a person in mental health crisis spent in A&E last year (2024) was almost 11 hours – an hour more than in 2023.
In 2024, 65,881 patients with a primary diagnosis of mental health waited 12 hours or longer in ED to be admitted, discharged or transferred, almost four times the number in 2019.
An average of just 43% of patients considered to be ‘medium’ or ‘high-risk’ received an appropriate level of observation during their stay in ED – but this was a significant improvement compared to last year’s average of 29%. And for just over a third (38%) of patients is there evidence they received compassionate care while in A&E (with 62% apparently missing out): this is after an 8% improvement on previous performance.
RCEM President Elect, Dr Ian Higginson, who leads on Clinical Quality for the College said: “Emergency Medicine teams will keep going, but ultimately there is only so much they can do until those with responsibility for designing and resourcing systems to care for these patients give this issue the priority it deserves.”
Nor is it just a problem for A&E: the latest NHS data analysed by Rethink Mental Illness show people are eight times more likely to wait over 18 months for mental health treatment than physical health treatment.
Rethink points out that the government’s Plan for Change includes an optimistic target for 92% of elective patients to start treatment within eighteen weeks – but it doesn’t include any commitment to tackling waiting times for mental health services.
Moreover with ministers endlessly complaining at the numbers of working age people not in work, Rethink warns that lack of access to mental health care risks undermining the government’s ambition for economic growth:
“With record and increasing numbers of people out of work due to poor mental health, ensuring prompt treatment can help improve lives, support people who are well enough to enter or remain in work, and boost productivity.”
What are the chances this grim situation will improve in the near future? The promise of shifting more care into community health services is held back by the chronic and continuing lack of investment and available funding to expand historically neglected services.
The same funding squeeze is forcing Integrated Care Boards (ICBs) and Trusts to make drastic cuts in their costs – and many are seeking to make savings by axing jobs.
While we have heard of the 50% cuts required by the end of the year in staffing costs for NHS England and ICBs, there is less information on the scale of cuts likely to take place in hospital trusts.
The Guardian has estimated up to 100,000 jobs could be axed by trusts, while the NHS Confederation, representing trusts and foundation trusts has expressed concern over the potential cost of large scale redundancies as trusts cut staff numbers by varying amounts between 3 per cent and over 11 per cent:
“Some leaders of NHS trusts have said they are each looking to cut between 200 and 500 roles, while some ICB leaders have said they are likely to remove anywhere between 300 and 400. Several trust leaders said that they were budgeting for around £12m worth of redundancy payouts and associated costs.”
Already plans have been revealed to cut almost 800 jobs from trusts in Portsmouth and the Isle of Wight, to save £39m towards a “savings” target of £82m in 2025/26, and there are reports of plans to axe 500 jobs in two Bristol trusts.
Although it is claimed that the focus is on cutting “non-clinical” staff, the knock-on effect on front line services is likely to be significant as admin and other non-clinical tasks are dumped on to already hard-pressed clinical staff. This is in turn could be the final straw that persuades demoralised medical and other professional staff to seek work elsewhere.
But while the NHS is being cut back in the hopes of delivering savings targets, other government policies seem certain to pile more pressure on NHS and social care – especially if savage cash-driven cuts in sickness and disability benefits take effect.
Here it is most obvious that far from bringing any change, Labour ministers have simply had another go at implementing policies that failed under the Tories: they plan to introduce a rule stripping claimants of the daily living component of Personal Independence Payments (PIP) from November 2026, for anyone who does not score at least four points in a single activity.
Labour’s quotes Office for Budget Responsibility projections that “only” 800,000 will actually lose their entitlement, but figures released under a Freedom of Information request reveal that a massive 87 per cent — more than 1.1 million people — of the 1.28 million currently receiving the standard daily living rate would no longer qualify under the new rule.
Analysis by the Disability Policy Centre (DPC) has pointed out that plans to cut £18bn in disability benefits between 2016 and 2021 resulted in savings of £800m, just 8% of what was initially claimed.
Labour’s attempt to follow suit with cuts of at least £5bn by 2030 are likely to suffer a similar fate: the DPC predicts the proposals will save as little as £100m – just 2% of the estimated savings.
But the DPC estimates the cuts will also leave local authority social care services and the NHS facing extra costs of £1.2bn, and lead to “unintended costs” as some disabled people seek alternative support from the NHS.
It will also increase poverty and reduce economic growth as disabled people are denied the support to enable them to work and disabled households reduce their spending amid rising legal and administrative costs of appeals against the cuts.
With all of this policy’s knock-on problems looming in the near future, capital-starved hospitals crumbling, clapped-out equipment failing, and no serious attempts to repair or reform the broken, privatised social care system until at least 2028, there is precious little light, if any, at the end of the tunnel for NHS staff.
This state of play leaves Labour’s much-vaunted 10-year plan for the NHS, promised for the summer, as a massive irrelevance. The NHS leaders at national and local level who are supposed to lead on this Plan when it appears are now busy scouring job adverts, polishing up their CVs and calculating their redundancy pay-offs, while trust bosses are once more seeking to make huge savings to balance the books, and short-staffed health staff are left struggling to prevent any further decline in the quality and availability of services.
Switching resources out of the hospital sector to help boost community services, as Streeting has hinted will be at the core of the Plan, would most likely kill off what small improvements have been made to waiting lists and waiting times—and ditch yet another Labour promise to clear the backlog of patients waiting over 18 weeks within five years—as well as obstruct any further progress on emergency treatment.
So while it’s always nice to be able to report on NHS achievements and successes, it’s also important to recognise that unless there is a change of course Labour will be remembered not as the party that rode for a second time to the rescue of the NHS, but as the party that failed to learn from recent and past policy failures – and continued the austerity regime so many people thought they were voting to reject.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
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