With 412 Labour MPs and a huge majority in the House of Commons, Keir Starmer’s Labour government clearly now has the power to bring in real change for the NHS.
The challenge for campaigners now is to ensure the new government seizes this opportunity to repair and rebuild the NHS, which is facing a long list of serious problems, all of which cost money to fix:
- The 7.6m waiting list that was bloated, but not created by the Covid pandemic
- The £3bn black hole in NHS finances
- The unresolved dispute with the Junior doctors seeking to restore pay to 2010 levels
- The need to negotiate a new dental contract to deliver Labour’s promise of an extra 700,000 NHS appointments a year
- Chronic A&E delays
- The £12bn (and rising) backlog of basic maintenance and renewal of equipment
- The estimated £50bn cost of the NHS Workforce Plan over the next 12 years
- The £30bn-plus cost over several years of Labour’s Manifesto promise to deliver the New Hospitals Programme (Boris Johnson’s empty promise of “40 new hospitals”)
Both the Nuffield Trust and the Institute for Fiscal Studies have warned that Labour’s boast to have costed all of its Manifesto promises was an empty one, and that both Labour and Tory manifestos ignored a looming black hole in the public finances opened up by Jeremy Hunt’s recent tax cuts.
The Lowdown has additionally warned that the last minute, low-key inclusion of the promise to build new hospitals was completely unfunded.
Labour leaders have made repeated promises not to raise taxes for ‘working people’, and if these are kept, then the commitments on the NHS and other public services can only be funded through progressive taxation on the wealthy – which could include equalising the tax on dividends with income tax, a wealth tax, increasing inheritance tax, or corporation tax.
Other more ambitious alternatives include a ‘Robin Hood’ tax on speculative transactions, or a turnover tax to ensure multinational corporations finally pay tax on the business they do in the UK.
National emergency
The British Medical Journal’s Commission on the Future of the NHS and the Royal College of Nursing have suggested that one way in which the new government could create more opportunity for bold action would be to declare a “national emergency” in the NHS. The SOSNHS campaign has pressed for an emergency cash injection of £20 billion to kick-start the revival of the NHS, tackle the most urgent repairs and rebuilding, and settle the pay claims of hard-pressed staff still taking home less in real terms than they were in 2010.
The BMA and the Royal College of Emergency Medicine published their own manifestos, and campaigners in Keep Our NHS Public have set out a vision for a “People’s NHS”. All of these are, perhaps predictably, more ambitious than the proposals set out by Labour. Many voters, too, as well as think tanks and NHS employers’ organisations will be impatient to see positive changes.
So it makes sense to pile pressure on ministers to act swiftly to deliver the positive changes they have committed to already (which would make a modest, but significant improvement to the NHS) and ensure that the financial implications are made clear and fully addressed.
Labour’s new Health and Social Care Secretary Wes Streeting has already committed to begin negotiations over pay with the junior doctors, which are taking place as this article is written. Even though he has warned that there is not enough funding in the pot to cover an immediate 35% increase to restore pay to 2010 levels, this change of approach will be widely welcomed.
The BMA has already agreed deals with devolved governments in Wales and Scotland which begin a process of restoring the value of pay, and Streeting’s offer also to discuss other grievances about the way junior doctors are treated by the NHS may open up scope for a compromise in England.
Promises
Campaigners and trade unions can also press for early action on the other prominent Labour promises:
- Cut NHS waiting times with 40,000 more appointments every week – achieved through paying staff to work additional overtime
- Double the number of cancer scanners (although there seems to be no plan for additional staff to work them or read the results)
- A new Dentistry Rescue Plan
- 8,500 additional mental health staff
These four proposals are the only NHS-related commitments costed (at less than £2 billion in total, to be covered by removing tax breaks for “non-doms”) in the final section of the Manifesto. However the costings are only for 2028/29: so the affordability and implementation of these changes this year or next, or in 2026 or 2027 is open to doubt.
But not to act on any of them until the final year before the next election risks Labour presiding over a further serious decline in the NHS, rather than the promised rescue.
There are also real doubts on what is meant by the “additional mental health staff”, since it appears they will not be qualified nurses. The Manifesto is vague:
“Labour will bring waiting times down and intervene earlier. We will recruit an additional 8,500 new staff to treat children and adults through our first term. As part of our mission to reduce the lives lost to suicide, these new staff will be specially trained to support people at risk.”
There is widespread agreement that action is needed to bridge the gaps that have opened up in access to mental health care, especially since the Covid pandemic: but there needs to be much more clarity on what level of training these staff will have and how they will fit into the existing mental health and community health services.
Primary care
Labour’s manifesto also highlights a commitment to “Return of the family doctor”. To make this a reality rather than a catch-phrase also costs money: it requires an urgent review of (and substantial improvement on) the miserable, below-inflation 1.9% increase awarded for GP contracts in 2024/25, on which the BMA is already balloting its GP members.
In short, to restore GP services means taking steps to restore levels of spending on GP services which have fallen by 50% since 2010. Without this, the numbers of fully-trained GPs will continue to decline, resulting in soaring numbers of patients on each GP’s list … and even more delays in seeing a GP.
And with Pulse online magazine warning of substantial unemployment among GPs unable to find locum posts this summer as practices struggle to cut spending to stay afloat, NHS England must be instructed to ensure that additional funding can be used to pay for GPs and nurses as well as less qualified “additional roles” staff.
However Labour does appear to be committed to bringing back one of the least successful policies from the Blair and Brown years – polyclinics, that aimed to centralise GP and other services, but which proved unpopular with patients (losing local access) and GPs, and financially unaffordable.
Now Labour is promising effectively the same thing, when it commits to “trial Neighbourhood Health Centres, by bringing together existing services such as family doctors, district nurses, care workers, physiotherapists, palliative care, and mental health specialists under one roof.”
If the policy could not be afforded back before the banking crash it is clearly unaffordable after 14 years of austerity funding. Nobody really wanted them then, and nobody except a handful of Labour advisors seem to want them now, so this is one promise that should be quietly ditched.
Prevention
But before Wes Streeting comes up with similar “reforms” it’s worth noting the suggestion from Private Eye’s Dr Phil Hammond on X/Twitter for ways that would really improve the NHS through prevention, but which all require investment:
“1. Prevent poverty. It’s the single biggest determinant of ill health, and health and social care demand, both now and in the future. Blair and Brown made good progress in reducing it. So it can be done.
“2. Prevent illness, with a relentless focus on living well, self-care, mental health support and tackling the commercial determinants of illness. Dental disease is the commonest cause of childhood operations, and yet it’s almost 100% preventable.
“3. Prevent existing risks and diseases getting worse, with evidence-based screening and a substantial shift in resources to primary, community and social care
“4. Preventing waste and medical harm, by ensuring patients receive the right care, in the right place, from the right people at the right time. This is the toughest nut to crack, as it requires adequate numbers of well trained and well rested staff working in safe, clean environments with the right equipment.”
Given the prolonged financial squeeze on all sectors of the NHS, any “shift of resources” to primary, community and social care will have to come from new money rather than forcing cutbacks on hospital care that will threaten any reduction in waiting lists.
Maintenance and new hospitals
One of the sharpest problems facing hospitals is barely mentioned at all in the Manifesto: that is the £12 billion backlog maintenance. The relevant section simply states:
“It is also clear that NHS estates are in a state of disrepair after years of neglect. Labour is therefore committed to delivering the New Hospitals Programme.”
But the New Hospitals Programme – itself already a long-running saga of failure since the promise of new hospitals was first glibly made by Boris Johnson, and which has not yet started on a new building – does not tackle the wider problem of billions of pounds worth of maintenance that has not been done as capital budgets were raided to cover gaps in revenue funding.
The chronic lack of capital for backlog maintenance has left some hospitals literally at risk of falling down – as recently seen in Stockport’s Stepping Hill Hospital, while over half of England’s trusts are hampered by chronic problems with buildings or equipment.
The new government is in post because voters rejected the Tory neglect of the NHS and public services: but its foundations are fragile, and its long-term future depends upon prompt action to deliver real change that people can see and feel.
A serious incident in which dilapidated hospital buildings collapse, putting patients and staff at risk, would be exploited by Labour’s enemies, and extremely damaging for its credibility: this makes it urgent to find new money to tackle and reverse the decline.
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