Why Labour Needs to be Bold on NHS Reform

As Keir Starmer outlines Labour's mission for health, James Maxwell makes the case for radical reforms to rebuild the NHS.

Before an audience of Labour progressives at this month's Progressive Britain conference, Keir Starmer declared that his reforms of the Labour Party would go further and deeper than what was achieved under New Labour. Starmer diagnosed that in order to deliver the transformation needed within the country, a new partnership between politics and working people would need to be formed with a Labour government at the heart of it. But this is only part of it, Labour needs to take the same reformist approach to public services, including the NHS, if it is to restore hope and deliver value, something the National Policy Forum’s draft recommendations fully recognise.

The NHS is in crisis and, at this rate, may not survive to reach its 80th anniversary in 2028. At this very moment, 7.3 million people are anxiously waiting to receive elective care, healthcare workers are leaving the NHS en-mass, and patients are dying because emergency departments are full and ambulances are not reaching them on time. The Government’s answer to this crisis is to unravel waiting time targets, move the goal posts for its own elective recovery plan, and point the finger elsewhere – at NHS England, at striking doctors and nurses, at COVID-19, and even at patients themselves – while taxes continue to rise and the health of Britain continues to deteriorate.

The social contract between the state and its people is wearing thin, and the situation is simply not sustainable. But equally, the challenge is immense. The NHS is by far the largest component of government public service expense, accounting for 36 per cent of Whitehall departmental spending in 2024/25, and it is the biggest bureaucracy in Europe. The reality is that while the Conservatives have historically underfunded the health service, the NHS has virtually received every penny it has asked for between 2019-2022 without showing much for it. So while resourcing is no doubt part of the problem, it is not the only part, and it would be irresponsible for Labour to write a blank cheque to the NHS in the hope that things will some how, some day improve. 

This is where reform comes in, and where Labour has to go further and bolder than New Labour if it wants to protect the NHS for future generations to come. Since 2019, the NHS has been on a journey towards integrated care, underwritten by the belief that by local services working together to deliver for the individual, patient outcomes will be improved, and it is one that Labour has rightly said it wants to continue. But these reforms, given statutory footing in 2022, will not be enough to secure the future of the NHS.

Given the scale of the challenge, Labour must be bolder than it has ever been before in testing assumptions and in reforming the NHS to deliver value.

In the immediate term, the focus should be on clearing patient backlogs through ambitious targets; rigorously-enforced by a powerful delivery unit in Downing Street and supported through incentivisation and a rapid expansion of pop-up treatment hubs. Asking the NHS to do even more will be difficult, but essential for patient care – so the independent sector should be better utilised and pharmacists and nurses should be entrusted to carry out more tasks. Retention is the elephant in the room, so in exchange for improved performance, healthcare workers should receive a proper pay rise which recognises their contribution and which restores the NHS as an attractive career option. This will be expensive but the alternative is even more so, so it’s essential that value for money is always achieved and maintained.

Over the long-term, Labour should radically shift the focus of the NHS from curative care to preventative health. Supporting patients to live happier and longer lives in good health will be critical as the population ages and demand for the NHS increases. Alongside this, care should become more accessible and easy to reach within the community - allowing patients to be treated within the areas they live and reducing the need for hospital visits (for example, through restoring walk-in services and having routes into the NHS other than through the GP or A&E). A proper long-term workforce plan would also support this agenda, creating new healthcare roles and transferring clinical decision-making outwards to pharmacists, opticians, and health visitors.

The NHS is one of Labour’s proudest achievements, and it will once again be a Labour government that reverses the decline from Conservative mismanagement and ensures that the NHS is there when it’s needed. Bold reform is a big part of that, and Labour should look forward to getting on with the job.

James Maxwell is a public affairs and health policy consultant. He co-chairs London Young Fabians and is an active member of both the Labour Party and Co-Operative Party. He tweets @MrJMaxwell.

Photo by Ian Taylor on Unsplash.

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