“A Labour government that won’t implement progressive tax policies despite its huge majority will not get to see, or deserve a second term, no matter who the leader might be.”
By John Lister
As the Parliamentary Labour Party’s choice of Prime Minister, Andy Burnham, and whoever he appoints as Health and Social Care Secretary, face a stiff challenge if they want Labour to regain any of the ground they have lost on health care in the past two years.
Far from hitting the ground running, Keir Starmer’s choice as Secretary of State, Wes Streeting, largely squandered the limited opportunity he was offered by Rachel Reeves’ tight-fisted approach to tax and spending, which has left a rapidly widening gulf between rich getting richer and poor getting poorer – and a renewed squeeze on public sector budgets.
Almost two years on, an NHS Alliance survey in March found almost two-thirds (64%) of NHS trusts and commissioners say they expect to reduce or close services in 2026/27, and 87% feared they may have to “redesign” services in 2026/27. Two-thirds (64%) of trust and ICB replies, and almost three-quarters (74%) of GP respondents said they were concerned about delivering a poorer patient experience this year.
Meanwhile, all Streeting offered was a belated word salad of a ‘Ten Year Plan’, which a year later is still devoid of any clear implementation, workforce or finance plan. It threatens to recreate the NHS competitive ‘market’ of the 2000s and further weaken the already minimal public accountability of NHS bodies while claiming to make health care more ‘local’ by opening a handful of vaguely defined (and privately-funded) Neighbourhood Health Centres.
Legislation, to rubber stamp the plan (and throw the NHS into turmoil through another top-down reorganisation and wholesale loss of top-level jobs as NHS England is abolished and rolled into the DHSC) is still going through parliament with pathetically minimal scrutiny or debate. It also merges the 42 Integrated Care Boards established in 2022 into even fewer and even less local bodies,
These changes were coupled with Streeting’s repetition of the mantra of “three shifts” in health policy:
Hospital to Community (Moving care out of centralised, acute hospitals and into local, neighbourhood health centres);
Treatment to Prevention (Transitioning the NHS model from reacting only to sickness to a proactive approach that stops illnesses from developing in the first place)
Analogue to Digital (Modernising the health system by adopting digital technologies, AI, and wearable devices to monitor patients remotely and streamline diagnostics.)
None of these is wrong in itself, but all three tacitly assume increasing resources in terms of capital investment, additional staff and much wider scale economic progress. The first shift also ignores the financial implications for hospitals of losing key aspects of their work (and income). None of them addresses the actual situation the NHS is facing.
Streeting has departed. His strategy has not delivered, and now needs to be dumped as well, in a decisive shift to confront reality.
A decade and a half of austerity funding since 2010 has squeezed spending and left dozens of acute hospital trusts in deficit and seeking cuts, while the population has increased (most notably the growing proportion of the older 65+ population most needing health care).
Moreover, the aftermath of the Covid pandemic has left its own scars, not least in a surge of mental illness in younger people as well as a more bloated waiting list for elective treatment.
If Burnham wants to ensure the NHS is switched from electoral liability to electoral asset, he needs some quick wins to catch the eye of the voting public and health workers alike. This means confronting the most urgent and pressing issues first – and perhaps urgently developing a new three-year plan that can deliver tangible results by the next election.
Some relatively easy wins could help Burnham kick-start a reset: axing any public sector contracts with Palantir (which Burnham has already done in Manchester) and scrapping the one-sided and disastrous drugs deal with the US, which could add £45 billion to drug costs over the next decade.
Other urgent issues in the headlines include the dire state and decline of Emergency services in the last few years, with the most seriously ill patients facing the longest waits and the most indignity, while almost all (96.7%) of the least serious (Type 3) patients are seen, treated and discharged within 4 hours.
Streeting did nothing on Emergency services, simply seeking to improve average performance by further speeding the treatment of the least demanding cases.
The Royal College of Emergency Medicine has argued that another 8,000 beds are needed to eliminate long trolley waits and ‘corridor care’: but they also argue that the best way to achieve this is by speeding the discharge of patients.
With another winter on the way, the NHS needs a small expert team to conduct a rapid, trust-by-trust analysis of root causes of ED delays, beginning with the trusts with the biggest problem, and backed by resources for action where necessary to help unblock patient flow. In some cases NHS systems themselves are delaying the discharge of patients who no longer need hospital care but do need support from community health or social care.
Urgent and visible action is also needed, again with resources where necessary, to follow through the hard-hitting Ockendon report on serious lapses of quality care in maternity services. This also requires national-level leadership from senior managers with relevant front-line experience.
Other scandals which undermine the government’s reputation and popularity include the dire shortages of capacity – and long delays – for child and adolescent mental health services, and the lack in many areas of dedicated emergency mental health services for adults in crisis, too many of whom wind up in the queue for emergency care in acute hospitals.
And demand continues to increase beyond capacity in primary care, especially since the government opted to impose the controversial GP contract in the teeth of overwhelming opposition. If Burnham does not want his premiership to be disfigured by an all-out row with GPs, he needs to give urgent attention to reopening negotiations and increasing funding to enable more GPs and relevant health professionals to be recruited.
A final priority for an early hit list has to be a substantial increase in NHS capital spending. Maintenance and investment have too long been neglected, with a rising backlog of £16 billion in maintenance alone, and no capital on hand to rebuild even the most crumbling hospitals.
We need action now on backlog maintenance and a swift process to build new hospitals to replace those crumbling with RAAC concrete beams. Again, priority has to go to the trusts with the highest backlog and the greatest safety and capacity problems. The building projects will create valuable new jobs as they construct public assets for the future.
Other important issues – bringing outsourced clinical and non-clinical services back in-house as contracts end, a realistic workforce plan that offers hope to newly qualified medics and professionals, and a plan for social care, can follow on once action is under way.
There’s no denying all of the priorities require additional funding, and Burnham has signed on to Rachel Reeves’ promise not to raise income tax or National Insurance.
But people want to see public services improving, and there is growing frustration that a failure to tax the super-rich and the super profits of high-flying businesses driving up the cost of living is standing in the way of progress.
A Labour government that won’t implement progressive tax policies despite its huge majority will not get to see, or deserve a second term, no matter who the leader might be.
- John Lister is a founding member of Keep Our NHS Public and co-editor of The Lowdown. You can follow him on Twitter/X here.
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