The state of the health service is one of the key metrics on which this government will be judged. Of course this is to some extent true for all governments. But it is particularly so for a Labour administration that made the revival of the NHS part of its core pitch to voters.
Such assessments of progress are all the more pressing in the context of Sir Keir Starmer’s increasingly beleaguered leadership. With Wes Streeting widely recognised to be among a handful of possible successors, colleagues and party members will be asking: has he delivered what they and voters hoped?
In terms of frontline improvements, the answer is no, or not yet. After falling for six months in a row, hospital waiting lists in England recently rose slightly. And while ministers point to figures showing that the overall numbers of GP and hospital appointments have increased, research reveals ongoing problems with staffing and low patient satisfaction. Although few people seem to have fully grasped this at the time, the £22.6bn boost in last year’s budget is being absorbed by inflation, higher national insurance contributions and pay rises – including the 22.3% awarded to resident doctors – restricting scope for spending elsewhere.
The difficulties involved in the ambitious behind-the-scenes reorganisation that Mr Streeting initiated in the spring have also become clearer. The tight timetable for the 42 regional integrated care boards (ICBs) to reduce their running costs by 50% is in doubt, after bosses revealed that they cannot afford redundancy payouts. With half of NHS England’s 15,000 staff also due to lose their jobs, as the organisation is merged with the Department of Health and Social Care (DHSC), it appears that ministers promised an Andrew Lansley-style shake-up before coming up with a plan to deliver it – and having previously ruled such a thing out.
It is not hard to find experts who think that bringing NHS England and the DHSC closer together makes sense in principle, or who agree that a more limited role for ICBs could turn out to be preferable. But the fear of some of those who have observed successive waves of change in the NHS is that the government has, once again, underestimated the distracting and destabilising effect of a restructuring exercise. Jennifer Dixon, chief executive of the Health Foundation thinktank, called it a “chainsaw approach” and compared the rapid turnover of health agencies in England to the situation in Germany, where an institute with a similar remit to the UK Health Security Agency has existed since 1891.
Now, with the cost of redundancies likely to lead to further cuts, on top of the “financial reset” already underway (due to a projected overspend of £6.6bn), the risk is that ministers have created the conditions under which organisations turn inward – rather than mobilise to deliver what the public wants. A suggestion from the new local government secretary, Steve Reed, that the devolution bill could be amended to give mayors new powers over hospitals, seems poorly timed given existing pressures – even if local control of public services is the right direction of travel in the end.
The 10-year plan for England launched in July rightly recognised that the health system must adapt to meet the challenges of the present and future. The worrying amount of attention being consumed by internal reorganisations is an unwelcome blast from the past.