The NHS is a totemic institution in Labour’s history and that of the country, and voters care more about it than most things the government does. So the publication of Labour’s 10-year plan for health in England was a crucial opportunity for ministers to show that they are in tune with the public. Given that satisfaction with the health service has hit a record low of 21%, and doctors are again threatening to go on strike, the announcement was also a moment of peril – even before the damage suffered by the prime minister and chancellor earlier this week, when rebels forced a U-turn on planned cuts to welfare.
The overarching principles of Labour’s reforms were set out last year: more prevention, more technology, more care delivered in the community (as opposed to in hospital). So the challenge was to find something fresh, original and hopeful to say. The promise of science and the potential of localism are what Wes Streeting’s team has come up with. The strand of DNA pictured on the document’s cover points to high expectations of genomic medicine and other cutting-edge technology. Neighbourhood clinics, by contrast, represent a prosaic recognition of demand for more ordinary services and treatments, from an ageing and increasingly unhealthy population. The aim is to deliver most outpatient care away from hospitals by 2035.
This could mean GP surgeries becoming more like hospitals, or hospital trusts taking a bigger role in primary care. The plans for new contracts make it clear that both are possible. But while this sounds fine in theory, questions remain over how, and by whom, such crucial decisions will be taken, and whether the new model will be better than the old one. With the abolition of NHS England, and scaling back of integrated care boards, the existing administration is being radically downsized. One of the risks of the next few years is that this backstage upheaval will distract time and energy from the frontline.
Plans to shift resources from richer areas to poorer ones deserve an unequivocal welcome. There is no great secret about expertise being concentrated in prestigious teaching hospitals, or about richer, better educated people being more confident advocates for themselves and their loved ones. Shifting the “best to the rest” is both a neat slogan and an acknowledgment of present unfairness. Plans to integrate employment support and services such as debt advice into healthcare hubs signal an encouraging awareness that illness and disability have socioeconomic as well as biological causes.
The plan tells a promising story. Healthcare is an area of human progress that all can celebrate. It is plausible that proactive Labour ministers can both drive advances and ensure that they are more equitably shared than in marketised systems. Embedding more healthcare workers in communities, and focusing on outreach, could help to improve population health. But there are some worrying gaps.
Social care reform is due to be tackled separately, but worsening mental health, particularly in young people, also needs dedicated attention and research. Ministers should also be pressed on the contradictions between their health plan and their pro-growth, anti-regulation message to businesses – including those that sell alcohol and the high-sugar foods that cause obesity. Having brought control of the NHS in England back in-house, to the heart of government, Mr Streeting must now find the people with the imagination to further develop his plan, while turning it into action.