Labour’s promises on health are setting the party up to failBMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1217 (Published 26 May 2023) Cite this as: BMJ 2023;381:p1217
- Richard Vize, public policy journalist and analyst
Keir Starmer is making big, conflicting, and unrealistic promises on health, without a clear plan for delivering them, which is setting Labour up to fail.
In a speech at a Braintree ambulance station on Monday 22 May 2023, Starmer, leader of the Labour party, committed a Labour government to meeting a raft of targets that haven’t been hit for years, saying, “Ambulances—seven minutes for cardiac arrest. A&E—back to the four hour target. GPs—the highest satisfaction levels on record. Waiting lists—down. Planned treatment within 18 weeks. No backsliding, no excuses—we will meet these standards again.”1
As if that isn’t enough to keep a new government busy, he also committed Labour to improving healthy life expectancy and halving the inequality gap between English regions.
He claimed this would be achieved by diagnosing 75% of all cancers at stage 1 or 2—which would require a huge performance leap2—and cutting heart attacks and strokes by a quarter within a decade. He also committed to cutting the number of deaths by suicide.
All this will be achieved while Labour shifts services from hospitals to communities with a big expansion of local health services.3
The underlying message of Starmer’s Labour party is the same as Tony Blair’s New Labour manifesto in 1997—Labour will save the NHS from the existential threat presented by the Tories and modernise it.
But Blair’s detailed commitments were few. At a time of robust economic growth, he promised to increase real terms spending every year and get 100 000 people off waiting lists. The rest of the health policy was largely vague commitments such as cutting bureaucracy, improving quality and making better use of technology.4
Starmer is putting himself in a bind by simultaneously promising to shift care out of hospitals while ramping up hospital activity to meet commitments such as treatment times and emergency department waits. Unless he delivers a big and immediate increase in both revenue and capital spending, he will not have the cash, the staff, the buildings, or the kit to deliver either of these goals, let alone both together.
By locking himself in with specific targets across a wide range of hospital activity, he will fall into the trap of successive governments of talking a good game on improving primary care but ending up reinforcing the excessive dominance of hospitals in the NHS to meet headline targets.
By international standards UK spending on hospitals is massive while spending on areas such as prevention is strikingly low.5 Labour’s instinct that strengthening primary and community services will be the best way to tackle issues such as late diagnosis and inequalities is correct. But as well as the practical difficulties of achieving it they need to create the political space to do it.
Starmer’s speech achieved exactly the opposite. By riding off in all directions simultaneously he has all but guaranteed he will fail to meet his commitments. He will be driven back to short term fixes to meet promises such as four hour emergency department waits while leaving too little resource and too little political capital to tackle the underlying problems.
Competing interests: none declared.
Provenance and peer review: commissioned, not peer reviewed.