Streeting presents ambitious plans for NHS, but can he make them a reality?

Labour may have got the basic idea right in prioritising primary care over hospitals if they come to power, but they risk deluding themselves about the scale of the task.

In a major speech at the King’s Fund last week1 fleshing out the opposition’s plans for the NHS, shadow health secretary Wes Streeting touted New Labour’s achievements in slashing waiting lists and waiting times2 as proof that his party could turn around the fortunes of the health service.

He said the plans would be delivered by a mixture of investment and reform, but “the state of the public finances means reform will have to do more of the heavy lifting.”

Keir Starmer’s team have been keen to learn lessons from New Labour’s time in power, and it shows. There is more than a hint of former health secretary Alan Milburn in Streeting’s approach—positioning himself on the side of patients to challenge the system rather than being a cheerleader for the health service.

But the scale of change Labour is proposing is massive, going far beyond recruiting more primary care staff. They are promising a fundamental shift of care from hospitals to communities and homes. “Healthcare on your doorstep” is now one of Labour’s three principles for healthcare, alongside “there when you need it” and “patients in control.”

The foundation of New Labour’s impressive achievements in improving performance and increasing public satisfaction to record levels3 was a steep and sustained increase in funding. While the average annual change in per capita health spending under the Conservatives between 1979 and 1997 was 2.03%, under New Labour it was 5.67%.4

The party has already made big commitments on staffing, including doubling the number of medical school places,5 doubling the number of district nurses qualifying every year and adding 5000 health visitors. On top of this Labour has promised to put a mental health hub in every community and mental health support in every school. Ostensibly the mental health facilities will be funded by abolishing tax loopholes for private equity fund managers and private schools, but in reality there is no such hypothecation. Local health centres will also act as one-stop shops for women’s health.

As senior King’s Fund fellow Beccy Baird pointed out in her response to Streeting’s speech, making his plans a reality will require nothing less than a wholesale restructuring of the health service, from medical training and staff deployment to redesigning care pathways, expanding the numbers and roles of allied health professionals and embarking on a major building programme. And even that won’t be enough—the most intractable part is delivering the cultural change to ensure NHS and social care staff think and work differently.

The barely perceptible progress of the government’s New Hospital Programme6 shows how hard it is to turn bold promises about NHS building projects into reality, while the failure of NHS England’s 2014 Five Year Forward View7 to gain significant traction in delivering new care models demonstrates the difficulties of making cultural change happen with minimal financial headroom.

Streeting ridiculed the Tories for comforting themselves with fairy tales rather than facing up to what needs to change. He is in danger of falling into the same trap.