- Richard Vize, public policy journalist and analyst
Labour’s plans for the NHS imply seismic changes in workforce performance and culture. They claim they can do it without major injections of money.
The party has set itself the challenge of clearing waiting times for elective treatment of over 18 weeks within five years.1 That means clearing the current backlog of 3.2 million cases and new ones joining the list. Its commitment to additional spending is £1.8 billion, although the baseline is unclear.2 The party is also committed to delivering an extra 40 000 appointments a week across the system.3
None of this will be possible until Wes Streeting, incoming Secretary of State for Health and Social Care, resolves the junior doctors’ pay dispute. His comments demonstrate he will not repeat the mistakes of the bungled negotiations over doctors’ pay under Tony Blair’s government, when big rises were delivered without extracting commensurate changes in working practices or performance.4 He has talked about a “journey to fair pay,”5 indicating that higher salaries and better conditions will be traded for more effective ways of working.
The aim will be a step change in productivity. Department of Health and Social Care spending increased from £158bn in 2019-20 to £182bn in 2022-23, staff numbers increased substantially, but performance barely flickered.6 Labour claims that existing funding and staffing coupled with technical efficiencies can eat away at the elective care backlog.
Labour’s approach to technology will have big indications for how staff are distributed and organised, and how they work. Streeting’s team sees no reason why the NHS should not follow every other sector of the economy in using technology to drive down costs while improving productivity and quality. Expect to see a push for technology investment to free up staff to do other work, not simply make life easier for the same team.
The other big pledge is to train “thousands more GPs” and give primary care a greater proportion of NHS funding, to substantially increase access to primary care and keep people out of hospital through prevention and early intervention.7
Streeting’s team sees expansion and reform of primary care as part of the solution to the elective care crisis rather than a distraction from it. It implies major and rapid changes in the use of staff and technology, since it will take years for newly trained GPs to arrive. This means substantially greater use of nurses and physician associates (PAs) in clinics and further expansion of the NHS app as a first port of call for patients.
Labour has promised to deliver the NHS long term workforce plan, which includes a pledge to increase the PA workforce to over 10 000, including many more in primary care. While Streeting is committed to PAs, he says doctors have “legitimate concerns” about using them as substitutes for doctors and pushing them beyond their scope of practice.
But, no matter how much it improves performance, Labour will have to confront the NHS funding crisis. The underlying deficit for the current year could be as much as £6bn,8 while the workforce plan for England implies real term funding increases of around 3.6% per year.9 The Office for Budget Responsibility says even greater spending increases will be needed to meet demographic and cost pressures.10
Short of achieving near miraculous improvements in economic growth, the stark choices over NHS funding will have profound implications for the incoming government’s entire programme.
Footnotes
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Competing interests: none declared.
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Provenance and peer review: commissioned, not peer reviewed.
