From government-in-waiting to mission control: what might the transition mean for health?

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By Laura Tantum, Associate Director, Incisive Health

It’s now been just over a week since the Labour Party launched its 2024 General Election manifesto, setting out big ambitions to rebuild the nation and reform the NHS. While light on new policy, behind the scenes the civil service will now be in transition mode, preparing to translate Labour pledges into implementable policy – perhaps made more complicated by the potential for the "biggest Whitehall shake-up in decades". In the Department of Health and Social Care, civil servants will also have some unanswered questions to grapple with: are the policies from the more extensive Health Mission document that didn’t make the cut in the manifesto forgotten for good, lower priority, or on an equal footing?

They will know a little bit more than they did last week. While transparency on NHS funding was lacking in all of the major manifestos, analysis by the Nuffield Trust suggests Labour’s NHS spending pledge would lead to real-terms increases of 1.1% per year by 2028/29. This is slightly more generous than the Conservatives’ offering of 0.9% per year, but still below the coalition government’s 1.4% ‘austerity’ offering – while all three of the major party manifestos fall far short of the funding required for delivery of the NHS Long Term Workforce Plan. If Labour is serious about its commitments to train “thousands more” GPs and midwives under the workforce plan, this will pose an immediate challenge for officials.

Labour itself has returned to policies originally trailed in the 2023 Health Mission in the days since the manifesto’s launch. Last weekend, Wes Streeting pledged that, under a Labour government, every cancer patient would receive treatment “fit for a king” – bringing back a Mission commitment that the NHS will hit cancer waiting times and diagnosis targets by the end of its first term in office, through a “fully-funded and fully-costed plan [to] catch cancer on time, diagnosing earlier and treating it faster to save lives”. Although now underpinned by the familiar pledge to double the number of cancer scanners, the absence of the commitment itself from the manifesto could put it lower down the civil service agenda – particularly given the substantial additional funding that would likely be required.

As this shows, Labour’s position as ‘government-in-waiting’ over the last few years has created time and space to announce policy pledges incrementally. However, officials and ministers will now have swathes of policy options to prioritise, and defend, as the new government beds in, and works out what is immediately deliverable in an NHS facing unprecedented performance and fiscal challenges. This begs the question: what will Labour need to do in the first 100 days in office to translate ambition into action, and where will the power lie? 

Starmer’s first job will be to appoint a ministerial team that will be able to drive through the short-term performance improvement and longer-term transformation that the Party has promised. Wes Streeting may be a rising star of the Party, but the health team’s experience in government is limited – so might an old face return to bolster the bench? Perhaps previous Secretary of State Alan Milburn – respected across party lines, and still an influential voice in the health world? Or, to avoid the potential power imbalance this could create, another former minister now sitting in the upper chamber? Lord Hunt of King’s Health, the first “Minister for NICE” going back to 1999, could be a helpful bridge to help deliver the Party’s commitment to strengthen the life sciences sector.

Second, ‘lifting the bonnet’: a new government will need to complete a thorough audit of current NHS finances and performance. This will have three purposes: 1) to get a clearer understanding of the issues it most urgently needs to fix; 2) so it can identify where any adjustments to its commitments might need to be made – and crucially, make these tweaks early, before the honeymoon period ends, and while it can still pin the blame on the previous administration; and 3), to prepare bids for the comprehensive spending review currently expected in the autumn. A look back to 2010, and the now infamous “I’m afraid there is no money” note left by outgoing Chief Secretary to the Treasury, proves how much this process can set the tone to a change in government.

Finally, a crucial step will be to rebuild the Department of Health and Social Care’s relationship with NHS England, which has become increasingly strained over recent years. While we may well see an NHS Bill coming to Parliament in due course, formally legislating to bring NHS England back within the Department would distract both attention and manpower from delivering commitments to improve NHS performance, where progress must be demonstrated rapidly. So, more informal avenues might be sought in the first instance – perhaps more NHS England personnel moving into 39 Victoria Street, for example. At least, with Amanda Pritchard’s speech at NHS Confed Expo last week emphasising the need for the NHS “to re-imagine, to do things differently”, they might be singing from the same hymn sheet.

If the polls are correct about the scale of a Labour victory we might see on 4 July, this will be no small achievement – but perhaps the bigger challenges will come in the days that follow, not least on health. Polling shows that 43% of Britons of all political leanings think the NHS would get better under Labour, with 41% believing the same for social care provision. A vote of confidence, to be sure, but one that brings with it considerable pressure, and which could irrevocably erode without early delivery.

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