By Henry Poust, Associate Director at Incisive Health
This week marks one year on from Labour’s landslide victory at last year’s general election. It also coincides with the imminent publication of the 10-Year Health Plan, which will set the tone for what Labour says and does on the NHS in the remainder of its term.
To mark the milestone – whilst the health policy community waits to see if the pre-briefing and leaks from the 10-Year Health Plan mirror the real thing – we wanted to reflect on Labour’s first year in office.
Smashing the ‘ming vase’
This time last year, political commentators were writing about how Labour’s approach to the election campaign resembled carrying a ‘ming vase’ – the chief objective to emphasise stability and trustworthiness on the economy rather than making new policy commitments.
There have been some frustrations this approach looked likely to continue in government. The gap between the election result and Labour’s first fiscal event in October saw it buffeted by events rather than shaping them, and the 10-Year Health Plan has taken Labour a full year in government to publish.
The 10-Year Health Plan should see the ming vase finally shattered, as the Government sets out its vision for the future of the NHS – abolishing NHS England and bringing power back to the centre.
Eliminating 18-week waits
The Secretary of State has been regularly referring to how waits have gone down month by month since the election and NHS England have published a press release to announce the NHS waiting list is at a two-year low.
The Prime Minister has also bet big on electives. Ending hospital backlogs is the health headline behind the Government’s overall Plan for Change – and its key commitment to ‘Build an NHS fit for the future’.
Progress still only amounts to around 60% of patients being treated within 18 weeks, and there is scepticism the Department of Health and Social Care (DHSC) will be able to hit an interim target of 65% by March. Prior to the Spending Review, internal modelling from the DHSC was leaked that showed only around 80% would be seen within 18-weeks by the end of this Parliament.
Transformation vs electives
The Government has been talking big on NHS transformation and investing in technology, with Wes Streeting’s three shifts characterising their thinking. The Spending Review included up to £10 billion in NHS technology and digital transformation by 2028-29 and moving from analogue to digital is one of those three shifts.
How this money will be spent should be revealed in the 10-Year Health Plan, and we already know from early leaks it will include a significant scaling up of the NHS app. Wes Streeting has referred to his excitement at how AI can be utilised across the NHS.
While DHSC may have been a relative winner from the Spending Review, the real terms growth in the health budget of 2.8% per year is lower than the recent historical average. Therefore, the tension facing the Government in the rest of this Parliament will be how it can deliver the funding required to deliver these transformative ambitions (including those relying on AI and tech, expected in the 10-Year Health Plan), whilst halving running costs in the DHSC and Integrated Care Boards.
‘Everyone has a plan until they get punched in the mouth’
Ahead of the election, Keir Starmer encouraged resident doctors to cancel industrial action, saying “we are very close now to the opportunity for a different approach with a Labour government”.
The Government then negotiated immediate progress, providing a pay uplift for junior doctors in its first month in office that ended long running strikes.
However this different approach is now at risk of yielding the same results: 50,000 resident doctors are being balloted for six months of industrial action in a dispute over pay, with the co-chair of the resident doctors’ committee saying the vast majority “are excited to go again”. The Royal College of Nursing (RCN) recently dismissed the Government’s pay award as "grotesque" and strike ballots are likely.
Whether DHSC’s spending allocation can stretch to pay deals, delivering the transformation agenda and meeting Labour’s manifesto commitments on eliminating the 18-week week wait, remains to be seen – not least given narrowing fiscal headroom after recent U-turns on welfare and winter fuel allowances.
What can we expect from the rest of this Parliament?
The 10-Year Health Plan will define the remainder of this Parliament on the NHS, setting out the vision for how the three shifts will be translated into care delivery. Early briefing and leaks from the Plan paint both an encouraging picture of a Government committed to transformation, but also one in which ambition could outpace execution when faced with realities of a service still teetering under financial and capacity challenges.
For all of us working in health policy, the 10-Year Health Plan is an opportunity to think about how we can support the Government’s transformation agenda, showcasing reforms that deliver on the three shifts whilst offering the potential to support ongoing work delivering efficiencies in policy and care delivery.
For more of our political commentary, follow us on LinkedIn. If you have any questions for the team, or would like advice or support, please do get in touch via info@incisivehealth.com.