Labour’s health “mission”

Abstract

Ambitious goals that won’t be delivered without investment

The UK is heading towards a general election—expected sometime in 2024—and the Labour party is currently ahead in opinion polls on how the public would vote.^{1 2} A lot can change between now and then. But if the party finds itself in government, Labour says its policy agenda will be based on five “missions”—broad goals for improving the economy, clean energy, health, education, and the criminal justice system.³ The Labour leader, Kier Starmer, announced plans for his party’s health mission in a speech on 22 May.^{4 5}

The headline ambition is to “build an NHS fit for the future.” Starmer backs the core principles of the NHS but says it must reform to keep up with changing health needs, such as more people living with multiple chronic diseases, and new technology. Labour would target improvements in three areas: faster access to NHS services (such as shorter waits in emergency departments), improved survival rates from “avoidable killers” (including cancer, cardiovascular disease, and suicide), and better health and health equity (with a target to improve healthy life expectancy for everyone and halve gaps in healthy life expectancy between English regions—though the timescale is unclear).

To make it happen, Starmer says Labour would prioritise preventing ill health, shifting NHS care out of hospitals and into the community, and expanding the health system’s capacity—including more staff and new technology. A “health in all policies” approach would encourage action across government to put in place the “building blocks” of good health, such as jobs, income, and housing.

Labour is right to look beyond the NHS. Health and inequalities are shaped by social, economic, environmental, and other factors—not just access to good healthcare.⁶ Life expectancy has stalled over the past decade, and gaps in health between richer and poorer areas are wide and growing.⁷ The last Labour government showed that progress on reducing health inequalities is possible with sustained investment in public services and new social programmes, such as SureStart and the minimum wage.^{8 9}

Missing pieces

But Labour’s plans for using wider public policy to prevent disease need fleshing out. For instance, the plan includes proposals to reduce childhood obesity, including promoting physical activity, funded breakfast clubs in schools, and restricting advertising of unhealthy foods. Yet other powerful population level measures—such as a sugar and salt reformulation tax or expanding eligibility for free school meals¹⁰—are not included. Labour’s plan is limited on smoking and says nothing on reducing alcohol related harms, despite rising deaths and hospital admissions.^{11 12}

Labour’s focus on “getting the basics right” in the NHS makes sense. The waiting list for routine hospital treatment has reached 7.3 million, and 360 000 people have been waiting more than a year.¹³ Waits in emergency care are grim,¹³ and people are finding it harder to make general practice appointments.¹⁴ The result is avoidable harm¹⁵ and fraying of the social contract underpinning the NHS. Boosting staff numbers will help reduce pressure. Labour promises to expand medical school places and think longer term about future workforce needs. But getting the basics right also means giving staff the modern buildings, equipment, and technology needed to work productively. The plan talks about reviewing NHS capital projects to eliminate waste and ensure efficiency. But a new government must invest: NHS capital spending has been below that in comparable countries for many years—and it shows.^{16 17}

Starmer has pledged to meet NHS waiting times targets within five years.¹⁸ This seems unlikely. Labour’s successful “war on waiting” in the 2000s was backed by substantial increases in funding and staff—and, even then, was made up of several battles over a decade.^{19 20}

Labour’s plan to strengthen primary and community care and join up services outside hospitals is nothing new. The same aims can be found in NHS policy documents dating back decades.²¹ A focus on new technology could help GPs and other staff work in new ways,²² but Starmer’s emphasis on the business model for GPs—he wants to “make sure salaried GPs serve all communities”—risks being a distraction.²³ And ambitions to shift care outside hospitals will not happen unless politicians grip the crisis in social care and reform the broken system. Social care is on its knees: many people go without the care they need²⁴ and rates of poverty and deprivation among care workers are high.²⁵ Yet Starmer made only passing reference to social care in his speech, and the plan provides little more.

The elephant in the room is money. Labour’s narrative is that reform will need to do “the heavy lifting” to improve the NHS²⁶—and Starmer dodged questions from journalists about how Labour would fund the plans.²⁷ Public services are creaking after a decade of austerity,²⁸ and the covid-19 pandemic will cast a long shadow. Health spending is set to increase by just 0.1% a year in real terms over the next two years—well below the decade before the pandemic (2%) and the long term average in England (3.9%).²⁹ Contrast this with spending growth of 6.7% under Blair and Brown in the 2000s. No amount of reform will avoid the need for substantial investment for Starmer’s Labour to make real progress.