The Guardian view on Labour and the NHS: there is no miracle cure for a struggling health system | Editorial

Speaking to MPs last week, Dr Penny Dash quoted the Guardian’s description of her as a reforming zealot. Dr Dash is less zealous than she used to be, she said, and better at listening. But the doctor and management consultant, who has just been appointed chair of NHS England, has lost none of her determination to make the health service better and more productive.

How this boost will be achieved is the multibillion-pound question. The upcoming 10-year plan is Wes Streeting’s chance to turn Labour’s manifesto pledges, and consistent poll lead on the NHS, into policies that could help his party win a second term.

But the conditions in which he must do this are hugely challenging. The UK has an ageing and increasingly ill population, and a health system which, while it performs reasonably well compared with other countries, has ingrained weaknesses. Some of these are to do with the workforce, with shortages in some areas and dissatisfaction with pay that makes further strikes likely.

Long-term underinvestment means technology and infrastructure are not what they should be. The lack of social care provision, and failure by successive governments to tackle this, adds significantly to pressure on GPs and hospitals. Since health is devolved, most of Mr Streeting’s decisions affect only England directly, though many of the problems are the same – notably long waiting lists and population health issues, including obesity.

In broad terms, Mr Streeting has already set out his reforms. These involve three shifts: from analogue to digital, from hospitals to community, and from treatment to prevention and public health. But conjuring up a vision of change is easier than delivering it, or persuading staff and the public to believe it can work.

Technology is the easy bit, although plenty of things could still go wrong. Mr Streeting’s recent announcement that the new GP contract will include more online booking, and the continued rollout of the NHS app, are modernisation measures that make obvious sense. Health tech businesses are eager partners, though campaigners are right to point to the risks of allowing them to access the NHS’s unique datasets.

Moving healthcare from hospitals to neighbourhood and community settings is an even trickier proposition. It is one thing to endorse this as a concept. But with hospitals under huge pressure from waiting lists, restive staff and a lack of investment, there is certain to be conflict over the extent to which spending is redirected away from the acute trusts that now absorb the majority of health budgets (59% of the total in England in 2022-23).

In an ideal world, new local services would be built up in parallel to existing ones. This is known as “double running”, but costs money that no one expects to be forthcoming. Hence the high hopes placed in efficiency savings, including recently announced cuts to NHS England itself.

Of course, clarity about who does what is desirable, and duplication of roles between civil servants should be avoided. Ambiguities about the remit of integrated care boards need to be ironed out. But how to allocate resources, and whether the NHS’s priorities are really going to be reoriented towards prevention, are political decisions that, in the end, will be taken by ministers. Change is far more likely to be incremental than sudden. The truest words Dr Dash spoke to MPs were when she said “this is hard”.

• Do you have an opinion on the issues raised in this article? If you would like to submit a response of up to 300 words by email to be considered for publication in our letters section, please click here.