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By kicking off the first full week of 2025 with a speech in which he called the NHS the “cornerstone” of his government’s plan to rebuild Britain, Sir Keir Starmer was in one sense stating the obvious. The health service is recognised as one of his party’s all-time greatest achievements by social democrats the world over.
Everyone knows that improving it is vital if polling numbers are to tilt the government’s way. By offering warm thanks to health service staff who worked over Christmas, while emphasising customer service values of convenience and flexibility, Sir Keir sought to square the circle of reform that champions the interests of both the workforce and the public.
While the rhetoric was about Britain, the government’s health policies mostly affect England, since health is devolved. A new deal with the private sector, and an additional £2.5bn annual investment, will double the proportion of elective activity that it is funded to carry out. The promise of 17 new community diagnostic centres, open 12 hours a day, starts to put meat on the bones of a pledge to deliver more care outside hospitals.
Having got the disappointing deferral of social care reform out of the way in an announcement from the health secretary, Wes Streeting, last week, Sir Keir focused on health as a means of national renewal. Martha’s rule, which enables patients’ families to seek a second opinion in hospital – and was campaigned for by a senior Guardian editor, Merope Mills – was singled out as an example of positive change and a counterweight to what the prime minister called an “anthem of decline”.
A 10-year plan setting out Labour’s vision for the NHS is being prepared alongside a multi-year spending review that will determine the budget. Already, there are tensions between supporters of top-down targets as the most effective means of driving – and demonstrating – improvement and those who want priorities to be set locally. There is also a real risk of further strikes, following a pay settlement with junior doctors last year that left other staff groups frustrated at their own less generous deals. Though funding has increased, there is no prospect of the sustained rises, averaging 5.5% a year, that boosted the nation’s health under New Labour.
Mr Starmer is right to strike an optimistic note. Increased human longevity should be seen as a miracle as well as a challenge; the UK’s socialised health system, and the public’s strong support for it, prove that market values are not the only ones that count.
But wishful thinking about innovation must be avoided at all costs. Digital technology brings with it risks of exclusion – as well as instant connection. People, as well as machines, can make change with the right support and resources. Over-reliance on the private sector can lead to erosion of public care. The current lack of dentists in some areas is a cautionary tale and opthalmology (eye care) must not be allowed to go the same way, with private providers enabled to take over and shape a service to suit their interests.
Ministers, including Mr Streeting, insist that pragmatism lies behind their decision to invest in private as well as public providers. But taking advantage of existing capacity to drive waiting lists down should not become a step towards privatisation. There are reasons to be anxious as well as hopeful about the government’s direction.
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