The government's 10-year health plan is still months away, as is the multi-year spending review that will determine funding. However, Labour has set three themes for its NHS reforms: shifting from treatment to prevention, from hospital to community care, and from analogue to digital systems. These plans apply directly only in England, but their impact will be UK-wide due to the size of England's health system and its influence on devolved nations.
The NHS app, with 34 million users, is a key tool for boosting productivity by allowing patients to book appointments, order prescriptions, and check results online. This is expected to contribute to the 2% productivity gain promised with £22.6bn of new funding in October's budget. However, ministers must ensure that digital exclusion does not worsen health inequalities, and that analogue access is retained.
Restoring the 18-week hospital treatment target is a compromise between advocates of top-down targets and those prioritising primary care. The commitment to have 92% of patients waiting no longer than 18 weeks by the end of this parliament is ambitious given workforce shortages and industrial action. With waiting lists in England already topping 7.5 million cases, many experts doubt it is possible to slash waiting lists while simultaneously re-engineering the health system towards preventive care.
Health has fared relatively well in funding since Labour took over, but due to fiscal constraints and a weak economy, spending increases are unlikely to match the 5.5% average seen during Labour's last term. This limits rapid investment, such as paying staff overtime. However, public awareness of the crisis may buy time, as health secretary Wes Streeting has calculated by declaring the system 'broken'.
Integrated care is the structural plan, with 42 regional NHS bodies working with councils and the voluntary sector to improve local health. But two years in, there is variation in how integrated care boards interpret their responsibilities, including their role in tackling social determinants of health like bad housing. The risk is that ministers may not relinquish control, with the 18-week target and league tables potentially undermining local empowerment.
