Sir Keir Starmer has outlined his 10-year plan to reform the NHS, warning that it must “reform or die.” In a key speech on Thursday, the prime minister emphasized the need to address long waiting lists, improve public health, and shift focus towards community services. His remarks followed the release of a critical report by Lord Darzi, which highlighted that the NHS is in serious trouble.
The nine-week rapid review identified issues in the NHS in England and recommended themes for the government to incorporate into a decade-long reform plan. Starmer accepted the challenge to fix the NHS but cautioned that the process would take years, not months, as he identified four urgent areas in need of reform.
No money without reform in NHS
While the NHS needs full funding, Starmer stressed it is not up to working people to bear the financial burden alone. He clarified that the NHS must undergo reform to ensure improvement. He suggested that the service is at a critical juncture, with a choice between raising taxes on the working class to cover rising costs or reforming to secure its future. Starmer insisted that working people cannot afford higher taxes, making reform the only viable option.
He also made it clear that reform is not solely about increasing funding. Though a Labour government would continue investing in the NHS, he argued that structural issues must be fixed first. He expressed frustration at money being spent on costly agency staff, delayed appointment letters, and patients staying in hospitals longer due to a lack of community care.
NHS to become more localized
Starmer emphasized the need for the NHS to become more localized, calling it the “Neighbourhood Health Service.” This would involve bringing back family doctors and easing the pressure on hospitals by expanding healthcare in communities. His vision included more tests and scans available in town centres, improved access to GPs, virtual consultations, and care in patients’ homes.
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Digitizing the NHS
One of the key reforms Starmer proposed was moving the NHS from an analogue to a digital system. Referring to the NHS app, he said that technology must be used to empower patients and give them more control over their healthcare. He described the app as a potential “digital front door” to the NHS, facilitating appointments, self-referrals, and better transparency through digital patient records.
When asked whether the public would face a decade of long A&E waits due to the lengthy reform process, Starmer pointed out that this demonstrated the need for more technology. He highlighted that delays are often due to waiting for test results, and better technology use would help address the issue.
Overcoming historic problems
Starmer attributed the NHS’s current struggles to the previous Conservative government. He argued that the pandemic alone could not be blamed for delays or cancellations of operations, noting that the NHS was already in a fragile state due to the Tories’ handling of the health service. He cited fewer doctors, nurses, and beds compared to other high-income health systems as evidence of this fragility.
Starmer attributed these problems to the 2012 “top-down reorganization” led by former health secretary Andrew Lansley, calling it “hopelessly misconceived.” He referenced the Darzi report, which labeled Lansley’s reforms a “calamity.”
Official data shows that public funding for healthcare in England reached £181.7bn in 2022/23 under the Conservative government, with the majority spent on staff salaries, medicines, and daily expenses, and the remainder on new infrastructure and equipment.
Darzi report
Lord Darzi, a highly regarded surgeon and former health minister, asserts in his report that the NHS can be improved. He maintains that nothing he has found undermines the principles of a taxpayer-funded health service, free at the point of use, and based on need rather than the ability to pay.
According to Lord Darzi, the country cannot afford to lose the NHS, making it crucial to reverse the current situation. He adds that while the NHS is in critical condition, its vital signs remain strong. He also criticises political decisions made by the Conservatives and the coalition government, particularly the effects of austerity and the 2012 NHS reorganisation under Andrew Lansley.
In his report, Lord Darzi describes the Health and Social Care Act of 2012 as an unprecedented calamity, calling it disastrous. The Act, which faced widespread criticism, was the largest NHS reorganisation to date and aimed to change the way the NHS commissioned services. It eliminated primary care trusts and established over 200 separate clinical commissioning groups.
Lord Darzi further states that in the past 15 years, the NHS faced three significant challenges: austerity and underinvestment, confusion from top-down reorganisation, and the pandemic, which struck when resilience was at an all-time low.
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