Briefings » NHS priorities for the new Government

NHS priorities for the new Government

After six weeks of intense campaigning, a new Government is in place and attention now turns to implementing the Labour party’s key policies for the first term.

The timing of Wes Streeting’s first speech as Secretary of State on 5th July, the NHS’s 76th birthday, was serendipitous but he made it very clear: the new Government’s view – and ‘From today, the policy of the Department of Health and Social Care’ – is that ‘the NHS is broken’. With medical metaphor, he said that ‘in order to cure an illness, you must first diagnose it’. Will we see the right treatment proffered for the NHS? What balance is needed between therapeutic intervention from politicians versus providing the trust, support and environment needed for effective ‘self-care’ for our health service from those working in the NHS? Despite the diagnosis made, one thing is clear: there will be no significant increase in funding. As a result, many of the perennial problems facing the health service are unlikely to be addressed immediately.

The new Government has made clear it has received a mandate to reform the NHS, but it will no doubt take time for detailed policy proposals to take shape, fleshing out the ideas contained within the election manifesto. Funding restrictions aside, there are some key policy areas which could, and perhaps should, characterise the new Government’s approach to the NHS:

1. A revised approach to capital

Capital investment accounts for a very small proportion of the overall NHS budget but is fundamental to ensuring the service has the most effective and efficient buildings and equipment. Increasingly in recent years, capital funds have been used to help support the day-to-day running of NHS services, leaving less available to spend on critical infrastructure. Using non-recurrent funding as an emergency backstop to prop up cash-strapped services is part of the reason why NHS buildings have fallen into disrepair, with a significant backlog of essential maintenance.

The cost of the maintenance backlog for buildings and equipment totals more than £12 billion. The state of the NHS estate and how to modernise it has long been a topic of discussion and debate. It is estimated that almost a fifth of GP practices and buildings for patients with mental health needs were constructed before 1948 and are classified as not suitable for modern care.

It has been recognised for some time that a new approach to capital investment is needed to provide a long-term solution and prevent ‘storing up’ problems for the future. Suggestions include increasing the amount of money allocated from the overall budget for capital in the NHS, allocating funding over several years rather than just one year, and better prioritisation of how and where capital funding is spent.

While the Labour manifesto does not directly address this issue, the NHS Confederation – among others – has argued that a different approach to capital funding is key to improving NHS productivity.

2. The New Hospital Programme

Against this backdrop of an ageing NHS estate portfolio and growing maintenance backlog, the New Hospital Programme was launched in 2020 with the ambition of building 40 new hospitals across England by 2030. In 2023, five hospitals that have reinforced autoclaved aerated concrete (RAAC) were added to the list, and the timeline to deliver some of the hospitals has been pushed back, with only 32 of the 40 being set for completion by 2030. The total cost of delivering the programme was initially estimated by the Department of Health and Social Care to be between nearly £20 billion and £30 billion.

In July 2023, the National Audit Office published a report on progress with the New Hospital Programme and concluded that the previous Government had not achieved good value for money with the programme up to that point. All of this, unsurprisingly, led to speculation about the future of the New Hospital Programme under a new Government.

On paper, the future of the programme looks safe as the Labour party’s manifesto includes a commitment to delivering it. However, recent commentary has questioned whether the standardised design for new hospitals (known as ‘Hospital 2.0’) is fit for purpose and will deliver the desired benefits.

There is also uncertainty over the supply chain and availability of materials, as well as concerns over the timescales for delivery, particularly for those trusts which need to acquire new sites to build on, and the associated planning timescales. Public consultation and NHS England assurance processes may also need to be factored into timelines, especially as the focus on improved outcomes rather than just new buildings, makes service reconfiguration more likely.

It is welcome that the new Government is committed to delivering the landmark hospital building programme, but it remains to be seen whether the committed funding will be delivered, and the anticipated timescales can be met.

3. A stronger focus on community and primary care

The pressure on acute hospitals has been all too apparent in recent years, with apocalyptic media headlines about urgent and emergency care, ambulance and mental health services, and planned care waiting lists under long-sustained and unrelenting pressure.

Putting aside the thorny issue of a long-term solution on social care, part of the answer has long been recognised as delivering more care closer to people’s homes and refocusing priority (and funding) away from the acute hospital sector and into the community. The 2019 NHS Long Term Plan included a strong vision for improving out of hospital care. The challenge since then has been how to turn this vision into a reality.

In their election manifesto, Labour promise a move to a ‘neighbourhood health service’ with more care delivered in local communities, shifting resources to primary care and community services over time. Most recently Wes Streeting gave his backing ‘one hundred per cent’ to a greater proportion of NHS funding being spent on out-of-hospital care.

Labour also commit to ‘trialling’ neighbourhood health centres, thereby bringing a range of community and mental health services together under one roof. This echoes the vision for integrated neighbourhood teams set out in the Fuller stocktake. Continuing to deliver this shift in NHS structures, funding flows and culture will not happen overnight and will be challenging without additional funding in the short term. However, with that said, over the course of a Parliament there are some key steps that could be taken. These include shifting the NHS to a longer-term funding cycle, which would allow integrated care systems to plan more effectively, and reducing the number of national performance targets that are focused on the acute sector.

In primary care, Labour commits to training more GPs, reforming the GP booking system to remove the ‘8am scramble’ and ensuring consistent access to the same GP. However, there is a lack of detail about the long-term future of primary care. Arguably, the primary care model is in need of significant reform, but this is unlikely to be achievable without serious investment and reform of the GP contract, perhaps explaining its absence from manifestos.

4. Empowering the public to take control of their own health

‘Prevention is better than cure’ is an old adage that remains relevant. Prevention is a key pillar of the NHS Long Term Plan and more recently the Hewitt Review recommended that an increased share of ICS budgets is dedicated to prevention in order to deliver a shift away from illness and towards health promotion.

Within their manifesto, measures on smoking and junk food are the main thrust of Labour’s plans on prevention. There is an argument to say that this could be strengthened by giving the public greater control over their own health. Artificial intelligence, improved digital access (including wider usage of the NHS App), and embracing the power of genomics are all tools that could be harnessed to help people prevent ill health in the future.

The impact of a preventative approach to health can take many years to bear fruit, which, cynically, means funding and focus is often put elsewhere by politicians to deliver visible results within a political cycle. But with little extra money available and against the backdrop of a country that risks becoming disillusioned with its national health service, perhaps now is the time for political bravery and greater focus to be placed on empowering the NHS to serve its communities in the best possible way. Investing time and effort in prevention would not only benefit individuals’ health outcomes but in the longer term would reduce health inequalities and lower the financial burden on the NHS.

A mandate for change, and a desire for early results

The scale of Labour’s victory presents a clear mandate for change, and in his first comments as Prime Minister, Sir Keir Starmer acknowledged that this will take time. When it comes to the NHS both the public, and those who work in the service, will want to see rapid progress. Health Secretary Wes Streeting’s desire for greater efficiency and improved performance in the NHS may find these measures are applied equally to his own delivery.