Are Labour’s new NHS proposals a cure or yet another sticking plaster?

With waiting times at near-record levels and an ageing population living longer in poorer health, Keir Starmer has his work cut out to ensure patients are seen and dealt with in a timely manner, writes Sean O’Grady

With the health and social care secretary Wes Streeting having played the role of media warm-up act over the weekend, Keir Starmer has announced some radical moves to reduce NHS waiting times and generally improve the service – and thus fulfil Labour’s manifesto promise that “patients should expect to wait no longer than 18 weeks from referral for consultant-led treatment of non-urgent health conditions”. Sadly, waiting times remain at near-record levels, and the current winter crisis, driven by high levels of flu and other seasonal respiratory illnesses, has highlighted once again the scale of the task and public concern. It’s a complicated picture, success cannot be assumed, and the fate of the government crucially depends on fixing it…

How bad is it?

The most commonly quoted figures are for “elective care” – crucial but not accident or emergency treatment, including surgery, for a wide range of illnesses, from, say, cancer to correcting an ingrown toenail. This is also what is focused on in the “18 weeks” limit enshrined in the NHS constitution, and the Labour manifesto. The government recently added a new interim target: “65 per cent of patients will be treated within 18 weeks by the end of next year. Based on the size of the current waiting list, that would mean a fall of more than 450,000 people waiting more than 18 weeks for treatment.”

In this context, then:

The NHS England waiting list stands at 7.54 million cases, or 6.34 million individual patients waiting for treatment (some needing more than one). The leak revealed:

• About 3 million of these patients have been waiting over 18 weeks
• Some 234,900 of these patients have been waiting over a year
• A typical waiting time for treatment is 14.2 weeks – almost double the pre-Covid median wait of 7.6 weeks in October 2019
• There are no people waiting more than two years to be sorted out (it peaked at 24,424 in January 2022)

What about A&E?

Even more grim. Extended waits in emergency departments were, not so long ago, unheard of – by definition. A decade ago, only 150 poor wretches were recorded as languishing untreated in A&E for 12 hours or more; now “trolley waits” are more normalised – about 150,000 in the first months of 2024.

Cancer?

The various targets are largely missed, with waits for diagnostics (tests, endoscopy and colonoscopy, say) lengthening to the detriment of happier clinical outcomes. About 40 per cent endure a longer-than-two-month wait from GP urgent referral to first treatment.

Why has it happened?

A long story, most recently chronicled in the Darzi report. Factors include:

• underfunding in relation to demand and demographics, even when spending kept up with inflation
• Staff shortages, including in social care, exacerbated by Brexit
• Neglect of infrastructure
• Failings in social care, meaning “stranded” patients cannot be discharged to support at home or in a care environment, so beds are in shorter supply and ambulances are left standing rather than attending cases
• Delays in GP appointments, making some people prefer to present at clinics or hospitals
• Trends in diet and fitness going in the wrong direction
• The backlog from Covid, especially in mental health and long Covid

What’s being done?

Some new funding is being met by tax hikes and various changes are now being implemented. These include:

• Using the private sector (though it is small)
• Incentivising trusts with new capital spending to get lists down
• Discouraging unnecessary follow-up appointments
• Creating more community hubs for tests and minor procedures (eg, in ear, nose and throat)
• Allowing nurses and physician associates a larger role
• AI to speed up diagnostics
• Trying to raise productivity

What will the benefits be?

A happier, healthier nation is also a more prosperous one. At the start of 2024, 2.8 million people were economically inactive due to long-term sickness. That is an 800,000 increase on pre-pandemic levels and is obviously adding to pressures in the labour market, constricting economic growth and adding to inflation.

What are the chances of success?

New drugs, AI and more efficient funding should help things along but an ageing population, living longer in poorer health, will continue to be the abiding challenge. The NHS cannot be made to work properly without a functioning social care system – still years away. The shortage of 30,000 nurses will also hold things back.

What does the opposition say?

The Conservatives say ideas such as the capital incentives were theirs (true) and that things were slowly improving when they were in power (also correct – but the record is more mixed than that suggests). Governments of all three parties failed to give the nation a social care system, albeit because the voters never liked to make the tough choices implied at election time. The Tories can never “win” on the NHS, but Labour could lose on it – if it doesn’t make people feel better about its prospect soon. At that point, people might be attracted to the more radical solutions offered by Reform UK – an insurance system that could lead to even worse outcomes for those unable to gain access to such a programme, as in America.