‘To secure the NHS for the next 75 years, Labour must start listening to staff’

As we approach the next general election, many people are wondering how Keir Starmer would approach the problems in the NHS should he become our next Prime Minister. The situation is pressing, and the problems are urgent, because the NHS is currently in the worst state it has ever been. Waiting lists have reached 7.4 million patients in England alone, and we’ve just had the worst winter crisis on record. 

Starmer made a speech in Essex at the end of May, setting out his vision for the NHS. But while there were some positive, exciting ideas (particularly around how he hopes to revolutionise the use of technology within the NHS and increase the NHS workforce by training many thousands of new doctors and nurses), there were important areas that barely got a mention.

Labour must focus more on supporting the existing NHS workforce

We were missing 124,000 full-time NHS staff in England at the last count, and analysis from Sky News showed that 10,000 staff members were lost in 2022 alone, due to issues related to work-life balance. While Starmer talks eagerly of recruiting new members of staff, Labour isn’t placing enough focus on supporting the current workforce, who are holding the service together and have endured enormous stress through the pandemic and beyond. 

There’s the sense that “big numbers” are being focused on; the number of medical school places, for example, or the number of new community nurses Labour hopes to train. But while these goals are welcome, it takes a long time to train new staff. The existing staff, highly experienced professionals who we are so lucky to have, will be pivotal in executing the ambitious plans that Labour has for the NHS. Labour must alter their policy proposals to do much more to retain our valuable workforce and support them in their roles. 

Staff have had their pay squeezed significantly in real terms, and so improving the pay of NHS staff must be a top priority. But it’s not just about pay. Staff deserve other forms of support too, such as meaningful and accessible mental health support across the board. There are fantastic programmes such as the practitioner health programme. These are deserving of significant investment in the coming years.

Some policies don’t feel thought through – and tone has been an issue

Some of Labour’s proposals for the NHS don’t yet feel properly thought through. Wes Streeting said in an interview with the Times in January: “I’m minded to phase out the whole system of GP partners altogether and to look at salaried GPs working in modern practices alongside a range of other professionals.” In the absence of proper detail shared publicly, these statements raised concerns from a lot of doctors. There are concerns about a loss of continuity of patient care in local areas and a loss of autonomy for GP partners who take responsibility for their populations and routinely go above and beyond to keep patients safe.

This conversation falls into a broader concern about the tone of messaging that is being used by Streeting at present. In a Sunday Telegraph interview in December 2022, for example, the Shadow Health Secretary spoke of a “something-for-nothing culture in the NHS” and then, in an interview with the BBC’s Laura Kuenssberg later that month, he said the BMA has “driven me up the wall”. If Labour wants to be taken seriously by NHS staff – who keep the NHS going day in, day out – they will need to become more sensitive to the tone of their communications.

The public deserves more detail on Labour’s plans for the private sector

Finally, there are deep concerns from many about Labour’s plans to involve privatisation in the NHS. During his bid for the Labour leadership, Keir Starmer had pledged to remove outsourcing from the NHS. He has now gone back on this, and he and Streeting have both spoken publicly about their desire to involve the private sector in driving down waiting lists.

Being pragmatic, if they were committed to enacting the fastest reduction of waiting lists possible, involving the private sector would probably form a small piece of the plan. In the short term, its limited capacity could be utilised to bolster the NHS’s work. But so far, there have been no clear assurances from Starmer or Streeting about the bounds of their involvement of the private sector. 

There are now thousands of NHS services in England run by non-NHS providers, and an observational study published in The Lancet last year called attention to the potential harm caused by outsourcing NHS services to private providers. The Labour Party needs to be specific about how and when they will be involving privatisation in the NHS. The public deserves to know this detail.

Labour has work to do to show it is truly committed to the NHS

There are other glaring issues within the NHS that we haven’t seen Starmer discuss yet; for example the astronomical private finance initiative (PFI) debt shouldered by some NHS trusts, which should be paid off to level the playing field. There should be an urgent focus on investing in capital infrastructure, given the terrible state of many NHS buildings, which has led to hundreds of recent sewage leaks onto hospital wards, A&E departments and maternity units. And thinking more expansively, the NHS needs to be rebuilt for the future. There are important conversations to be had about building sustainability into the organisation, and equipping our public healthcare system to meet a population with changing demographics and an ageing population. All of this will cost a lot of money, and it’s a question of priorities. We need to know how committed Labour truly is to the NHS. 

If Labour wins the next election, the party has an opportunity to create exciting and transformative plans, to rebuild the NHS and equip the service to care for the public for the next 75 years. But if they want to do this, they need to start listening properly to NHS staff and the professional bodies, collaborating towards ambitious shared goals and communicating their plans more clearly to the public. Starmer and Streeting have a lot of work to do.