‘Five pledges that could save the NHS in Labour’s first 100 days in government’

Keir Starmer has told his shadow cabinet to have a manifesto ready for an expected spring election. But even with a May ’97-style landslide, Wes Streeting and Labour’s shadow health team have an unprecedented challenge ahead: how to dig the NHS out of 13 years of Tory underinvestment, following a pandemic that has led to some of the longest waiting lists in living memory.

Starmer has taken inspiration from New Labour in much of his campaigning, bringing in key figures from Blair’s communications team to aid his strategy. So what should we expect from a New Labour-style policy pledge card, and what changes need to take place to make the NHS a healthcare system fit for purpose once again?

I started my medical career shortly after the 2010 Tory takeover of the NHS. I have worked under ever-shrinking real-terms investment in the health service and though years of disaffected doctors’ strikes. I’ve seen the social care system crumble under the weight of an ageing population with complex long-term needs. But I can see five ways a Labour Health Secretary could bring the NHS back from the brink.

1. Start a bonfire of bureaucracy

Doctors’ surgeries use a system of payments called QOF (the Quality Outcomes Framework) that was designed to incentivise various health checks for all patients who require them. The clunky software we use means that GPs are increasingly rewarded for hours spent wading through spreadsheets, to ensure data already collected has been inputted in a format that can be understood by this software.

Streeting has sat in GP surgeries himself and described the “outdated IT systems” and “ridiculous amounts of red tape” he witnessed. I spend around four hours a week doing this sort of administration – an entire clinic’s worth of time that could be instantly reallocated to seeing patients.

2. Make social care great again

Who would be a social worker? They shoulder an emotionally exhausting job with often brutal hours. But our current system of social services relies upon a workforce that is dwindling in numbers as demand for it grows ever larger.

Labour could forgive the student debt of those graduates working in social care and offer grants to prospective frontline social workers to make it a viable profession for a new generation.

The longer-term goal of bringing together the NHS and social work into a National Health and Social Care Service has been hinted at by Labour; a Fabian Society report requested by Streeting has set out a roadmap for just such a nationalised service.

3. Apply some golden handcuffs

Streeting has already strongly hinted that this will be in the next manifesto – a forgiveness of doctors’ student loans tied to a commitment to working for the NHS.

It is the type of work eligible for such debt forgiveness that is crucial – the NHS is burdened by a large workforce of locums, who have little incentive to commit to long-term salaried jobs. Anything that gets doctors away from zero-hours contracts and casual work and back to regular patient contact with a continuity of care will significantly reduce the health service’s spend on its workforce.

4. Make it easier for international medical graduates to work here

International medical graduates want to work in the UK, and the country is desperate for doctors. Yet Home Secretary James Cleverly’s announcement of rising salary thresholds for people wanting to come to work in the UK does nothing to welcome them. Even with the subsequent U-turn on a £38,000 minimum salary threshold, doctors on work visas still have to pay hundreds of pounds to apply and reapply for the right to continue to practice medicine.

Pointless form-filling is a regular burden whenever they move jobs – which is often, given the way medical training often relocates junior doctors around the country. My early career involved five different hospitals in three different counties. As a GP trainer of doctors from outside the UK, I am appalled by the hoops they have to jump through compared to their British and Northern Irish colleagues.

A visa waiver scheme would incentivise physicians from all over the world to work for us – a new Windrush generation of badly-needed doctors.

5. Early investment to set young people up for life

Early-years care, health visitor contacts and the impact of the social determinants of health resonate across a child’s lifetime. Get this right, and you avoid excess GP visits, A&E trips and social care involvement. Early investment sets a young person up for life – so we should give baby boxes to all new parents, as is already practised in Scotland.

We could extend the contacts made by health visitors, prolonging the support inexperienced parents receive in the fragile early months of their new baby’s life. We should replenish the funding for Sure Start centres, closed in their hundreds by the Tories despite having saved the NHS millions.

Various revenue streams could be available to Labour

Like all Labour policies of the recent past, this would need costing. The shadow health team has repeatedly vaunted the closure of the non-dom tax loophole as a revenue stream for rejuvenating the NHS, allocating this to an increased number of GP appointments and the clearing of the waiting list backlog.

More still could be raised via Scottish-style 45% tax rates for those earning more than £75,000 or a new Health and Social Care Bond, akin to the Green Savings Bond already issued by the treasury via National Savings & Investments. Labour’s commitment to claw back the billions lost through PPE procurement corruption during the pandemic would also be well spent on getting the NHS back on its feet.

“Reform is not a Conservative word,” Streeting says, and the Tories’ neglect of badly-needed NHS reform over the past 13 years is clear to see. With a plethora of policies available to reinvigorate our health service, and an election on the horizon, a new dawn could break in May 2024.