No more consultations – it’s time to operate on the sickly NHS

Sir Keir Starmer and Wes Streeting, his health secretary, will today launch a “national conversation” about the government’s 10-year plan for the NHS, due next spring. At first glance, it looks like another consultation exercise, a device often used by politicians to delay action.

However, in a round of Sunday broadcast interviews, Mr Streeting explained that the government wants to “engage” with the public, NHS staff and experts, who will be asked to submit ideas via a website. He noted, correctly, that he could not impose change from his desk in Whitehall, and needed a partnership with NHS workers to make his reforms work.

The health secretary, undoubtedly one of the government’s best communicators, repeated his “no money without reform” mantra, hinting that health trusts which do not embrace changes such as carrying out operations at weekends will lose out financially.

The “change” message is vital because Rachel Reeves will boost NHS spending in a rare piece of good news in what will inevitably be a painful Budget in 10 days’ time.

The chancellor needs “reform” to accompany her extra money for the NHS; while the public might still love the NHS, they know from their own experience it is in a sickly condition. Although its budget has more than quadrupled since 1980, productivity has fallen.

As Ara Darzi noted in his review last month, hospital staff numbers rose by 17 per cent between 2019 and 2023, yet there are 7 per cent fewer daily outpatient appointments than 15 years ago, along with 12 per cent less surgical activity by each surgeon and 18 per cent less activity for each clinician in emergency medicine. Lord Darzi blamed a lack of money for buildings and equipment and a social care crisis which means 13 per cent of NHS beds are occupied by people who do not need to be there.

The fall in productivity is not sustainable. Like Sir Keir, Mr Streeting vowed no more “sticking-plaster solutions” – but that is what the new money will prove unless their reforms are more than just another headline. Ominously, some NHS leaders are already warning the expected Budget cash boost will not allow them to cut waiting lists for another 18 months.

When challenged to spell out his reform agenda, Mr Streeting referred to three shifts: from treatment in hospitals to the community, in a “neighbourhood health service”, including new neighbourhood health centres; from analogue to digital with a long-overdue single patient record; and from sickness to prevention – for example, with smartwatches given to patients with diabetes or high blood pressure.

This all makes sense, and some of these ideas are hardly new. But it is time to move on from generalities to more specifics.

Mr Streeting insists the government has “hit the ground running”, and it is true the marathon pay dispute with the junior doctors was an obstacle that had to be removed. But Labour has not yet told us how the “fully funded, fully costed” health commitments in its manifesto will be implemented – including a promise of 40,000 extra appointments a week, and 700,000 more urgent dental appointments, which will take time as it will hinge on negotiating a new contract with dentists. To be fair, it is early days and we should know more details at the time of the Budget.

To repair our crumbling hospitals, there is talk of a new private finance initiative so not all projects would be funded by government borrowing. However, ministers should proceed with care and learn from past mistakes; the government abandoned the previous private finance initiative in 2018 because hospitals, schools and local authorities faced crippling debt repayments.

The health secretary was less convincing when he claimed he is also “hitting the ground running” on social care. Higher pay for care workers is in the pipeline, a welcome development, but the new government’s main decision so far was to scrap the Conservatives’ plan for a £86,000 cap on an individual’s care bills.

Mr Streeting welcomed the willingness of the Tories, Liberal Democrats and Reform UK to join talks on reaching a cross-party consensus on social care reform. But he is still “thinking about the best mechanism” for such discussions.

He should avoid a time-consuming royal commission and fast-track the process. Although he promised a 10-year plan for social care alongside the NHS blueprint, the suspicion is that Labour is dragging its feet in the hope more money becomes available for the care sector later in the five-year parliament.

However, there is no time to waste. The government’s laudable attempt to rescue the NHS will fail unless social care reform is part of the solution.