As Sir Keir Starmer unveiled his government’s 10-year plan for the NHS to a room of journalists and health staff, the prime minister set out a hopeful vision for the future of the service.
The NHS is going to be one of Labour’s biggest gambles and, as the second largest area of government spend, one of its most expensive bets.
The prime minister, hot off a tumultuous 24 hours over his government's welfare bill, appeared confident this new plan to save the NHS would work and achieve the improvement last seen by his Labour predecessors in the 2000s.
But experts were clear that there is little new in it - in terms of ideas - and warned it lacks much of the necessary detail to make any real judgement over its success.
The respected Institute of Economic Affairs accurately described the plan as “mostly a reaffirmation of long-running policy goals…things that their predecessors and their predecessors' predecessors would also have said.”
Sarah Woolnough, chief executive for think tanks the King’s Fund, told The Independent: “I think the plan lacks some of the detail around the house, and for people to believe in it, I think there's a huge consensus. This is the right direction of travel...We urgently need more details on how and why it will be different this time?”
Jacob Lant, chief executive for charity National Voices, pointed out that it isn’t necessarily a bad thing that the plan rehashes past policies - if they are good ones.
He pointed out that the focus on the patient’s voice is a step change to what has come before: “Some new proposals on deciding hospitals’ funding levels based on patients’ experience, good and bad, are rooted in the right idea.” But he too pointed out the plan does not spell out what outcomes will be measured.
What will and won’t work?
The neighbourhood health centres proposed in the plan – there will be around 200 across the country – will require a number of components to work, including the investment and staffing to flow to them. The problem is that when winter or a crisis hits, the NHS has always struggled to divert these resources.
Much of what the 10-year plan banks on in its bid to save the NHS is rooted in the use of technology, most prominently AI and an all-singing, all-dancing NHS app.
Several promises on the NHS App include that by 2028, it will be a “full front door to the entire NHS” and act as a “doctor in my pocket” for patients.
The app should also give people access to a single patient record, choose a preferred provider to have their treatment, manage medicines and manage appointments for children.
The expanded use of AI features prominently, including “Ambient AI” which can record patients and health professional appointments and put notes directly into care records. This is sold as a way to unburden clinicians.
On tech, Ms Woolnagh said: “They are clearly really going for it on tech and I do welcome that because the NHS app is getting better, but a pretty slow pace and it has to be the way one of the major ways that we drive for form you just think about how the NHS compared to every other sort of service we use in our life It's quite frankly embarrassing that is still paper but whether it stacks up I think the jury is out.”
One issue in the expansion of health tech is health leaders being “bombarded” by medical tech companies trying to sell them new devices – how do we know which are quality tools and which aren’t?
The single patient record is an issue that successful government policies have grappled with, one barrier being that those who hold the data have been reluctant to let it go. However, if the government were successfully able to fulfil this, it would be very important to patients and could drastically improve their experience.
What is it missing?
The plan has some very big omissions, the key ones being workforce numbers, costing, and, as usual, social care. The document appears to be thin on ambitions around mental health services – the two main points are mental health A&Es and the further rollout of mental health teams in schools.
The main nod to the workforce, outside of 1,400 GPs, is an admission that there will be fewer staff than projected in the long term, as the workforce plan published in 2023 under the former government.
The King’s Fund chief pointed out the omission of the number of staff needed to deliver the plan was, in one sense, welcome honesty from the government over the lack of money to pay for the workforce.
However, she warned, “Too often the workforce follows the main plan, but who is going to deliver this plan?” she said.
Without workforce details, the plan requires the government’s “bets to come off”, such as those around technology freeing up staff time.
Experts speaking with The Independent also said it is short on detail about prevention ambitions, which touch on tabacco, junk food and a “moonshot” on weight-loss.
Ms Woolnagh said: “I think that the measures they have talked about are welcome and I think, for example, it's easy to dismiss because tobacco and vapes don't feel terribly new. It's easy not to give it the kind of due it should have, but it's a big step.“It's a big deal, so they are welcome. I think taken together, this doesn't represent the radical mission that we were promised, and if you think the headline ambition in the government's manifesto was half the gap in healthy life expectancy between the wealthiest and most deprived.”
Overall, much of the verdict on this plan rests on the additional detail needed, and so the jury is out on whether this will be Labour’s shining achievement and finally deliver reform for the NHS.NHS.
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