Good morning. Wes Streeting’s first statement as health secretary was a startling one. Just a day after Labour’s historic election triumph, he declared that “the NHS is broken”. Now, almost exactly a year later, he returns with a 10-year plan to fix it, in what’s been billed as the most ambitious health reform agenda in a generation.
It’s hard to overstate the significance of this moment. Reforming the NHS was central to Labour’s election manifesto, and last year prime minister Keir Starmer made the consequences clear: “Reform or die,” he warned, and with it, staked the next election on his government’s ability to deliver meaningful change.
NHS leaders, unions, thinktanks, patient groups and other key stakeholders may not agree on every detail, but they are united on one thing: the NHS is in crisis and change is urgently needed.
But what exactly is in this plan and will it make a difference? To find out, I spoke to health policy editor Denis Campbell, who has been covering the NHS for two decades. That’s after the headlines.
Five big stories
UK politics | Downing Street has said Rachel Reeves will keep her post and has not offered her resignation, after the chancellor was seen in tears at prime minister’s questions.
US news | The federal sex-trafficking and racketeering conspiracy trial of Sean “Diddy” Combs reached its conclusion on Wednesday, with the jury finding the music mogul guilty on two charges The government has said that it will seek the maximum 20-year sentence.
UK news | Detectives investigating the former nurse Lucy Letby have passed evidence to prosecutors alleging she murdered and harmed more babies, the Crown Prosecution Service (CPS) confirmed on Wednesday.
US military | Iran’s nuclear program was set back roughly one to two years as a result of the US strikes on three key facilities last month, according to an assessment by the Pentagon.
Covid inquiry | Discharging untested patients from hospitals to care homes during the Covid crisis was the “least worst decision”, the former health secretary Matt Hancock has told a public inquiry.
In depth: ‘The NHS is no longer able to give people the care they need, when they need it’
At its most basic, the 10-year plan is the Labour government’s detailed 150-page blueprint to get the NHS back on its feet after nearly 15 years of serious neglect, Denis Campbell told me. “It aims to address the fact that the NHS is sadly no longer able to perform its most essential function, which is to give people who need care the care they need, when they need it.”
Waiting times are too long for many of the NHS’s most vital services, including GP appointments, ambulances, mental health support and surgery.
“The 10-year plan is meant to get the NHS back on its feet in a way that we as patients, voters and taxpayers will appreciate and notice, but crucially, to also modernise the health service, to make it work better and more efficiently to help deal with the fact that we live in a tech-driven age, with an ageing population and the fact that people expect health care to be much more convenient in the way that so many things in life are now,” Denis added.
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How will it do this?
The 10-year plan proposes to do this with three big “shifts”:
• From hospital-based to community-based care: Services are moved out of hospitals and into community settings like GP surgeries, clinics and the promised new neighbourhood health centres.
• From analogue to digital: Rely more on digital tools like AI to spot problems early, speed up diagnoses and improve efficiency.
• From treating illness to preventing it: Focus more on keeping people healthy – by tackling smoking, obesity and misuse of alcohol – instead of just treating illness when it occurs.
But, Denis told me, there are many practical questions, particularly on the first shift: “What will these new centres actually look like? Will they be new places or expansions of existing GP practices? Who will staff them? Is there any money behind this bold vision to make it a reality?”
On staffing, the NHS workforce continues to grow in England. “There are 1.5 million people, but the NHS in England has for many years had roughly about 100,000 vacancies at any one time. So we know the NHS in England does not have the staff it needs already.
“The government is unveiling an ambitious and potentially voter-friendly plan to make the NHS more accessible, responsive, convenient and patient-friendly, with lots of consumer friendly positive language like this,” Denis said. “But we do have to ask the hard question: if there isn’t enough people hired to do what the NHS already does, where will the extra people come from to provide these extra services?”
Denis added that while there has been some progress that the 10-year plan can build on, there’s still a crisis to accessing care. “Too many people wait too long. So there’s clearly a big job to be done here to make the NHS as accessible as the government is saying,” he said.
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What has the reception been so far?
Denis was being inundated with responses from thinktanks, unions, patient groups, and other stakeholders when I spoke to him. “Many are welcoming the boldness of the government’s vision, but they’re questioning the practicality of delivering all of this and the timescale, what will it take to do this?”
For many of these stakeholders, much of the plan is appealing, Denis added – who wouldn’t want a local neighbourhood health centre where you can get an X-ray or scans, mental health support, pharmacist services and GP appointments? But there is scepticism.
Denis groups the criticism into three main concerns: it will take a long time, there’s no extra money for new buildings or services and there’s not enough bold action on public health.
“This is billed as a 10-year health plan, not just the 10-year NHS plan. The government says it will improve the nation’s health. But several thinktanks like the King’s Fund are saying it doesn’t include enough bold action to tackle the drivers of ill health and the fact we’ve got an increasingly sick population, particularly through diet and obesity and misuse of alcohol,” Campbell said.
He added that the criticism is that there’s no equivalent in this plan to past transformative policies like the sugar tax or indoor smoking ban. “The NHS at the moment is not able to outrun a growing tidal wave of preventable illness that has been lapping at its shores for some years now. We have an ageing population and an increasingly sick population, will this plan make it any more able to cope with this growing burden of illness? At the moment, unfortunately the answer to that question is, ‘No’.”
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Is this the last chance to save the NHS?
The prime minister’s positing that this is “reform or die” certainly makes it seem that way, but Campbell suggested that it’s a bit hyperbolic.
“The NHS is so deeply embedded in British life that no one is going to replace it with something else. But there is enormous pressure on this government to deliver. Keir Starmer promised transformative change into something people would notice and value,” he said.
“We’re a year into this government, and England doesn’t yet look much improved. So the pressure on this plan to deliver real, visible improvements quickly is intense. By framing it as ‘reform or die’ the prime minister is setting a very high bar for success.”
What else we’ve been reading
Sport
Tennis | Emma Raducanu stormed past Marketa Vondrousova in her second-round Wimbledon match in two sets, 6-3, 6-3, lining her up to face the world No 1 Aryna Sabalenka. Katie Boulter was knocked out after losing in three sets to the world No 101 Solana Sierra. Cameron Norrie came back from a set down to stun 12th seed Frances Tiafoe.
Football | Switzerland were denied a fairytale start to their home Euros as Julia Stierli’s own goal ultimately settled a 2-1 victory for Norway. Finland secured their first victory of the tournament in 16 years with a narrow 1-0 win against 10-player Iceland, thanks to Katariina Kosola’s superb second-half strike.
Cricket | India closed day one of the second men’s test match with England at Edgbaston with 310 runs for 5 wickets, as Shubman Gill’s scored his second century of the series. Rishabh Pant was also a standout, swapping his usual scatterbrain batting for notable self-control, restricting himself to just one glorious four and a single crisp six in the 60 minutes he was at the crease.
The front pages
Rachel Reeves crying on the frontbench at prime minister’s questions after Labour’s stunning welfare climbdown is on a number of front pages today. The Guardian splashes on “Tears and turmoil as PM forced to defend Reeves after welfare fiasco,” the Telegraph has “Pound falls after Reeves’s tears,” the FT leads with “Gilts and pound slump after Reeves’ tears trigger fears for fiscal vigilance,” while the i Paper has “Reeves future in doubt after tearful PMQs.” The Metro goes with “Tears & jeers for Starmer,” the Daily Mail asks “What – or who – caused the tears that sparked turmoil in the markets?” while the Sun splashes on “I’m under so much pressure,” referring to what Reeves’ said before her tearful moment. The Mirror was the outlier, splashing on “Kate: My rollercoaster recovery” on the princess’s experience after cancer treatment.
Today in Focus
The truth about Iran’s nuclear programme
After 12 days of bombing by Israel and the US last month, opinions vary about the extent of the damage caused to Iran’s nuclear facilities. The Guardian’s diplomatic editor, Patrick Wintour, and Rouzbeh Parsi, a historian who studies Iran’s nuclear programme, tell Michael Safi what could happen next.
Cartoon of the day | Ben Jennings
The Upside
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