Does Keir Starmer want to use Lord Darzi’s report on the NHS today merely as the latest ‘shocking’ piece of evidence of Tory mess, or will it actually lead to meaningful reform?
The Prime Minister suggested he wanted to do both in his speech this morning. Yes, he ran through how things were much worse than anyone, even Darzi, a renowned surgeon who has worked in the NHS for decades, imagined. But he also included several phrases designed to show that he is serious about changing the health service – and about the battles he will have to fight to get there.
He told the audience at the King’s Fund that ‘I haven’t come here just to set out this appalling inheritance, though it is really important that we know it and properly understand it in detail. But my Labour government was elected on a mandate for change, so I’m also here to talk about how together we can fix it. I feel very profoundly the responsibility for this, and indeed the opportunity of this moment.’
The most striking – for a Labour prime minister – thing he said was the ‘no new money without reform’ line. He argued: ‘We have to fix the plumbing before turning on the taps. So hear me when I say this – no more money without reform. I’m not prepared to see even more of your money spent on agency staff who cost £5,000 a shift, on appointment letters which arrive after the appointment, or on paying for people to be stuck in hospital just because they can’t get the care they need in the community.’
Those reforms would be in three big shifts: moving from an analogue to a digital NHS, shifting more care from hospitals to communities, and moving from sickness to prevention. None of these moves are surprising: Labour has been rolling the pitch on this for years now. Starmer himself acknowledged that ‘successive governments have repeatedly promised’ the shift from hospitals to community care, but ‘what’s happened is the opposite’.
He didn’t offer much analysis on why, but the reason is not that politicians before haven’t been all that bothered, it’s that it is extremely hard to shift resources from acute to primary and community care. The NHS tends to run on an important and urgent basis, as opposed to fixing important but not yet urgent problems earlier. Funding tends to follow the crisis, rather than have a strategic direction. The key word that the Prime Minister used is ‘shift’, because Starmer is not promising to give primary and community a big upfront boost while still maintaining acute funding at the same level until the change lessens acute demand. That means that acute will be stretched initially, and this is politically very difficult.
Starmer didn’t mention capital funding in his speech, on which Darzi’s report is very clear. He was asked about it in the question and answer session after, and replied: ‘I was struck by what Lord Darzi said about capital funding, which I think was really profound, and obviously that has to be part of the ten year plan in terms of the investment in the NHS.’ Given hospitals are significantly less productive as a result of crumbling buildings and outdated equipment, it will be very difficult to pursue reform without more money in this area.
Hear Isabel’s analysis on our Coffee House Shots podcast:
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