The first week of a frantic, long campaign is over. National service, a pension triple lock plus and Ed Davey taking a dive in Lake Windemere: there have certainly been plenty of people trying to make a splash in an effort to move the polls.
Except of course, for Sir Keir Starmer and Rachel Reeves. Despite the one-word campaign slogan: “Change”, Labour so far have been much keener on emphasising their stability and trustworthiness with the public finances than making new policy commitments. Not quite carrying a ‘Ming vase’, but not far away.
With the polls still consistently showing Rishi Sunak and his party heading towards a defeat – the main debate among pundits has seemingly been whether that could be 2005 bad, or Canadian Conservatives 1993 dreadful – it has been the Conservatives setting out the bolder policy positions. If all elections are between “change” and “stability”, this election could feel very strange: Labour’s “Change” campaign focused on stability, and the Conservative’s “Clear Plan” increasingly punctuated by new policy.
With that dynamic in mind, we should take notice of Labour’s health interventions. A pledge to meet the NHS’s target for 92% of patients to be treated within 18-weeks (the referral-to-treatment (RTT) standard) is notably ambitious. Despite being one of only two targets enshrined in legislation, the NHS has failed to hit the target since 2016. Current performance is closer to 50% than 90%. Labour will be judged in five years’ time, on the assumption that, on waiting lists “we did it before and we can do it again”.
Labour’s recovery plan relies on delivering an extra 40,000 appointments, scans and operations a week, as well as doubling the number of scanners, using private capacity and learning from existing “crack teams”. Taken at face value, the numbers work. As Rob Findlay highlights, 40,000 extra NHS activities a week is more than enough to drop the waiting list over three-five years from its current 7.8 million down to around 3 million – a level where the 18-week target should be being hit.
Whilst the numbers add up in theory, the question quickly becomes whether they are achievable. We see three broad risks:
- Money. Labour has ruled out increases to any of VAT, National Insurance and Income Tax. Combined with Rachel Reeves’s iron fiscal rules, the chances of an inflation busting increase for the NHS is slim. At the same time, the NHS seems to be in dire financial straits. ICS plans for 2024/25 are projected a £3bn deficit (compared to £700m this time last year). Labour is promising overtime pay for out of hours and weekend clinics to deliver extra activity, but where that money is going to come from, or what else is going to be displaced is unclear (and that’s without getting into settling the junior doctor’s industrial dispute…). Labour's argument is that it “did it before”, but that was at a time when the NHS was getting 7% real terms increases – the test is going to be whether it’s possible to repeat the feat in a much more constrained environment
- Distraction. A new government can choose to set the focus on electives, but it will be near impossible for extra money or capacity to solely go to non-urgent care with ambulances queuing outside A&Es, GP appointments as scarce as a balanced budget and cancer patients waiting many months for treatment. Labour has also previously made much of transforming the NHS – with greater focus promised on prevention, health inequalities and mental health. Where they fit in to a clear focus on electives is unclear. The NHS of the early 2000s, whilst good at clearing waiting lists, was notably poor at all of them
- Structures. Power flows very differently in the NHS that Labour is inheriting compared to the one it left in 2010. With NHS England separate to the Department of Health and Social Care, and money and decision-making increasingly devolved to Integrated Care Boards (and beyond to more local organisations in some places), the Secretary of State has never been further from the levers of NHS power. A formal reorganisation seems unlikely, so the key test for a new Secretary of State will be whether they can bridge the gap that has emerged between the NHS and Whitehall
What was meant to be an NHS day for Labour was overshadowed by ongoing rows over Dianne Abbott's future and other (de)selections. But, make no mistake, Labour's commitments will dominate much of the health debate for years to come, should Labour secure the majority the polls suggest is likely. Time will tell if they will live to regret setting such an absolute measure for their ability to recover NHS services.
by Kieran Lucia, Senior Director