Starmer’s inbox: Prescription for change - what's Labour's cure for the public health crisis?

5 Jun 2024

Jon McLeod and Gina Watson take a look at the growing challenges facing the UK’s attempts to address its public health emergency and the difficult decisions that an incoming Labour government may need to make.

The UK is facing a significant public health crisis. NHS waiting lists continue to soar with patients forced to endure increasing delays to receiving treatment and critical diagnoses. Chronic diseases, such as diabetes and heart disease, are becoming ever more prevalent, putting an added strain on a healthcare system which is already being pushed to its limits.

These challenges are not just health issues, they also represent significant economic and social burdens. Delays in treatment lead to worsened health outcomes, increased healthcare costs, and lost productivity. Future Health estimates that 25 million people in England have at least one long-term health condition, with 13.4 million now having two or more. The cost of these conditions is significant and widespread. Recent figures from the Health Foundation estimate that the number of people out of the labour market as a result of a long-term health condition has surpassed 2.6 million, while people with these conditions account for half of all GP appointments, three quarters of occupied hospital beds, and are estimated to cost the health and care sectors £115.2 billion annually.

Meanwhile, public dissatisfaction is growing, with widespread frustration over access to GPs, dental care, and mental health services. It is undeniable that the state of public health will be a critical issue for any incoming government and, should Keir Starmer end up in Downing Street on 5th July, he will be presented with a series of difficult decisions.

To address the current situation, Labour will be faced with two choices: increased intervention or increased spending. Choosing the former, the Party risks being seen as a ‘nanny state’, while the latter also seems unlikely under Rachel Reeves’ tight grip of the taxpayer’s purse strings.

Starmer will also need to balance the temptation to seek out ‘quick wins’ versus laying the groundwork for more comprehensive reform and long-term change. While short-term solutions to the health crisis may be appealing to set the tone for the Labour administration and affirm public confidence, many of these issues require significant structural reform that will not yield rewards overnight. Any approach should consider recent calls from The Royal Society for Public Health, that any future government should place “an unwavering focus on prevention” to tackle the crisis, demanding a more long-term view.

To address the current situation, Labour will be faced with two choices: increased intervention or increased spending. Choosing the former, the Party risks being seen as a ‘nanny state’, while the latter also seems unlikely under Rachel Reeves’ tight grip of the taxpayer’s purse strings.

Part of this balancing act is already evident in the Party’s recent policy announcements. Notably, Shadow Health Secretary, Wes Streeting, has expressed Labour’s plans to prioritise NHS ‘reform’ rather than simply ‘pouring’ money into it, insisting that any spending will be done on a strictly strategic basis. Despite this, at the forefront of Labour’s latest round of policy announcements is the Party’s commitment to delivering two million additional NHS appointments each year, which it claims will be funded by ‘cracking down’ on tax avoidance. While initially sounding ambitious, with the NHS now delivering 1.4 million appointments each day, a 0.5% increase seems unlikely to make any substantial difference to the nation’s healthcare provision.

On the other hand, Labour has also recently announced that, if it were to form a government, it will trial ‘Neighbourhood Health Centres’, perhaps demonstrating a willingness to adopt a more strategic approach. This would seek to bring doctors’ services, care workers, physiotherapy, and mental health support under one roof, in an attempt to improve access to healthcare at the community level. As part of Labour’s efforts to promote the decentralisation of such provisions, Streeting may want to consider how to maximise the role of local authorities and their statutory public health functions. Encouragingly, research by The King’s Fund has reported that a more positive vision for public health could be realised if local government were to put public health “centre stage”. However, after 14 years of austerity measures and significantly constrained budgets, it is difficult to envision how much further authorities could stretch without considerable additional investment.

The Party has also committed to a Child Health Action Plan, to drive its ambition for the ‘healthiest generation of children ever’. The Plan seeks to reverse what Labour says is the Conservatives’ short-term ‘sticking plaster’ approach to the health sector. Instead, Labour has set out a commitment to expanding and improving health services alongside more interventionist measures such as banning junk food advertising and making physical activity a compulsory feature of the national curriculum.

The Party claims these commitments will all be ‘fully funded’ by closing tax loopholes and ensuring ‘mega-rich people’ pay their dues. However, given the extent of the UK’s public health crisis, it is difficult to delineate where the budget should stop. While Labour is evidently cognizant of the need to prioritise public health, a bolder, more costly approach may be needed to achieve any substantial reform. Come 5th July, should Labour succeed in forming a majority, how it chooses to navigate this trade-off will be critical. The effectiveness of any of its plans will depend not only on adequate funding but also on efficient prioritisation and allocation of resources. Starmer’s ability to implement these changes and maintain public support will be integral to determining whether Labour’s plans can transform the UK’s healthcare landscape and restore the UK’s health.