Browse the corpus

New technology offers hope—for instance, in reducing administration for clinicians17—and government is right to try to harness it. But the plan borders on techno-optimism. For example, giving patients more information and choice through the NHS app is expected to reduce inequalities in care.18 But more information will not tackle the structural issues that shape inequalities—for instance, some patients being unable to afford to travel further for treatment or facing discrimination in their care.19 New technologies can also widen inequalities if richer groups make better use of them.20 Standing back, the guiding ideas behind the plan are muddy. A mix of measures rely on competition and choice to stimulate improvements—for instance, by encouraging a “plurality” of providers and asking patients to shop around between them. Yet large integrated providers will become the “norm.” And some measures look destined for perverse effects. For example, a scheme where patients will be asked to rate their care and decide whether the provider gets reimbursed in full is likely to result in already struggling NHS hospitals being penalised for issues beyond their control, such as crumbling buildings.

norm.” And some measures look destined for perverse effects. For example, a scheme where patients will be asked to rate their care and decide whether the provider gets reimbursed in full is likely to result in already struggling NHS hospitals being penalised for issues beyond their control, such as crumbling buildings. What is clear is that the plan means more NHS restructuring. Government had already announced plans to abolish NHS England and cut spending in NHS integrated care systems.21 But now these systems will be reorganised too—merged across larger areas, with changes in their role and governance. This is not radical: it is part of the constant cycle of “redisorganisation”22 that characterises NHS policy making. Evidence suggests it won’t help.23 Taken together, these changes signal a shift back to a sharper purchaser-provider split in the NHS, away from the more collaborative approach envisaged for integrated care systems just a few years ago. The rhetoric in the plan will soon meet the reality of the resources on offer to deliver it. Health spending will grow by 2.8% a year in real terms between 2025-26 and 2028-29—lower than the historic average (3.7%) and much lower than during Labour’s last period in government in the 2000s (6.8%).24 Capital investment—in new buildings, equipment, and technology—will grow by just 1% a year.

offer to deliver it. Health spending will grow by 2.8% a year in real terms between 2025-26 and 2028-29—lower than the historic average (3.7%) and much lower than during Labour’s last period in government in the 2000s (6.8%).24 Capital investment—in new buildings, equipment, and technology—will grow by just 1% a year. A bigger problem is that the “health plan” is really an NHS plan. The document rightly talks about social and economic conditions shaping health, and includes some tougher measures on obesity. But most of the document’s 150 pages cover the NHS. Stronger action on other major health risks, such as alcohol, is lacking. And social care is left for Louise Casey’s review.25 Improving the NHS may be Labour’s best route to re-election, but it will not be enough to improve the nation’s health.