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But Labour’s plans for using wider public policy to prevent disease need fleshing out. For instance, the plan includes proposals to reduce childhood obesity, including promoting physical activity, funded breakfast clubs in schools, and restricting advertising of unhealthy foods. Yet other powerful population level measures—such as a sugar and salt reformulation tax or expanding eligibility for free school meals10—are not included. Labour’s plan is limited on smoking and says nothing on reducing alcohol related harms, despite rising deaths and hospital admissions.11 12 Labour’s focus on “getting the basics right” in the NHS makes sense. The waiting list for routine hospital treatment has reached 7.3 million, and 360 000 people have been waiting more than a year.13 Waits in emergency care are grim,13 and people are finding it harder to make general practice appointments.14 The result is avoidable harm15 and fraying of the social contract underpinning the NHS. Boosting staff numbers will help reduce pressure. Labour promises to expand medical school places and think longer term about future workforce needs. But getting the basics right also means giving staff the modern buildings, equipment, and technology needed to work productively. The plan talks about reviewing NHS capital projects to eliminate waste and ensure efficiency. But a new government must invest: NHS capital spending has been below that in comparable countries for many years—and it shows.16 17

ans giving staff the modern buildings, equipment, and technology needed to work productively. The plan talks about reviewing NHS capital projects to eliminate waste and ensure efficiency. But a new government must invest: NHS capital spending has been below that in comparable countries for many years—and it shows.16 17 Starmer has pledged to meet NHS waiting times targets within five years.18 This seems unlikely. Labour’s successful “war on waiting” in the 2000s was backed by substantial increases in funding and staff—and, even then, was made up of several battles over a decade.19 20 Labour’s plan to strengthen primary and community care and join up services outside hospitals is nothing new. The same aims can be found in NHS policy documents dating back decades.21 A focus on new technology could help GPs and other staff work in new ways,22 but Starmer’s emphasis on the business model for GPs—he wants to “make sure salaried GPs serve all communities”—risks being a distraction.23 And ambitions to shift care outside hospitals will not happen unless politicians grip the crisis in social care and reform the broken system. Social care is on its knees: many people go without the care they need24 and rates of poverty and deprivation among care workers are high.25 Yet Starmer made only passing reference to social care in his speech, and the plan provides little more.

s politicians grip the crisis in social care and reform the broken system. Social care is on its knees: many people go without the care they need24 and rates of poverty and deprivation among care workers are high.25 Yet Starmer made only passing reference to social care in his speech, and the plan provides little more. The elephant in the room is money. Labour’s narrative is that reform will need to do “the heavy lifting” to improve the NHS26—and Starmer dodged questions from journalists about how Labour would fund the plans.27 Public services are creaking after a decade of austerity,28 and the covid-19 pandemic will cast a long shadow. Health spending is set to increase by just 0.1% a year in real terms over the next two years—well below the decade before the pandemic (2%) and the long term average in England (3.9%).29 Contrast this with spending growth of 6.7% under Blair and Brown in the 2000s. No amount of reform will avoid the need for substantial investment for Starmer’s Labour to make real progress.