Keir Starmer vows to resist ‘loud opposition’ to fix NHS

Keir Starmer has vowed to be brave and face “vociferous opposition” to his planned public health measures and NHS reforms after a major review found the health service is in “critical condition”.

The Prime Minister said he was prepared to take “controversial” measures to restore the NHS and public health in England following the findings of cancer surgeon and former minister Ara Darzi.

In a speech at the King’s Fund, Starmer said he planned to “do major surgery and not stick plasters” on the NHS and take “much bolder” measures to prevent disease.

He said the NHS had to “reform or die” and that it would take 10 years to make the changes needed. “We have to have the courage to make long-term reforms – big surgery, not sticking plasters. We have to face the challenges – an ageing society, a higher burden of disease,” he said.

The Darzi report concluded that years of neglect by previous governments had left the NHS “in critical condition” and unable to provide patients with the timely care they needed, amid an explosion in demand caused by an ageing, growing and increasingly sick population.

The emergency department was said to be in a “terrible state” and evidence from emergency doctors was cited showing that long wait times were likely to lead to an additional 14,000 deaths a year.

The Prime Minister said he was “absolutely convinced” that prevention had to be at the heart of his government’s 10-year plan for the NHS, including tackling tooth decay, smoking and obesity. He said he had been shocked to learn how many children were being admitted to hospital to have rotten teeth pulled.

“There’s diet, there’s healthy lifestyle, we’re going to have to go into that space,” Starmer said. “I know some of the prevention measures are going to be controversial, but I’m prepared to be bold, even if there’s loud opposition. So no, some of our changes aren’t going to be universally popular, we know that, but I will do the right thing for our NHS, our economy and our children.”

Asked whether he thought doctors’ unions would welcome productivity reforms in the NHS workforce, Starmer said he was prepared to challenge anyone who was “an obstacle to change”.

“I’ve said we’ll do it with the staff, and we will,” he said. “But I know from my old job as head of the Crown Prosecution Service that whenever you try to reform something, there are people, I’m afraid, who will say, ‘Oh, don’t do that, it’s better the way it is, I wouldn’t do that, leave things as they are.’

“We have to take that attitude. I think it’s an inhibitor of change. So even though we say we’re going to do it with people, and we will; we’re going to do it together, and we will; I know in my heart of hearts that we’re going to find pockets of people who are going to say, ‘Don’t do it, take it easy, go there, don’t go there, leave things as they are.’

“We have to address that, and we will address that. That is an essential part of the change that we have to bring about,” Starmer said.

In a speech just over six weeks before the Budget on October 30, Starmer said the NHS would “not get any more money without reform”.

“Reform doesn’t just mean investing more money. Of course a Labour government, even in difficult financial circumstances, will always make the investment in the NHS that is needed, but we have to fix the pipes before we turn on the taps,” he said.

“So listen to me when I say this: no more money without reform. I am not prepared to see any more of your money spent on agency workers costing £5,000 a shift, on appointment letters that come after the appointment, or on paying people who are stuck in hospital because they can’t get the care they need in the community.”

Starmer said the long-delayed social care reforms would be part of the government’s 10-year plan, but any change had to be achievable.

He said he was committed to building the 40 new hospitals first promised by Boris Johnson in 2019, although he insisted the previous government’s plans were misguided and unrealistic. Rachel Reeves, the Chancellor of the Exchequer, announced a review of the plan in July and said it could not be implemented before 2030.

When Labour came to power in July, the 142-page report was commissioned by Lord Darzi, who was health secretary under Gordon Brown.