The NHS is at risk of being paralyzed as it waits for Wes Streeting’s 10-year plan for reform and must be given the strength to press ahead with changes in the face of huge waiting times for care, a think tank has said.
Victor Adebowale, a cross-bench peer and chair of the Institute for Public Policy Research, said there needed to be a clear message from Streeting that healthcare leaders should be able to deliver reforms where they are in line with government priorities.
He described the long wait for care as “the tragic new normal” for many patients in the NHS and highlighted the IPPR analysis which found that 25 times more people waited more than four hours in A&E this summer than in the same period in 2009 .
Lord Adebowale is also chairman of the NHS Confederation, the membership body of health authorities and trusts in England, Wales and Northern Ireland. In his role as IPPR chairman, he said several senior NHS leaders have described to the think tank “a sense of ‘sitting and waiting’ for the 10-year plan, and not being able to drive major change in the meantime”.
He wrote in a bloggingshared exclusively with The Guardian: “A system in which local leaders have long been expected to look ‘up’ for instructions generates crippling uncertainty, powerlessness and leadership turnover.
“This must be replaced by a clear message from the Secretary of State that leaders should not wait for the NHS 10-year plan, but press ahead with reforms that align with the government’s three shifts: towards prevention, digital and community-based care . Leaders must be empowered to work toward these goals now, with the reassurance that these efforts will not be in vain.”
Adebowale, who is also a charity founder, said better data sharing in Greater Manchester between GPs, ambulance services, hospitals and social care had led to improvements after careful planning and consultation with staff, adding: “This could start today. ”
He also said that spending in primary and community care should increase compared to hospitals, which should be a strong expectation for the 2025-2026 financial plans, which should be drawn up before the 10-year plan is released.
Adebowale said two more immediate steps are also needed: for Streeting to add a fourth priority of local empowerment rather than national micromanagement; and better, ongoing engagement with NHS staff to improve morale.
“Otherwise, this promising (10-year) plan could fall on barren ground, leading to a deeper crisis every winter,” he said.
He also highlighted new IPPR analysis data showing that NHS is facing “the coldest winter on record” when it comes to its performance.
Adebowale said that from July to September this year, the number of people waiting for diagnostic scans has tripled, compared to a similar period in 2009, and the number waiting more than 18 weeks for elective care has increased twelvefold.
“Worse, 25 times more people waited more than four hours in the emergency room, This quarter will affect more than 1.6 million people,” he said. “This is not about purpose, it’s about safety – and hundreds of thousands of people are facing even more dangerous wait more than 12 hours.”
Waiting lists for hospital treatment peaked at 7.7 million in September 2023, after rising sharply during the pandemic. Keir Starmer’s government has said it will take at least five years to clear the backlog of elective treatment.
A few months after becoming Health Secretary, Streeting launched a consultation on how the NHS should change, which will run until spring 2025. It explores the views of the public, patients, carers and NHS staff for ideas on how healthcare can be made appropriate. for the future.
He also commissioned an inquiry into the state of the NHS in England by Lord Darzi, which found that long delays in hospitals, GPs and mental health services are leading to thousands of unnecessary deaths and have ‘broken the social contract between the NHS and the public’ . ”. The study was cited by Starmer, who warned that the NHS must “reform or die”.
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Adebowale said Streeting was right to put NHS reform at the top of the agenda with his 10-year health plan, which aims to “restore the foundations of healthcare”. But he said steps to lay the groundwork for change were needed immediately and that Streeting’s reform plan “risks being displaced by the immediate crisis”.
On staff involvement, he said staff should be consulted both locally and nationally regarding the 10-year plan.
“The Ten Year Plan is commendable for its extensive consultation at national level, engaging with staff across the country and at every level to identify challenges and routes to improvement. Yet meaningful engagement cannot be delivered in a one-time session,” he said, arguing that any frontline professional can describe a long list of frustrations that waste time and hinder patient care.
He said that, as one regional surgical leader explained: “Staff feel much less ownership and ability to improve services in their area than they did ten years ago.”
The IPPR highlighted the example of the NHS ‘staff councils’ in Barking, Havering and Redbridge, east London, which have helped unlock new ideas, boost morale and reduce staff vacancies.
In terms of a new goal of local empowerment, he said the government must make clear its willingness to champion success stories and support local efforts with money, support and autonomy.
“For change to take root, change must start now,” he said. “Starting with these three steps today could provide the bandwidth to emerge from the ongoing crisis and prepare the fertile ground for the implementation of the Ten-Year Plan when it arrives.”
A spokesperson for the Department of Health and Social Care said: “We are committed to making the NHS fit for the future, which is a key mission within our Plan for Change.
“That’s why we’re focused on reducing the huge waiting lists we inherited, so people can be seen more quickly. Through our 10-year plan, we will deliver the critical reforms to make our healthcare system work better for everyone.
“We have already made progress and are supporting wider improvements in the NHS with a record investment of £22 billion in day-to-day spending, with a further £3 billion in capital expenditure including hospital repairs and new equipment.”