The next government should support staff to improve care and increase investment

Opinion polls seem to agree that a Labour Government led by Keir Starmer will take office on 5 July. If winning a general election is difficult, governing is arguably even harder, especially after 14 years of sluggish economic growth and declining public services. With government debt and taxation already high, the scope for investing more in public services to tackle falling standards is limited.

The challenge Starmer will face is how to begin a process of renewal and reform that will likely require two terms in government to deliver the sustained improvements the public expects to see. This was how long it took the last Labour government in which I served as director of the Department of Health’s strategy unit between 2000 and 2004. My experience then offers several pointers for the incoming administration.

One positive lesson is that the performance of the NHS improved hugely through the concerted effort of many people and funding increases above the long term average. Under New Labour, the personal involvement of Tony Blair as prime minister and the leadership of Alan Milburn as health secretary were especially important in the early stages, as well as the contribution of special advisers like Simon Stevens, later to become chief executive of NHS England.

A major caution is that there were many missteps along the way. The reasons included inexperience on the part of ministers in leading change in large organisations like the NHS—by no means unique to that government—and a preference for hyperactive policy making over more measured interventions. Impatience to see increased investment deliver rapid results was another factor.

Looking back on that time, it is clear that if the government sets stretching goals it must recognise that these goals are delivered—or not—by thousands of staff across the NHS. The vast majority of these staff have a strong intrinsic motivation to treat patients to the best of their abilities and they need to feel valued and supported in doing so. Looking after them as they care for patients should be a very high priority.

Closely linked, improvement in a complex system like health and social care results from the accumulation of many small changes rather than eye catching initiatives that promise major breakthroughs. Small changes are usually made by frontline teams in which managers work with clinicians to use resources more effectively. The government can facilitate this work by establishing a coherent policy framework and avoiding the temptation to micromanage every detail.

In doing so, the government should seek to be consistent in its approach. While there will always be a risk of adding further policies to those already in place, especially when progress appears slow, this is rarely the right answer. Constancy of purpose in major transformations is an essential requirement according to quality improvement guru W Edwards Deming, an injunction sadly honoured more in the breach than the observance in public policy.1

Constancy of purpose is easier to achieve when there is continuity of leadership. Government ministers need time to master their brief and establish productive relationships with civil servants, public officials, and NHS leaders. This includes challenging officials while also seeking their counsel. The frequent churn of ministers in recent years should be avoided if changes that take time to work are to be put in place.

A critical task for Wes Streeting if he becomes Health and Social Care Secretary is to build learning and improvement capabilities throughout the health and care system in taking forward reform. He has already acknowledged that for every problem in the NHS there is a solution to be found somewhere. What is lacking is an effective means of linking problems and solutions and sharing good practice.

Integrated care systems in England are working to fill this gap by supporting innovations in care, and the dissemination of these innovations.2 An example is the integrated intermediate care service in Leeds that enables people to be cared for at home, referenced by Streeting in a pre-election briefing.3 This service is the product of partnership between the NHS, local government and voluntary and community sector organisations.

Benefits include reduced pressures in emergency departments and delayed transfers from hospitals. These will be priorities for the next government as it strives to improve patients’ access to care, reduce the intensity of work for staff, and cut deaths that occur when patients experience long waits for emergency care—around 300 each week according to the Royal College of Emergency Medicine. The solution in Leeds and elsewhere will be found where services work together to deliver care that is joined up around the needs of patients.

Starmer and Streeting have been clear that substantial investment in the NHS will have to wait until the public finances improve. New Labour was explicit in embracing investment and reform and doing one without the other is high risk. Healthcare spending, staffing, and equipment like scanners in the United Kingdom lag well behind the OECD average and this helps explain the accelerating decline of the NHS since 2010.4

Streeting has described the NHS as “broken” and has made clear his commitment to fix this. By backing the NHS and its staff to lead reform in collaboration with other partners, the next government could leave a lasting legacy. But unless staff have the resources required to put right 14 years of government neglect, with public satisfaction at a record low and key targets missed for several of these years, disappointment lies ahead.