Work
About
Work
About
Hitting the ground running: The first 100 days
Hitting the ground running: The first 100 days

Posts Tagged ‘Labour Government’

How Darzi’s dossier of desolation sets the stage for a rebooted, more radical Long Term NHS Plan

The NHS is on ‘life support’ and needs ‘major surgery’. Years of increasing demand, systemic strain, and the challenge of the COVID-19 pandemic mean it is now time to ‘reform or die’.  

With rising public dissatisfaction, mounting waiting lists, and a system struggling to keep up with demand, Lord Darzi’s report is stunning in its frankness and makes for sobering reading. And while it’s the latest in Labour’s ‘look what we’ve inherited’ strategy, the report paints a picture that health leaders recognise. 

David Thorne, WA Health Adviser and Director of Transformation at Well Up North PCN said ‘It’s a true portrait of the difficulties faced from top to bottom in the NHS. But with this comes the chance to reform, transform and drive change.’ 

Labour intends to use the report as a platform to set out how it needs two terms in Government and a long-term mindset to overcome these major problems – doing so will need them to balance urgent against important, acute vs critical, and public demand vs operational and budgetary realities – Labour knows this, which is why the Darzi report is the precursor to a new ten-year plan being crafted by Professor Paul Corrigan, that will set out the how.  

Another one? Aren’t we five years into an existing NHS Long-Term Plan? One that was rich with thought and requested by the NHS itself?  

With some of the critical challenges sounding familiar, the temptation when the 10 year plan consultation eventually opens might be to dig out submissions from 2019! 

That would be a mistake. Darzi’s report does not make policy recommendations (as set out in its terms of reference) but if we take it to be the bedrock for the ten-year plan, Darzi has set the stage to go beyond the LTP, pushing for what may need radical and transformative reforms.  

How could this rebooted plan differ, and what new directions will it take to secure the future of the NHS? 

What’s familiar? 

Several key themes remain consistent but have evolved from 2019, particularly on prevention, digital transformation and workforce. 

1. Prevention and health inequalities: Both the LTP and Darzi stress the importance of prevention. Wes Streeting has also aligned to this heavily. But while the LTP focused primarily on reducing the burden of preventable diseases like smoking, obesity, and alcohol-related harm, Darzi has gone beyond and expanded the focus more heavily on issues including social determinants of health, recognising the impact of factors such as housing, income, and education on public health. The aim is to tackle these issues in a more integrated and community-focused way 

2. Digital transformation: Darzi has placed a major emphasis on AI, data integration, and enhanced digital tools to improve efficiency and patient care. The goal is to create a more digitally-enabled NHS that can respond to the needs of modern healthcare. 

3. Workforce expansion and retention: The workforce crisis in the NHS remains one of its most pressing problems. While the LTP set out to increase the number of healthcare professionals, particularly in nursing and primary care, the Darzi report has also included issues such as re-engaging staff and tackling issues of burnout and low morale. Retaining existing staff and improving working conditions will be central to Labour’s long-term strategy to restore the NHS workforce, with an early win in the bag via the Junior Doctor’s pay settlement.  

A more radical shift: What does Darzi tee up? 

Lord Darzi has created a platform for a much more radical and ambitious vision for the future. 

1. System reorganisation: One of the most significant changes will need to be in the way the NHS is structured and managed. 

The priority will be to shift more services out of hospitals and into community settings, with the intention to deliver care more efficiently and at a lower cost.  

Working within the current legislative architecture (which Darzi welcomes as a restoration of sanity), this may mean expanding integrated care systems (and giving local health bodies more decision-making power by ‘reinvigorating the framework of national standards, financial incentives and earned autonomy as part of a mutually reinforcing approach…’ 

2. Financial reforms: The Darzi Report highlights the imbalance in spending, with too much of the NHS budget going towards hospital care and not enough being directed towards primary and community care.  The report sets the need for a reallocation of resources. The new plan will therefore need to restructure NHS funding, ensuring that resources are used more effectively and in line with patient needs. 

3. Rebuilding and maintaining resilience: The COVID-19 pandemic exposed significant vulnerabilities in the NHS (see the COVID-19 Enquiries’ findings) particularly in its ability to manage public health crises while continuing routine care. Lord Darzi has therefore focused heavily on resilience and preparedness, and the need to ensure the NHS is better equipped to handle future emergencies. There is now a greater understanding of how the UK fits into a global health system, supply chains and onshore capabilities. 

4. A focus on disease: After the focus on major conditions seen in the last few years, there is a notable focus on diseases. Again, many priorities remain from the LTP, but others appear to be scaled back or integrated into broader health strategies. Given Streeting’s noted prioritisation of cancer, mental health (particularly in children) and cardiovascular disease, these are unsurprisingly front and foremost of the report. Interestingly, diabetes looks set to be included within CVD and dementia care (a prominent part of the LTP) has dropped out.  

The path forward: Rebooting the NHS 

Darzi’s stark analysis means the upcoming ten year plan cannot just be another strategy in a long line of NHS strategies – the scathing diagnosis will springboard an opportunity for radical thinking.  

While the 2019 Long Term Plan laid the groundwork for important improvements, the Darzi Report makes it clear that more radical reforms are needed to meet the evolving challenges in the coming decade.  

The shift towards community-based care, better resource allocation, and pandemic preparedness signals a bold new direction for the NHS. 

In Lord Darzi’s words, “The NHS is in critical condition, but its vital signs are strong”. The new plan offers a real opportunity to rebuild the NHS into a more resilient, patient-centred, and forward-thinking institution. However, as the report acknowledges, it will take time to fully implement these changes.  

The challenge now lies in the effective execution of these reforms to ensure that the NHS not only survives but thrives in the years ahead. 

Share this content:

General Election Briefing

The political landscape is transformed, but a volatile electorate creates pressures for both Labour and the Conservatives.

While the overall result this morning was no surprise, Labour’s landslide victory was just one of several electoral stories – from the return of the Liberal Democrats as Parliament’s third largest party, the rise of Reform, and the success of left-wing independents, to the SNP’s deepening crisis, and a historic low for the Conservative Party.

Keir Starmer will set to work immediately – with key moments over the next 100 days including Cabinet announcements, NATO and European Political Community summits, the King’s Speech and an Autumn Budget.

Our analysis examines some of the key trends from today’s election results, how these will shape Keir Starmer’s government and the new Parliament that reconvenes on Tuesday, and what this means for business.

General Election Briefing

 

Share this content:

How will the Whitehall machine deliver a Mission-Based government?

“We need government to be more agile, empowering, and catalytic….

“The old model of departments working in silos … needs to be replaced with a genuine joined-up approach. This means collective agreement on the government’s objectives and how best to deploy time, attention and resources to meet them.

“This could mean new structures and ways of working to facilitate collaboration, including replacing some of the cabinet committees with new delivery focused cross-cutting mission boards.”

5 Missions for a Better Britain: A Mission Government to End ‘Sticking Plaster’ Politics

A change in government is very often accompanied by a new vision for how government as a whole should be organised – from the role of No.10 and the powers of the Treasury and the Cabinet Office; to the responsibilities of the central government departments and their agencies; to the use of cross-government ‘Czars’, boards and committees.

Some of these shifts are formally called ‘machinery of government’ changes because they involve moving responsibility for functions from one department to another, or creating whole new departments devoted to goals like Net Zero. Others are changes in the balance between central and local, or in the style and way of doing things.

So what changes can we expect to see under a new Labour government? And how could Government really reflect Starmer’s ‘Mission’-focused government – supporting his cross-cutting ambitions around economic-growth, clean energy, an improved NHS, safer streets, and breaking down the barriers to opportunity?

In Starmer’s own words – these issues are long-term, complex challenges “that need lots of actors and agencies working to achieve them”. And of course those actors aren’t just central government policy-makers but also “business working with unions. The private sector working with the public sector. And partnership between national and local government.”

These are also issues where Labour must deliver on the promise of Change, but with little headroom for further funding increases – meaning good leadership, driving operational improvements and marginal gains become ever more important.

So, under a newly elected Labour government, it’s more likely we’ll see an emphasis on making existing structures more accountable, with stronger central control and cross-government coordination, rather than a wholesale shake-up of the structure of Whitehall.

This evolution rather than revolution also reflects the instincts of Keir’s senior team – an inner-circle heavily populated with experienced public servants. Starting with Keir himself:

These are long-term Whitehall operators, who will have a clear view on how to control the levers of power effectively, based on personal experience – they are not Steve Hilton or Dominic Cummings figures who join government to implement ‘blue-sky’ thinking.

Here are some thoughts about what might happen in five areas:

Central Government Departments and Agencies

Sue Gray in particular will have the instinct of most senior civil servants that major changes in the number or role of departments is a distraction, and Keir Starmer will be familiar with the disruption that big organisational changes caused for other parts of government working on the affected policy areas.

Instead the focus will be on making the departments that exist more effective, and holding the Secretaries of State in charge of them to account more effectively.

In some cases this may mean central departments becoming more powerful relative to agencies – expect for example the Department of Health and Social Care to reassert some control and powers from NHS England.

The weakest departments organisationally, and probably the ones most vulnerable to change, are those that Rishi Sunak created recently in the business area – Business & Trade, and Science, Innovation & Technology.

If there are any major machinery of government changes these will be announced when Cabinet Ministers are appointed. Key decisions on cabinet committees will be made shortly afterwards – including their terms of reference, chairs and membership.

Inevitably every Prime Minister gets to a point where a refresh or a reset is required, so notwithstanding the above, machinery of government changes will not have gone away entirely under Labour: expect the option to be on the cards either later in the Parliament or the next Parliament.

HM Treasury:

We can expect an early announcement by Rachel Reeves about increasing the department’s organisational firepower – perhaps beefing up the Growth Unit function, which may also include the appointment of a new Second Permanent Secretary, a figure who can engage credibly with business (currently a big gap, especially in a department to be tasked with a greater role in galvanising business investment).

An early announcement about strengthening the role of the OBR could also be followed up by legislation, probably in the first session.

No10 / Cabinet Office:

It is less clear what Starmer and Gray will do with No10 and the Cabinet Office.

The Cabinet Office is the least loved bit of Whitehall, a sprawling mix of central functions for the Civil Service and higher-end policy coordination across domestic and security policy. No10 by contrast is a small operation which takes a different shape in each administration reflecting the personal preferences and style of the Prime Minister.

In general I’d expect Sue Gray to take a fairly traditional view of what a high-performing centre of government should look like. The shadow of Jeremy Heywood still hangs heavily over Whitehall in this way of thinking – one brilliant individual who could combine superb instincts for policy and political handling with strengths in organisational leadership and transformational drive. The trouble is that individuals like Jeremy are few and far between, and absent this kind of hero the traditional version of the centre is a long way from the strategy-setting motor of government that the modern state needs.

Expect a lot more speculation about who might succeed the current Cabinet Secretary, Simon Case, if he does move on early in 2025. A lot of this has so far been linked to the rumoured return to government of Sir Oliver Robbins – who stepped into the public limelight as Theresa May’s chief Brexit negotiator, but also held jobs in Home Office and Treasury. Other names may however also enter the frame.

Mission Boards

The much heralded centre-pieces of the new government’s administrative reforms, these will be intended to fill that central strategy-setting gap.

They may also be an important forum to draw together the range of partners, beyond central government, that ‘5 Missions for a Better Britain’ identifies as key to delivering change – for example opportunities for the private sector and corporate expertise to contribute have been heavily floated in the media, and it would be no surprise to see union and local government representation.

But the boards will struggle to be effective unless:

The objectives are tightly defined, have some realism and are not too rhetorical

One senior Minister is put in charge of each and has the power and authority to direct other colleagues/departments (as that Minister cannot always be the PM or Chancellor, you immediately get into issues of ranking / personality / rivalry)

Preferably there is one senior official responsible for driving the work of the board, with a supporting team and with budgets to match

The risk is that these boards will turn into coordinating and overseeing committees (as with many before). And that is ultimately an issue of political direction from the top, not administrative process. If they are to have real power they need to have the status of Cabinet Committees: it is possible to have non-Ministers attending Cabinet Committees but not as full members.

Local Devolution

While not a ‘Machinery of Government’ change per se, attention should also be drawn to Labour’s plans for further local devolution – where Metro Mayors are an influential part of Labour’s eco-system, and a “full fat approach to devolution” promises a further transfer of policy-making and spending powers on transport, skills, energy, and planning.

If really effective this could be the most important long-term change of all.

Watch out though for whether the Treasury concedes any ability to raise revenue – or just to spend allocations from the centre.

Share this content:

A clear cultural shift: how Labour will govern differently

Attention is now focused on what a new Labour government – but beyond policy differences, how will the party govern differently?

Firstly, it is worth remembering that Labour have been out of power for 14 long years. This means that many of the MPs who will be stepping into departments as newly minted Ministers will have little to no ministerial experience. And this is the same for the army of SpAds who will be assuming their new roles.

In terms of understanding quite how different Labour will be, it helps to start by looking at the people – there is every likelihood that Labour will have a huge number of new MPs, some in seats that they very much didn’t expect to win. Labour PPCs are full of those with backgrounds in local government, trades unions and charities. Many are campaigners, some are public affairs professionals, and quite a few may well be elected with relatively shallow majorities in a number of diverse regions. This will leave Keir with a large and new PLP to manage, and though it is a nice problem to have, it can pose it’s own complications with a number of competing priorities and egos.

In terms of the practicalities of government, it is worth reflecting that Keir respects process and institutions, as does Sue Grey his Chief of Staff, (Sir Philip Rutnam, Chair of WA’s Advisory Board and former Permanent Secretary explores how this will shape the structure of Whitehall more broadly here), so unlike previous PMs there will not be the informal sofa government we have seen previously.

There will also be a clear cultural shift – Labour is more than a political party, it’s a movement. And it has an eco-system very different to the Tories with a far stronger and robust internal democracy which includes the trades unions, who are an integral part of the Labour movement.

The new Cabinet themselves will come from a far more diverse range of backgrounds than we have seen under the Tories. Some grew up in poverty and many have working-class backgrounds which they’ve spoken about, especially in framing their political outlook. The times when Eton dominated the Cabinet table will be long gone and the tone and language of the new government will reflect this.

Also important is an appreciation of how laser focused Labour will be on their key missions and policies. Keir has been keen to consistently stress that economic growth is their absolute priority, so companies and organisations will want to look at how they can be part of this narrative.

There will be very little bandwidth for anything other than their stated priorities as well as very limited fiscal headroom. For those looking to engage with Labour, the challenge will be to use smart and nuanced ways in, where policy aligns with priorities, and companies can demonstrate their role in both growing the economy and shaping the fairer society Labour want to see.

There will be opportunities for engagement, whether it is through the various new consultations that will be launched, working groups or roundtables, as well as keeping up to date with the left of centre think tanks who in the last Labour government provided a lot of policy kite flying.

Questions around the structures of government and how Keir will manage No 10, not least the challenge of getting departments working together on cross departmental policy priorities, are not clear yet. What is clear is that HMT will be central to all key decisions as they focus their attention on budget and spending review in addition to making their growth plans a reality.

And this is forgetting what happens to all the best laid plans of governments…events! Unforeseen issues and events impact greatly on a PMs time and energy – whether this is pressing foreign policy issues or domestic crisies that can come out of nowhere, the pace and relentlessness of government is a different level to opposition.

Labour will be hoping that a predicted Tory leadership race, with all the ‘fun’ that entails, will give them some time and space before the media inevitably want a new story and turn their focus onto Labour.

Still, even on its worst days, being in government is a million times better than being in opposition, and after 14 years out in the cold, Labour will not be complacent about finally having the ability to do, rather than just say.

Share this content:

Register for insights

Speak to us
020 7222 9500 contact@wacomms.co.uk

6th Floor, Artillery House
11-19 Artillery Row
London
SW1P 1RT
close_pop
Sign Up
Complete the form below to sign up to our newsletter:

    YOUR NAME:

    EMAIL:

    ORGANISATION:


    By submitting this form you agree to WA Communications’ Privacy Policy.