𝓤𝓷𝓲𝓽𝓮𝓭 𝓝𝓮𝔀𝓼

Wes Streeting spent much of his first year as Health Secretary describing the NHS as “broken” — but 12 months after he took office it remains in a “critical state”, experts have said. Asked for their views on Labour’s first year for health and social care, sector leaders said the Government deserved credit for quickly resolving a pay dispute with junior doctors that had been raging for over a year and for securing two strong funding settlements.

But the threat of fresh strikes, glacial progress on waiting lists, and another winter of chaos in A&E departments mean the health service still has “a mountain to climb”. Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: “Throughout the Government’s first year in power, we have heard the Prime Minister and Health Secretary, time and time again, describe the NHS as ‘broken’. Now it falls to them to fix it. We are 12 months into its term and so far we have reviews and plans, now is the time for action.”

The NHS featured heavily in Labour’s election manifesto, with promises to “build an NHS fit for the future” by cutting waiting times, doubling the number of cancer scanners, rescuing dentistry and bringing back the family doctor.

It also pledged to return to the NHS constitutional standard of ensuring that 92% of patients receive planned treatment within 18 weeks by the end of Parliament in 2029.

NHS data shows the waiting list has fallen from 7.62 million procedures or appointments in July 2024 to 7.39 million this April — the most recent month for which data is available. But the proportion of patients treated within 18 weeks remains almost unchanged, declining from 60% to 59% over the same period.

Siva Anandaciva, director of policy at The King’s Fund think tank, suggested the target may be out of reach. He said: “It’s a really ambitious, herculean target to get back to 18 weeks on this timeframe. When I look at the charts, they just look incredibly steep for how quickly performance has to improve.

“Even if you can do it, it will take so much money, so much resource that it will be a black hole that pulls in all that resource. What does that mean for A&E, cancer, ambulances and mental health?”

Mr Anandaciva added that the Government’s narrow focus on this flagship 18-week target means “we don’t know where it wants to get to on pretty much everything else”.

He said the public does care about waiting lists but “if that’s the only thing that matters to a healthcare system, what happens is even if you achieve it, you’ll look around and see that A&E waiting times haven’t improved, that life expectancy hasn’t improved. That’s a high cost for one target.”

Mr Anandaciva said the past 12 months could have been “much worse” with spiralling waiting lists if Mr Streeting had not managed to reach a deal with junior doctors within weeks of taking charge.

But he added: “Overall, when I look at waiting lists, staff and public satisfaction, access to care, it still feels like [the NHS is] in a pretty critical state. It certainly doesn’t feel like it’s rapidly improving.”

Matthew Taylor, chief executive of the NHS Confederation, also praised the Government for resolving the previous rolling strikes and for having negotiated hard with the Treasury for NHS funding, including £29bn in the Spending Review.

But he warned that pressure on all public services meant “we must prepare for a future where the NHS will face an even tougher financial environment than it currently faces”.

Mr Taylor added: “The reality is that the NHS is not currently meeting the basic needs of patients, particularly those living with multiple long-term conditions and those from the most deprived areas.

“This might sound alarmist, but the health service is fighting for its life as a universal service right now and that is a very daunting challenge.

“Lots of difficult decisions lie ahead for NHS leaders including how to balance the books to cover the cost of new treatments and medicines and meet increasing staff pay costs.”

Sir Keir Starmer is this week due to unveil a wide-ranging 10-Year Health Plan. Policies that have been trailed include world-first use of an AI system to identify potential safety scandals early by spotting patterns of abuse, serious injuries, deaths or other incidents.

A new maternity AI system will launch across NHS trusts from November, using “near real-time data” to flag higher-than-expected rates of stillbirth, neonatal death and brain injury. It comes after Mr Streeting announced a rapid national investigation into maternity failings at up to 10 worst-performing units.

Hospital payments could be linked to patient satisfaction, and supermarkets will be asked to help tackle obesity by encouraging shoppers to buy healthier products.

The plan will also include measures to increase “neighbourhood health” and move more care from hospitals into the community.

Mr Taylor said this shift was welcome but with more strikes looming, delays to action on social care and another difficult winter on the horizon, “there is a mountain to climb”.

How well — or, in recent years, terribly — the NHS copes with winter has become a key metric, with ambulances queuing outside hospitals and horror stories of patients waiting for days and even dying in corridors now normalised.

Analysis by the Royal College of Emergency Medicine (RCEM) estimated that 16,600 deaths in 2024 were linked to long A&E waits, with 1.7million people waiting over 12 hours to be admitted, discharged or transferred.

Labour recently unveiled an Urgent and Emergency Care Plan which includes measures such as publishing A&E performance data for hospitals, opening mental health crisis assessment centres, and 500 new ambulances.

But the RCEM said the plan lacked any cast-iron commitment to ending “dangerous and demeaning” 12-hour waits. Dr Boyle said: “Considering lives are being lost because of the crisis in emergency care, why isn’t this a political priority too?

“The goodwill of emergency department clinicians, and the patience of the public, is running out. The permacrisis in urgent and emergency care cannot continue.”

The root causes of chaos in A&E departments include bottlenecks caused by delayed discharges from hospitals which are fuelled by an ongoing crisis in social care.

In January, Mr Streeting wrote that successive governments had failed on social care and it was “not a shortage of good ideas that’s the problem, but a shortage of good politics”.

But his solution — the announcement of an independent commission led by Baroness Casey — was widely seen as yet another delay to any concrete action. Mr Anandaciva said: “I think it’s right to ask: Why wasn’t more done, more quickly?”

Dennis Reed, director of over 60s campaign group Silver Voices, said Mr Streeting had got it “so radically wrong” that his failure to grasp the nettle on social care “will blight all his efforts in other directions”.

He added: “His refusal to recognise or deal with the social care crisis, despite pre-election promises, will ensure that he does not meet his targets on waiting lists, accident and emergency waits and ambulance response times.”

A first phase of the commission is due to set out plans for how to implement a national care service by 2026, with a second phase making longer-term recommendations by 2028.

But Mr Reed said this timeline meant any meaningful reform would be unlikely until the early 2030s. He added: “All independent commentators and even NHS leaders recognise that the main blockage in the system and the cause of the most pressure on hospitals, is the lack of social care support at home.”

A government spokesperson said: “We inherited a health system in crisis and made rebuilding the NHS an immediate priority. Our Plan for Change has already delivered 4.2 million extra NHS appointments – more than doubling our target of two million in the first year.

“Thanks to record investment, reforms and the hard work of NHS staff, the overall waiting list fell in April for the first time in 17 years, dropping by almost a quarter of a million since we took office. With the investment and reform we are delivering through our Plan for Change, we will rebuild the NHS.”