NHS chiefs must be free to bring in change now, says thinktank

The NHS is at risk of paralysis while it waits for Wes Streeting’s 10-year plan for reform and needs to be empowered to get on with change in the face of huge waiting times for care, a thinktank has said.

Victor Adebowale, a crossbench peer and chair of the Institute for Public Policy Research, said a clear message is needed from Streeting that leaders in the health service should be able to start bringing in reforms where they are aligned with the government’s priorities.

He described long waits for care as “the tragic new normal” for many patients in the NHS and highlighted IPPR analysis showing that 25 times more people waited over four hours in A&E this summer than during the same period in 2010.

Lord Adebowale is also chair of the NHS Confederation, the membership body for health authorities and trusts in England, Wales and Northern Ireland. Writing in his role as IPPR chair, he said several senior NHS leaders have described to the thinktank “a feeling of ‘sitting and waiting’ for the 10-year plan, unable to initiate major change in the meantime”.

He wrote in a blog, exclusively shared with the Guardian: “A system in which local leaders have long been expected to look ‘upwards’ for instruction generates paralysing uncertainty, disempowerment and leadership churn.

“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 get on with reform aligned with the government’s three shifts: towards prevention, digital, and community-based care. Leaders should be empowered to work towards these goals now, with the reassurance that these efforts will not be wasted.”

Adebowale, also a charity founder, said better data-sharing in Greater Manchester between GPs, ambulance services, hospitals and social care had driven improvements after careful planning and staff consultation, adding: “This could begin today.”

Victor Adebowale said the NHS is facing ‘the coldest winter on record’ when it comes to its performance

He also said spending in primary and community care should increase relative to hospitals, which should be a firm expectation for 2025-26 financial plans, due to be drafted before the 10-year plan is released.

Adebowale said two more immediate steps were also needed: for Streeting to add a fourth priority of local empowerment rather than national micromanagement; and better continuous engagement with NHS staff to improve morale.

“Otherwise, this promising [10-year] plan may fall on barren soil, leading to deeper crisis each winter to come,” 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 this year from July to September compared with a similar period in 2009 people waiting for diagnostic scans have tripled, and the number waiting more than 18 weeks for elective care is up twelvefold.

“Worse, 25 times more people waited over four hours in A&E, affecting over 1.6 million people across the quarter,” he said. “The target is not the point here, safety is – with hundreds of thousands facing even more dangerous waits over 12 hours.”

Waiting lists for hospital treatment reached a peak of 7.7 million in September 2023 after climbing sharply during the pandemic. Keir Starmer’s government has said it will take at least five years for the backlog in elective treatment to be cleared.

A few months after becoming health secretary, Streeting launched a consultation on how the NHS should change, which will run until spring 2025. It is canvassing the views of public, patients, carers and NHS staff for ideas on how to make the health service fit for the future.

He also commissioned a review on the state of the NHS in England from Lord Darzi, who found that long delays for hospital, GP and mental health services are leading to thousands of unnecessary deaths and have ruptured “the social contract between the NHS and the people”. The study was cited by Starmer, who warned that the NHS has to “reform or die”.

Adebowale said Streeting was right to put NHS reform at the top of the agenda with his 10-year plan for health, which is intended to “fix the foundations” of the health service. But he said moves to lay the groundwork for change were needed immediately and Streeting’s reform plan “risks being crowded out by the immediate crisis”.

In terms of staff engagement, he said staff need to be consulted locally as well as at national level in relation to the 10-year plan.

“The 10-year plan is laudable for its extensive national-level consultation, speaking 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-off session,” he said, arguing that every frontline professional can describe a long list of frustrations that waste time and stand in the way of patient care.

He said that as one regional surgical lead explained: “Staff feel far less ownership and ability to improve services in their patch than a decade ago.”

The IPPR highlighted the example of NHS “staff boards” at Barking, Havering and Redbridge, in east London, which has helped to unlock new ideas, boost morale and reduce staff vacancies.

In terms of a new goal of local empowerment, he said the government should make clear it is prepared to champion success stories, and back local efforts with money, support, and autonomy.

“To take root, change must begin now,” he said. “Embarking on these three steps today could give the bandwidth to break out of perpetual crisis and prepare the fertile ground to implement the 10 Year Plan when it arrives.”

The Department of Health has been contacted for comment.