Is this really going to be the year that the government “gets things done”? Keir Starmer is branding it as a “year of rebuilding”, returning to work with a series of announcements that he claims show the government is serious about fixing the NHS. Tomorrow, he will unveil an elective recovery plan for the health service, which he hopes will be received as a radical overhaul – and a sign that he is on the right track after a difficult start to his premiership.
The changes include patients being able refer themselves for tests and scans, as well as consultations on the same day as those tests so that they can get on with treatment or have the reassurance of knowing nothing is wrong. There are also changes to the way surgery is planned, so that hip and knee replacements aren’t routinely cancelled during winter crises.
That’s all very well, but Starmer’s first act in his year of rebuilding was to delay doing anything about one of the greatest failures of modern public policymaking. By setting up a long-term commission on creating a national care service that won’t report until 2028, the prime minister risks looking more like one of those builders who turns up when they feel like it and leaves the site under a tarpaulin for months at a time.
Social care is an extreme example of the policy problems that Labour needs to do some serious rebuilding work on: successive governments have produced towers of documents in the form of commissions, taskforces and even manifesto proposals, all amounting to very little in the form of concrete reform.
The final report deadline of 2028 seems almost deliberately designed to prevent any meaningful reform and allow the blame to fall on the other parties that didn’t help. We know from Andy Burnham’s experience back in 2009 what happens when a government has cross-party talks on a social care reform that conclude shortly before an election: the consensus turns out to be false, the parties turn on each other and use the proposed reform as a means of attack, with a scary slogan like the “death tax” – or indeed the “dementia tax” that Labour itself campaigned against in the 2017 election. Politics hasn’t suddenly turned into everyone holding hands and singing Kumbaya since then, so it’s not clear how trying a commission with cross-party talks again will work this time around.
If Labour doesn’t want to be urgent about social care reform, then it will struggle to realise whatever National Health Service improvements the party wants. I say “whatever” because we don’t really know what those changes are, either, save the sort of rough sketch that no decent builder would accept as a plan. We know that ministers want to shift resources from the acute sector to preventive and community settings, but we won’t know how until this spring.
Starmer and the chancellor, Rachel Reeves, went from insisting that there would be “no more money without reform” for the NHS to announcing £22.6bn for the health service in the budget – without any more details on the necessary reforms. Those won’t arrive before a “national conversation” on how the health service needs to change.
Both this conversation and the cross-party talks on social care, which will start next month, are largely aimed at getting public and political buy-in for the plans the government eventually pursues, rather than coming up with new ideas that no one has thought of yet.
If the “national conversation” doesn’t lead to a clear plan that is already being put into action by the end of this year, then it won’t be unreasonable to suggest that Starmer and his ministers are not quite as serious about their big rebuilding project as they claim.
Real reforms take a long time to implement and even longer to produce results, which means there is also a political reason for getting on with it now. By the time of the next election, Labour needs to have signs of solid progress to show to the highly volatile electorate as proof that it is worth sticking with the party for a second term to get the rebuilding project finished, rather than turning to someone else in the hope they might do a better job.
It is not just in the NHS and social care where this is the year to get on with the building work. Ministers have started to talk about their broad intentions on welfare reform, but have so far only produced sketches on how benefits should work differently, rather than any detail. Getting people back into work with the skills they need is an essential part of growing the economy, rather than a nice side project for this government.
Dissatisfaction with the welfare state and jobs market often manifests itself in voter anger about uncontrolled immigration, both legal and illegal, which means that this year needs to be the one where the regular but piecemeal announcements on smashing the gangs and making employers less reliant on overseas workers are linked in strategies that make sense.
Immigration is also not a side project: there is a populist alternative now in the shape of Reform UK, which presents a genuine challenge to both Labour and the Conservatives in “red wall” areas. Rightwing politicians are undoubtedly guilty of posturing on this topic, but it is also the case that those who have genuinely looked at the current problem have concluded that the system as it is set up does not allow a government to control its borders – unless it goes for the kinds of changes that Starmer has already ruled out, such as breaking the international legal framework of the European convention on human rights (ECHR). Voters are unlikely to give them credit for their moral fortitude.
The justice system, which is as overlooked and beleaguered as social care, has been on its knees for years, and is again something Starmer has complained volubly about from opposition. The government’s sentencing reforms will need to be accompanied by proper investment in, and reform of, rehabilitation in the prison system so that those who are jailed get more than a prison “library” with a few dog-eared books that they can’t read and too few staff to unlock their doors for exercise each day.
Those at the sharp end of the justice system – the victims of crime – also need a sense that the government hasn’t forgotten about them, as rises to national insurance contributions for employers, coupled with cuts in funding for victims’ charities, mean the sector is seriously struggling to stay operating. Ministers insist that more detail will be forthcoming on how victims will be supported this year: at the moment, the sector is holding its breath and hoping it has got the wrong idea about what a Labour government means for the people it helps.
Starmer has a lot of faith in himself as a politician who is better than the Conservative leaders who came before him and who knows how to run a public service. Most people on the left genuinely believe they have come into politics with a moral mission, and that those on the right are lacking the compassion and ethics to be able to rebuild the country. It would therefore be a particularly uncomfortable experience for Labour backbenchers if, over the next few months, the Conservatives can set up a narrative that Labour isn’t getting on with the things its MPs went into politics to achieve.
Letting down the NHS, leaving vulnerable people without the social care they need and deserve, cutting the winter fuel payment, reneging on promises to Waspi women (Women Against State Pension Inequality) and putting up taxes on charities and hospices: these are not the things that Labour MPs were elected to do. You can just imagine Starmer’s riposte to the Conservative leader, Kemi Badenoch, as she says that, pointing out that the Tories did absolutely nothing to protect vulnerable people either. That might remind the Conservatives of how much work they have to do before they are electable again, but it’s hardly inspiring stuff to stir the troops behind the prime minister, given that it is essentially him saying: “Yes, we’re a bit rubbish, but you were worse.”
Starmer enjoys the “you were worse” line of attack a lot, like a builder complaining about the last bunch of cowboys. But this is the year where he has to prove that he can actually get on with the building work, not just talk about it. If by the end of 2025 he’s still keeping his plans under a tarpaulin and blaming the last lot, he’ll have a much harder time convincing voters that they picked the right builder when he asks them to stick with him at the next election. Before then, his own MPs will be getting seriously angsty if they start to believe the Conservative attack that they aren’t rebuilding the country for the people who need them the most.
• Isabel Hardman is assistant editor of the Spectator and a presenter of Radio 4’s The Week in Westminster
