Karin Smyth MP, Labour’s Shadow Minister for Health speaks at the Institute for Government’s Annual Conference

"Good morning and thank you Hannah for inviting me here today.

If you want to know just how dismal a state the Conservatives have left the country in, then you only need to look at the Institute for Government’s annual performance tracker.

Its latest report finds:

“The Government is stuck in a public service performance doom loop.”

“The public is experiencing first-hand the consequences of successive governments’ short-term policy making.”

“Fragility has become a defining characteristic of today’s public services”.

In health:

Demands on GPs are rising, as the number of GPs is falling.

Hospitals did fewer procedures and appointments in 2022/23 than in 2019/20 - despite more funding.

And, in a damning indictment from an organisation as expert, respected, and independent as the IfG – “Political turmoil in 2022 contributed to arguably the worst winter in NHS history.”

Let me sum that up, in a way the IfG can’t: the infighting, leadership coups, and instability of the Conservative Party, which gave us four health secretaries in four months, directly caused the chaos in the NHS.

The report concludes:

“Fixing the problems described in this report will take time and will not be easy. But higher standards could be achieved if services are reformed to work more productively. Such improvements will, however, require a different approach from government.”

Today, I want to outline how a government led by Keir Starmer will take that different approach.

Keir is unlike any candidate for Prime Minister our country has seen in my lifetime.

His superpower is that he came to politics late in life - he was 52 when he was first elected, having already reached the very top of the legal profession.

He doesn’t come equipped with an ideological straightjacket or factional loyalty that constrains his decisions. What matters is what works and what is right.

He doesn’t think in electoral cycles. Keir has set the project of the next Labour government - a decade of national renewal, committing us to incredibly ambitious missions that look beyond not just this election, but the one after it.

No leader of the opposition has had to prove their worth as much Keir has. Yet he has cleared every hurdle, as he transformed Labour from the wreckage, he inherited four years ago.

And along with Rachel Reeves and the Shadow Cabinet, he has finally answered the question which has hung around our party’s neck for years – ‘What is the point of Labour, when there is no money left?’

The answer is that it is precisely when times are tight, that Labour is most needed.

We understand the value of the pound in people’s pocket, how hard they work for it. So, unlike the Tories, our first and last resort isn’t picking the pockets of working people. And we will never be as careless as this Conservative government has been in spending the public’s money.

We come from public services; we rely on them. It is because Labour is rooted in our public services, that we can see how they need to change.

Keir’s mission-driven approach will harness all of our country’s talents. This proposition has at times proved controversial.

When Wes Streeting said that Labour would hold the door to the NHS open for tech entrepreneurs, it sparked hysteria amongst some very online people.

Putting aside the irony of these howls of outrage against the private sector being tapped into their Apple iPhones, and posted on Elon Musk’s X…

You have to ask- where do these people think the NHS gets its equipment from? Who do they think supplies NHS medicines?

The view that only the state can provide was roundly rejected in 2019. And the small statism of the Conservatives has left the country in the mess we find ourselves in today.

It will require a genuine partnership, business and government working together, to get Britain back on track.

Developers of new technology and treatments are banging on the door to the NHS. They have the potential to transform healthcare for millions of patients. Those who can afford to go private are already seeing the benefit. So yes, we’re going to hold the door open to them and usher them through, so every patient can benefit from the fruits of the technological revolution, not just the wealthy.

Around the world, the NHS is envied for its potential for fast adoption of new medicines, technology, and use of data. It’s about time the NHS realised that potential.

That is what Keir Starmer’s mission-driven government will be about.

As the IfG’s report makes clear, it is not just because the Conservatives are incompetent that they have failed, although they are and they have.

It is that their approach is wrong.

When Labour proposed toothbrushing in schools and nurseries for 3-5 year olds, Conservatives gave three different reasons to oppose it. George Osborne called it ‘nanny-state’- apparently working class three-year-olds don’t deserve the same care and support as Jacob Rees Mogg received aged 27. The Health Secretary said it’s already happening but then voted against it. While Andrea Leadsom, Children’s Health Minister, said Labour’s proposal started too late, because teeth begin to grow 9 months before conception. No wonder Rishi Sunak is so keen on Maths to 18.

The problem with the small statism of the Conservative party is not just that it fails to address the moral outrage of children going to hospital to have their rotting teeth pulled out - The number one reason for hospital admission for 6-10 year olds.

It fails on its own terms.

Hospital tooth extractions for children cost the NHS £81 million last year, up from £36 million 5 years earlier. With one in five children suffering from untreated decay, the costs are set to continue rising. In contrast, Labour’s plan to intervene earlier and prevent tooth decay will cost just £9 million. Yet the Conservatives choose to waste taxpayers’ money, and put children through unnecessary misery, because it fits their confused ideology.

We see this play out across the NHS.

Failure to invest in mental health means GP practices and A&E departments are full of people who’ve reached crisis point.

Because patients can’t get a GP appointment, they end up in A&E. Worse care for the patient, costing up to £2.5 billion for the taxpayer

You could fill 26 hospitals with the patients in hospital beds today, unable to be discharged, because there is no care available for them in the community. Worse care for the patient, at a cost of £1.7 billion for the taxpayer.

The Conservatives’ refusal to train enough doctors and nurses over the past 14 years hasn’t just left the NHS with 121,000 vacancies and patients with record-long waits. It has stuck the NHS with an annual bill of £3.5 billion for agency staff.

The Tories’ timidity on public health means obesity costs the NHS £6 billion a year.

Red tape that prevents health visitors administering vaccinations has left thousands of children without their MMR vaccine.

The alarm bells have been sounding since the UK lost its measles-free status five years ago.

Yet the Government has failed to act.

The cost of that failure is the deeply troubling measles outbreak we’re seeing today.

Strikes have cost the NHS £2 billion- almost certainly more than it would have cost to settle the junior doctors dispute at the start.

Across the health service - we are paying more and getting less.

This is the irony of the Conservative Party. They say they believe in a small state and low taxes. Yet they have left our country with the highest tax burden since the 1950s.

The NHS budget is £169 billion this year, yet record numbers of patients are waiting for treatment, waiting longer than ever before.

We must do better with the money the public gives to the NHS.

If we don’t, then the pressures coming down the track, caused by our ageing population and rising chronic disease, could overwhelm and even bankrupt the health service.

That’s why Labour is declaring war on NHS waste.

Every patient using the NHS has seen waste in the system. Whether that’s appointments missed because the letter arrived too late in the post; tests already done at the GP having to be repeated at hospital; or wasting a day’s work to go to an outpatient appointment at a hospital, that could have been done locally.

Everyone knows the inconveniences and inefficiencies. Especially those working in the NHS. They see it every day. From frozen computers at the end of a long shift, to the unnecessary box-ticking exercises that wastes staffs’ time.

Across the service, it adds up to an enormous waste of money we don’t have. A waste of time that is running out. And a waste of potential- because the NHS has so much going for it.

This is a cultural problem, set from the top. I don’t just mean the carelessness which led the Conservatives to waste £15 billion on unusable PPE.

The recklessness with which they crashed the economy.

Or the corruption, which saw them hand out crony contracts, so their mates could get rich quick off the back of the pandemic.

It is the caution, the lack of bravery in taking on necessary reforms. The Conservatives’ cowardice sees billions of pounds spent in the wrong places, and billions more missed in potential gains.

When Wes Streeting announced that Labour would cut red tape to bring back the family doctor, I was genuinely shocked that the Conservatives opposed it.

GPs are currently measured against more than fifty different targets. These experienced doctors are made to do millions of tick-box appointments. They’re even made to fill out forms about how burnt out they are. If Ministers bothered to ask GPs why they are so exhausted, they would know it’s largely down to burdensome bureaucracy grinding them down.

Yet Andrea Leadsom insisted ‘these targets are important’ and Victoria Atkins tweeted: ‘what would Wes cut?’

This knee-jerk opposition to change reveals that the Conservatives are now the defenders of a broken status quo, the enemies of reform.

In Singapore, hospitals run programmes called ‘Get Rid Of Stupid Stuff’. As someone who worked in the NHS, let me tell you, staff in this country are not shy about pointing out the stupid stuff they are made to do.

So, today Labour has set out ten ways in which NHS funds are wasted, being spent in the wrong places, or in which unnecessary red tape is keeping doctors from spending more time with patients.

From £200 million on paper and postage, a decade after Jeremy Hunt promised to go paperless…

To the £300 million cost of missed outpatient appointments, caused by NHS clerical errors.

If the Government doesn’t act on this, then Labour will.

We will set a Red Tape challenge for GPs and remove the unnecessary bureaucracy and targets which GPs say take up their time, and takes them away from the things that really matter.

In return, we will bring back the family doctor, so patients can see their regular GP each appointment, if they choose to.

No one understands where waste lies better than those working in the NHS. All parts of the service should become reformers in driving down wasteful costs. Labour will end the Department of Health’s expensive addiction to management consultants – costing over £600 million last year - because we will get better results consulting nurses, doctors, and staff on the ground. Cutting out waste shouldn’t be outsourced. Every part in the NHS must have a collective focus on getting more out for what we put in. This is critical. Not just to keeping costs down, but to improving care for patients.

Some in the NHS are already showing that simple changes can make a big difference.

One trust has cut a third of missed appointments, by texting patients with an appointment reminder, and allowing patients to reply if they can no longer make it. If this was adopted across the health service, hundreds of millions of pounds could be saved, and millions of appointments freed up. If we are successful at the next election, our job will be to take the best of the NHS to the rest of the NHS.

The Conservatives have refused to reform; refused to intervene early; and treated taxpayers’ money with utter carelessness.

But with a government that understands the value of public money, that is brave enough to undertake the reforms needed, that knows prevention is better than cure, the crisis in the NHS can be turned around.

I am not focusing on waste today just to bash the government – I would never do that. I want to give the public hope that the NHS can be saved. The money that is wasted today can be used to get the NHS back on its feet tomorrow. Labour has a serious plan to do just that.

Now, I can accept if the average person can’t recite all the elements of Labour’s plan off by heart. I cannot accept it when I hear media commentators say, ‘Labour is yet to set out its policies.’ It’s clear why the Conservatives say this- they don’t want the public to hear about Labour’s plans - They’re worried voters might like the sound of them. But it isn’t true. Just look at what we have already announced for the NHS alone-

• 2 million more operations and appointments at evenings and weekends
• Doubling the number of NHS scanners
• 700,000 more urgent dentistry appointments
• Recruiting new dentists to the most underserved areas
• 8,500 new mental health professionals
• Mental health support in every school
• Mental health hubs in every community

All paid for by abolishing tax breaks for the wealthiest.

Anyone one of those would make a real difference. Taken together, they will be transformational for patients who are today stuck on waiting lists, suffering from the impact of lockdown on their mental health, or unable book an appointment with a dentist.

More than just gripping the immediate crisis, Labour has set out our long-term reform agenda. The three big shifts we need to make the NHS sustainable for the future – so it becomes a Neighbourhood Health Service as much as a National Health Service, a digital service not an analogue service, a preventative service not just a sickness service. 

And we have worked up the first steps we will take to bring about these changes.

Earlier this month, Keir Starmer led the charge on public health, with our children’s health action plan. Keir is willing to take on the inevitable cries of “nanny state,” because our children’s health is too important.

The plan would mark a step change in our nation’s approach to prevention- not just toothbrushing, but protecting children from those who would cut their lives short, from vaping companies to the fast-food industry.

And don’t just take my word for it. Boris Johnson’s Health Minister, Lord Bethell, said:

“We’re seeing Labour and Keir Starmer mapping out a proposition based on healthiness and longevity. This chimes with voters worried about their kids, parents and their own futures. The Conservatives would be wise to take note.”

Lord Bethell felt so strongly about our plan, he managed to find his phone to tweet about it.

Labour’s Fit for the Future fund will mean patients in every hospital can benefit from AI.

Our reforms will get the latest technology into the hands of NHS staff far quicker than today.

And we will give power to the patient through the NHS app. 31 million people have the app in their pockets. Think of the good that could be done if it was used properly.

With Labour, patients will be able to take charge of their own healthcare. If you can track your order on Amazon, you should be able to manage, schedule, and track appointments for the NHS. Doing so could cut millions of missed appointments a year.

All patients will receive notifications when they become eligible for vaccinations and screenings.

When they are diagnosed with conditions like asthma or diabetes, they will be told what care they should receive from the NHS- so it’s not just the wealthy well-informed who can hold the service to account.

And they will be able to see which practices in their area are providing the best care for their conditions, so they can choose to switch if they want to.

Labour will trial neighbourhood health centres in every part of the country, so patients can get the help they need on their doorstep. These will bring together healthcare professionals like family doctors, nurses, physiotherapists, dentists, and mental health specialists under one roof. Patients could get treated for minor injuries like cuts and sprains, or have a scan, all without having to go to hospital. By bringing these existing services together, we will stop patients being pushed from pillar to post and take pressure off hospitals and GPs at the same time.

This is the shift in the focus of healthcare Labour will bring about over the next decade- out of the hospital and into the community.

It is more expensive to treat patients in hospital, less convenient for the patient, and much of what is done in hospital could be done closer to home. To be an outpatient, you shouldn’t have to go into hospital. The clue is in the name.

Take eye care. 619,000 patients are waiting for treatment. 17,000 have been waiting more than a year, while their eyesight worsens. Most are waiting for routine tests, scans, and assessments- simple appointment which could be done in an opticians. Patients are left with a desperate choice – wait and risk losing their eyesight or pay to go private. This is the two-tier healthcare system emerging under the Tories. It is unacceptable and Labour will end it.

I can announce today that the next Labour government would seek to negotiate a deal with high street opticians to deliver NHS outpatient appointments. There are 6,000 high street opticians in England, equipped with specialist staff and kit that can get patients seen faster. We will put them to work to beat the Tory backlog, free up hospital specialists to treat the patients in serious need, all at greater convenience to patients. As these are routine appointments, it will be less expensive to the taxpayer for them to be delivered on the high street than in hospital.

This is the partnership Keir’s mission-driven government is about – the state and the private sector working together to give patients get the treatment they need.

As we get closer to the general election, I keep being told of how, in 1997, Labour had big, bold, ambitious pledges that led to our landslide victory.

So, I looked back at our pledge card, and found the promise on health was not to deliver the lowest waiting lists and highest patient satisfaction in history – which we did. It was a commitment to cut waiting lists by 100,000 patients, by sacking a few NHS managers.

When Tony Blair appointed Alan Milburn as Health Minister after the 1997 election, he asked him to come up with a health policy, because we didn’t have one.

Today, people are even more cynical about the power of politics to change things than they were 27 years ago. I would argue cynicism is a bigger opponent for Labour at this election than the Conservative Party. That is why we have been so careful with our commitments – everything we have promised is fully costed, fully funded, funding better healthcare for the many by ending tax breaks for the few. But do not confuse a lack of big spending commitments with not having a plan.

In contrast to 1997, Labour is approaching this general election with:

• A plan to grip the immediate crisis in the health service

• A reform agenda for the next 10 years
• The first steps of that reform already in place
• And a set of ambitious missions over the next decade - ending long waits in the NHS, tackling the biggest killers, and building a healthier Britain.

Ours is a serious plan, not just for investment, but reform. A garden that has been neglected for 14 years doesn’t just need the hosepipe turning on. It needs tending, pruning, it takes time, it is an ongoing project, but after a lot of hard work, it blossoms.

If you want proof that Labour has changed- that metaphor isn’t mine. It came from a Labour party member speaking from the conference stage in Liverpool this year. Keir Starmer has changed the Labour Party, winning the argument for reform, and now he is ready to change the country.

And if you want proof that Labour’s plan is credible, then look at the response of the Conservative Party. They haven’t said it won’t work, it’s risky, or that it’s unaffordable. They can’t find fault with it, so they pretend it doesn’t exist. By ignoring Labour’s plan, they are giving it the biggest seal of approval possible, confirming that this is the serious plan for change the country needs.

A plan that will deliver a decade of national renewal for our country’s health.

A plan to get our NHS back on its feet and make it fit for the future.

Thank you."