Why Sir Keir Starmer's NHS report could be bad for Scotland

The rapid review, carried out in nine weeks, said the health service in England “is in critical condition, but its vital signs are strong”. The 142-page report sets out widespread issues, including a failure to cut waits in accident-and-emergency (A&E) departments, missed targets for treatment and cancer care, and low productivity in hospitals despite investment in staffing.

Sir Keir said he would “accept the challenge” of fixing the NHS, but warned it would be “measured in years, not months”.

But a significant question looms over what the report’s findings mean for the devolved health system in Scotland, whether in terms of funding or changes to how the Scottish Government approaches the health service.

The Prime Minister appeared to suggest the report will not mean an immediate boost from Barnett consequentials, in terms of more money heading north of the Border, stressing “reform does not mean just putting more money in”.

Sir Keir said his ten-year plan for the NHS would be about changing it into a “neighbourhood health service”. He said this would mean “more tests, scans, healthcare offered on high streets and town centres, improved GP access, bringing back the family doctor, offering digital consultations for those that want them, virtual wards and more patients safely looked after in their own homes where we can deal with problems early before they are off work sick and before they need to go to hospital”.

If there is no more funding but an expectation services will improve, NHS Scotland will also likely have to innovate rather than simply spend more money.

Dr Iain Kennedy, the chair of British Medical Association (BMA) Scotland, told The Scotsman while the report focused on NHS England, it echoed many of the concerns the professional body had been highlighting for some time.

He said: “The NHS in Scotland too is suffering from years of underinvestment, staff shortages and surging waiting lists. Patients in Scotland are struggling to see their GP, with demand outstripping capacity, and waiting far too long for procedures and in A&E departments. Despite staff doing their best to cope with enormous challenges, there is no doubt the NHS in Scotland is in serious trouble and we are seeing the creation of a two-tier system where those who can afford to go private are forced to pay for care.

“Lord Darzi warns in his report that the first step towards rebuilding public trust and confidence in the NHS is to be completely honest about where it stands. We would urge the Scottish Government and politicians from every party in Scotland to heed that finding and ensure the crucial issue of the future of the NHS is not treated a political football.”

BMA Scotland is now calling for an urgent discussion about the future of the health service, and repeated its calls for the Scottish Government to have a “National Conversation” on the future of the NHS.

Dr Kennedy said: “As Lord Darzi points out, we cannot afford not to have the NHS and it will take years, rather than months, to fix the challenges. It is not too late to return it to peak performance – but we also need radical action right now in Scotland to ensure it will survive.”

From a UK government perspective, relations with the BMA remain fractured. Earlier on Thursday, UK health secretary Wes Streeting told BBC Radio 4’s Today programme the BMA should stop “sabre-rattling” and work with the government on the future of general practice. Mr Streeting said there was still the “unnecessary threat of collective action” from the BMA’s GP committee that “would harm patients”.

Another conclusion from the report was the NHS was “weakened by austerity in the 2010s and a lack of investment in buildings and technology”. Responding, SNP sources were keen to stress their party had called Labour to commit an additional £16 billion of investment in the NHS to help address inflationary pressures and long-term underfunding. While this report does not assess NHS Scotland, it is undeniable the impact of this in England will also have been felt in Scotland.

The SNP has previously published research showing the UK spends less per capita on health than many countries in Europe, and also has fewer hospital beds per capita. As such, they hope this issue is addressed, but that is a wider desire rather than a clearer policy goal.

SNP Westminster leader Stephen Flynn argued the report showed the impact of “14 years of Westminster austerity cuts, chronic underfunding and Brexit”. He said: "For more than a decade, the SNP has repeatedly warned about the damage UK government cuts and underfunding were causing our NHS. There is no escaping the fact that alongside constant modernisation, the NHS needs more money - and it needs it now, if it is to deliver the best possible healthcare.

"The Chancellor must deliver a major funding boost for the NHS at the UK budget, as the SNP called for during the UK general election. The simple fact is hospitals won't build themselves - and you can't recruit more doctors and nurses, or secure better equipment and waiting times, without adequate investment.

However, speaking to MPs, the overriding feeling is this is about investment, rather than simply adapting.

One Lib Dem source pointed to the promised 40 new hospitals committed by former prime minister Boris Johnson, which still have not been delivered. The source told The Scotsman: “You can innovate or use AI or go digital, but you cannot build a hospital or pay staff or buy equipment without increasing spending.”