Yesterday, Wes Streeting and Keir Starmer announced a ten-year plan to save the NHS. ‘There are moments in our national story when our choices define who are,’ Streeting explained. ‘Unless the NHS changes, the argument that it is unsustainable will grow more compelling. It really is change or bust. We choose change.’ One wonders whether he was tempted otherwise.

Starmer says the plan will oversee ‘three fundamental shifts in how the NHS works’. First, care will move from hospitals to the community. Second, new technology will reduce admin and ‘make booking appointments and managing your care as easy as online banking or shopping’. Third, the NHS will shift its focus ‘from sickness to prevention’, preventing ill health to begin with.

History sometimes seems to consist of governments failing to learn from their mistakes, and each one of those three ambitions will seem immediately familiar to even the most amateur students of the NHS.

Streeting seems genuine about wanting to make the NHS better and he is certainly correct that we need to

Beveridge, at the foundation of the NHS, believed that over time its budget would fall – by preventing sickness. He was wrong. Enoch Powell, later Minister for Health, called it ‘a miscalculation of sublime dimensions’. Why should it be different now?

The plan aims to reduce vaping amongst the young, attack junk food and soft drinks, expand free school meals, prescribe weight loss drugs, introduce new alcohol labelling, get people to exercise more, and to use genomics to enable ‘early identification and intervention for individuals at high risk of developing common diseases’. This last part sounds glittery, but the point about common diseases is that we’re all at high risk, and ‘genomics’ has not been shown to deliver benefits anywhere. The likelihood of it meaningfully doing so within a decade is small, and not obviously under the government’s control.

As for the other ambitions, none are new. Weight loss drugs, it is true, are at least fresh, and their use will grow immensely over the years to come, but that was always going to happen. Including them in the ten-year plan is opportunism, not innovation. Smoking rates have been steadily falling and will continue to do so. Diet and exercise are lovely ideas, but plans built on telling everyone to live healthier lives have not, thus far, borne fruit.

Our health since 1948 is fundamentally a happy story. We live longer, healthier lives. But for every extra year that has been added to longevity, an average of ten months are healthy, two months not. Perfectly reasonable to expect that our lives will continue to lengthen, but to imagine that the total time we will spend in bad health will somehow start to decline is to wilfully ignore reality. Prevention is a noble and worthwhile goal, but the notion it will make the NHS more affordable is a delusion. One worries about people whose plans are based on assumptions like these.

Harnessing information technology is also a dismally familiar ambition, and not only because Streeting has already described his plans in this regard. Writing about them in The Spectator, a somewhat grumpy doctor – as it happens, me – suggested that the NHS did not have a great record when it came to large IT projects. Efforts to introduce an integrated national electronic system – much like the one Streeting now plans – were judged, in 2013, when they were abandoned, to have wasted £10 billion.

Attempting to do the same again, and hoping for better results, speaks well of hopefulness but less so of sense. And declaring that ‘wearables’ will become a routine part of NHS care, as the plan does, sounds reassuringly high-tech, but nowhere in the world has anyone shown how to do this in a genuinely helpful way. Arguably our roll-out of wearables should depend on them being shown to be useful, not introduced because it makes a plan sound forward-looking.

Then there is care in the community. Enoch Powell pulled this one off to a high degree, shifting psychiatric care away from long-stay asylums. He improved a lot of lives in the process. The trend has continued across the NHS, and we now deliver more care (and spend a damn sight more money) with ever fewer hospital beds. We have fewer beds per capita than most comparable countries. Reducing them further, as the population continues to get frailer and more numerous, may still be possible, but it is far-fetched to imagine it will be transformational.

The plan talks of neighbourhood health centres ‘open at least 12 hours a day and 6 days a week’. Potentially, these will be popular with patients and helpful in providing high-quality care, but it isn’t obvious how they will save us money elsewhere. Notably, the plan somehow doesn’t mention which bits of hospital budgets, or what portions of hospital work, are going to become redundant as a result. Nor does it say how these places will work when the ‘Darzi centres’ – to which they sound eerily identical – failed so miserably. 

I have some lingering sympathy for Wes Streeting. He seems genuine about wanting to make the NHS better and he is certainly correct that we need to. Much of what is in the ten-year plan will succeed or fail not depending on its headlines, but on whether the bureaucrats can proceed in a sane and thoughtful manner; identifying their mistakes, avoiding hollow words and hollow acts, and learning from experience. Given how blind the ten-year plan appears to the lessons of past failures – and the fact it is recycling them – my hopes are not high.