Streeting can't heal the whole NHS now – he should focus on our hospitals

Sam Freedman

- 

The health secretary, Wes Streeting, will soon announce his long awaited 10-year plan for the NHS. We know it will talk about "three shifts": from hospitals to communities; from sickness to prevention; and from analogue to digital services.

Few would argue with the ambition. Clearly, it would be preferable if fewer people required expensive hospital treatment. The problem is that the last dozen or so NHS plans, stretching back to the mid-2000s, have all said much the same thing and it hasn't happened. The 2006 white paper used almost the same phrasing, and yet here we are with record waiting lists and public satisfaction at record lows.

As Lord Darzi said in his NHS review last year: “Successive governments have promised to shift care away from hospitals and into the community. In practice, the reverse has happened.” When an organisation continually follows the inverse of its stated strategy, there is little point restating that strategy without explaining why it will be different this time.

Part of the problem is that money intended for long-term shifts is often diverted to managing immediate crises. The Blair government was focused on rescuing the NHS from the mess it was in at the turn of the millennium, when a winter crisis left a single free intensive care bed in the whole country. All the focus was on cutting waiting lists and A&E waiting times, but this meant resources going into hospitals rather than community and preventative care.