Labour 2 years in: progress so far and prospects for health and care reform

When Labour took office in summer 2024, it inherited a health and care system in crisis. The following summer, the new government unveiled its 10-Year Health Plan. This promised a ‘truly modern NHS’ and outlined a reform agenda structured around three big strategic shifts. But despite a year in development, the plan was long on vision and short on detail. 

Fast forward to July 2026, and the 10-Year Health Plan has lost its political architect following Wes Streeting’s departure as health secretary. And with a new prime minister imminent, the government’s future priorities for reform are uncertain. Against this political tumult, we reflect on major policy milestones of the past year, Labour’s progress on heath and care reform so far and the inheritance awaiting the incoming leader.

Streeting’s legacy?

Our recent analysis shows that the NHS has made progress on the flagship political pledge to improve waiting times for routine hospital care. There are glimmers of improvement in public satisfaction with NHS services, though levels are still very low by historic standards. Our polling shows that a gap remains between public and political priorities, with access to GPs and improved A&E waiting times higher priorities for the public than waiting times for routine hospital services. NHS leaders have also emphasised progress made towards achieving financial balance across local NHS bodies, and a vote by resident doctors to accept a new pay offer this week may mark an easing of industrial tensions. 

Some progress has been made in fleshing out policy plans, for instance via clearer trajectories for recovering NHS performance, preliminary guidance on neighbourhood health services and steps to support the implementation of the government’s lofty digital ambitions (for example on ambient voice technology, a single patient record, a new digital NHS trust and other new technologies). On social care, legislation – though only limited funding – has been passed to improve pay and conditions for the workforce.

But a year on from the 10-Year Health Plan, there is still scant detail on how change will happen in key policy areas and clear gaps in Labour’s plans to transform the NHS and reform social care. A new national workforce plan is over a year late. Plans for digital transformation await an AI strategic roadmap and an MHRA national commission report on regulation. The latest GP contract shows signs of incremental change but is not transformative, and new neighbourhood contracts – seen as integral to shifting care from hospital to community – are not due to start until at least April next year. Other key parts of the puzzle on financial flows – such as the review of the Carr-Hill formula, detail on rebalancing spend between acute and community care services, and proposed new payment mechanisms – are also yet to come. Moving forward with much-needed social care reform awaits Louise Casey’s interim report. 

Meanwhile, significant energy continues to be spent restructuring the NHS, despite the government saying it would not embark on another top-down NHS reorganisation. Integrated care boards have been working through redundancy schemes and merger/clustering arrangements following deep cuts to their budgets last year. They are also navigating their reshaped role as ‘strategic commissioners’, an approach that has been tried before but has struggled to have a major impact on patient care or outcomes. Redundancies in central bodies are also underway, with associated costs across the NHS estimated at upwards of £1bn. Local government is working through its own reorganisation, with uncertain implications for adult social care. Our research with local NHS leaders last year found that these recent policy changes have caused widespread disruption and distracted integrated care system leaders from the government’s three shifts. And the disruption isn’t over for local leaders. 

Government introduced its health bill to parliament in May 2026. This includes measures to abolish NHS England and transfer its functions to the Secretary of State for Health and Social Care, make changes to integrated care boards, abolish local and national Healthwatch and more – alongside broad new powers for the secretary of state to direct local NHS bodies. 

But the bill requires further scrutiny and could yet be changed if Andy Burnham becomes prime minister. Key areas for potential revision include stronger safeguards to keep some policy processes at arm’s length from ministers, changes to maintain and strengthen collaboration across the health and care system, and rethinking the decision to abolish an independent patient voice function. 

New PM, new direction?

The bill may simplify the structure of the NHS and enable progress towards a single patient record, but it will do little to address the underlying challenges driving the UK’s poor health and struggling health and care system. With health declining and health disparities between the most and least deprived parts of England widening, the bill in its current form represents a missed opportunity to strengthen the statutory framework for improving health and reducing health inequalities.

More fundamentally, a new prime minister offers Labour a chance to revive its ‘health mission’ – so far largely abandoned – and widen the government’s focus from the NHS to health in support of its manifesto promise to halve the gap in healthy life expectancy between rich and poor regions in England. Amendments to the bill could help, but making it happen will require more than legislation alone. Investment and action are needed across government to address the wider factors that shape people’s health.  

Looking ahead

Resources to deliver Labour’s ambitions continue to look constrained, with a modest spending review settlement, new budgetary pressures arising from the UK–US drug-pricing deal and increased defence spending, and inflationary pressures due to a range of factors, including conflict in the Middle East. Local NHS leaders are sounding the alarm that cuts to services or reduced staffing levels may be needed this year. 

On social care, current investment will not be enough to fund promised improvements to services or planned wage rises – or to make more fundamental changes to reform the system. Burnham has previously advocated a ‘national care service’ funded by a national levy, so we can expect increased focus on social care reform, and a potential acceleration of the Casey Commission timeline. 

Starmer’s government chose improving elective waiting time performance as its headline political target on health. Delivering it increasingly looks like a long shot, and trade-offs are inevitable – particularly given the tight spending settlement for the NHS. Time will tell whether this remains the guiding light for ministers in the remainder of this parliament. Either way, they have much ground to make up if Labour wants to demonstrate progress on its promises to transform the NHS and reform social care by the next election.