Happy New Year. At this time of year, it is customary for columnists to discuss what they think will be important and could happen in the next year. There are many real problems in the world at the moment, but I am going to focus on two which I have mentioned during the past year, Ukraine and the state of the NHS. I believe we could make progress to solving both with firm political leadership in the year to come.
Ukraine
The Ukraine War grinds on, and both sides are becoming exhausted both physically and militarily. Despite its greater strength in rockets and armaments Russia is finding it harder to find recruits. The Ukrainians have shown great ingenuity, with making drones, for example, but their supplies are limited and will soon be exhausted. There are echoes of Finland in 1939, but the Ukrainians would quite rightly refuse any solution which required concessions from them but offered no guarantee that Russia would not regroup and invade again. Remember they were offered assurances of territorial integrity by Russia at the Minsk summit in 1991 which were not honoured, but none of the supposed guarantors of that agreement, The Organisation for Security and Cooperation in Europe, took any action
Trump has said he would end the war quickly, and if that includes ceding territory in the east to Russia, there must be guarantees that Russia will not try to invade again. The only effective way to do this would be western troops in Ukraine or membership of NATO. I have reluctantly come round to the idea that to effectively end the war Ukraine must be allowed to join NATO as part of a territorial settlement. Finland was supposed to stay neutral after 1939 but has now joined NATO. Putin will make a lot of noise, but his past behaviour has shown he is reluctant to take serious action against the west.
The danger is that Trump will want a quick deal to save face, and reduce the cost to America of supporting Ukraine, and will not worry about guarantees. This is where Britain will have a role. As a strong supporter of Ukrainian independence, we should take the lead in allowing Ukraine to join NATO, whatever Trump does or says. Britain has a role here, and we will have to stand up and be counted.
The NHS
My second issue, the state of the NHS, will need a much longer time span to resolve, but a determined government needs to make progress.
The NHS faces a basic challenge. The population is ageing, and this means the demand for health care will increase. The two big challenges are helping people live healthier lives and caring for the increasing population of elderly people outside hospital. The immediate concerns of the public though are always how long it takes to see a GP, and the length of a wait for an operation. When he was Secretary of State Jeremy Hunt admitted the immediate pressures on him to reduce waiting lists prevented him from thinking about the longer term problems.
To be fair the government has taken some measures aimed at improving health. Junk foods cannot now be advertised on TV before 9 pm and not at all online. But the real challenge is to increase the funding for Public Health to enable them to work in the community to encourage healthy lifestyles. The last time a serious effort was made to do this was by the Blair Government, with some success. You cannot order people to live healthily. You have to work with them so they can do it themselves.
The problem of social care needs to be resolved too. Far too many older people are in hospital because the care they need is not available in the community. Care has to be commissioned by local authorities from the providers, usually private, whose budgets are limited. The long-term solution would be to integrate social care into the NHS so it was available to hospitals and community services when needed, but this will inevitably be costly initially as the facilities will have to be purchased from the current providers.
It is easy to feel frustrated by the immensity of the challenges if we are to make the NHS fit for the sort of society live in now. Suggesting that the problems of the NHS can be solved by greater efficiency, or even using appliances which are now discarded more than once are not going to be enough. As Darzi demonstrated in his recent report, that far from reducing the share of the NHS budget they consume, hospitals have increased the proportion of the NHS budget they use from 47% to 58% between 2006 and 2022. This means less money for GPs and community services. But Streeting and Starmer both know this is not the right direction of travel.
The Labour Party needs a challenge all the members will support to counter the current mood of despair amongst many of them. Is not fixing the NHS for the new century one which would receive considerable public support? Yes, it would require an immediate injection of funding as Tony Blair did back in 2005. If the public believed this would fix the NHS then they would support it. The challenge for this government in 2025 is to begin the task.
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