April 9, 2024 - 10:40am
At last. A frontline politician willing to take on the Left — and not just where it’s most vulnerable, but in regard to the cult that surrounds the NHS.
In a blistering op-ed for the Sun, our hero points out that “the NHS is a service not a shrine”. He goes on to argue that private sector capacity should be used to cut waiting lists. He disdains the “middle-class Lefties” who cry “betrayal” at the very idea, insisting that the NHS must have “major surgery”.
So who is this man? A Tory Right-winger? The leader of Reform UK? It’s actually Wes Streeting, Labour’s Shadow Secretary of State for Health and Social Care.
I worry about him. Not because he’s wrong, but because he’s right. There is no saving the NHS without reform — and it’s going to take extremes of political courage to make it happen.
Streeting claims that “only Labour” can deliver fundamental reform, and he’s probably right about that too. The last time the Tories had a proper go was when Andrew Lansley tried to restructure the NHS in 2012. In doing so, he provoked a full-scale rebellion by the Royal College of Nursing and the British Medical Association. He was soon replaced by Jeremy Hunt, that Tory grim reaper of would-be reformers.
But on the Nixon-to-China principle, could Labour forge ahead where the Tories drew back? It’s certainly worth a try, but Streeting should remember what happened to Frank Field, who was appointed Tony Blair’s Minister for Welfare Reform in 1997.
The parallels between the two men are intriguing: both inspired by their Anglican faith, both leading lights of the Labour Right, both widely admired for their expertise, both expected to achieve great things in government.
But once in office, Field soon fell foul of Labour’s internal politics. His radical proposals for welfare reform were blocked by a jealous Gordon Brown — and Blair, unwilling to battle with his Chancellor, abandoned Field, who left the government and, eventually, the Labour Party.
If Streeting doesn’t want to follow a similar trajectory he needs to be confident that Keir Starmer has his back. Of course, every word of his Sun article will have been approved by the Labour leader’s office — including the dig at “middle-class Lefties”. But that doesn’t mean that Streeting can relax.
Indeed, he should still be suspicious. The latitude he’s been given to épater Labour’s bourgeoisie may look like a mandate, but it also makes him enough of an outlier to be thrown overboard (should the need arise).
Even if he isn’t being prepared as a sacrifice, Streeting is the canary in Labour’s coal mine. If he falls from his perch, then that would be a signal to every other reform-minded minister to wind their necks in.
It would mean the loss of yet another chance to reform the NHS — just as Blair and Brown blew their opportunity to reform the benefits system and the welfare state more generally. The difference between then and now, however, is that the last Labour government had plenty of money to spend. The same will not apply to Starmer — if he abandons his reformers, there’ll be nothing left.
Peter Franklin is Associate Editor of UnHerd. He was previously a policy advisor and speechwriter on environmental and social issues.
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SubscribeAt best we’ll get a bit of tinkering – when what’s required is a completely new model based on mutualism rather than the centralised state control which empowers vested interests at the expense of taxpayers.
In fairness to Labour I do sense that as government comes closer there is more of a realism, at least in part, coming to the fore. I do have some disagreements with Streeting, notably he seems to have bought big tech snake oil, but he deserves real credit for his comments on a need for less sentimentality around the NHS. And I would agree that it probably needs a Labour figure to say it.
Indeed it is interesting that he doesn’t (yet) seem to have been attacked particularly strongly for his views by either Labour or Conservative folks. Whether that means they think he’s right and just can’t say so politically, or whether he’s not had a response because no one seriously thinks his ideas will go anywhere is an open question.
Like you I think that, sadly, we won’t get the new model that we need and the NHS will go into business as usual mode. Which is a shame, not least because Streeting has put his head above the parapet and he should get a hearing.
In that regard the Frank Field comparison seems a good one.
Whether that means they think he’s right
I suspect they know he’s right. But there are just too many sinecures at stake for him to be allowed to succeed. Hope I’m wrong. We’ll see.
If something is free, people will abuse it. Still is and always has been.
All those boomers insisting on getting their hips replaced, even though they don’t need it, just because it’s free! Enough already!!
But that the issue, the NHS does a lot more than hip replacements. Its scope is ridiculously huge.
People do time waste the NHS because it’s free. I know nurses who tell me about people turning up to A and E for a paracetamol. They also don’t bother with a healthy lifestyle due to the free NHS.
The scope is probably somewhat too great (fertility treatments?) – but the overwhelming bulk of costs full upon conditions that we would all accept as medical. Costs have risen greatly mainly because people live much longer and we can treat many more conditions.
While I support NHS reform and I’m not even averse to some direct charges being made, I do become irritated by these glib “bon mots”. Yeah, I would be queuing up for as much dental treatment as possible, if it were free, I enjoy it so much!
What do you mean “always has been”?. Nothing was ever provided “for free” for hundreds of years, perhaps with the exception of the bread dole in the Roman Empire.
The problem is too large and too serious to be a political football, which it is. There should be a commitee drawing representatives from all parties. They should take evidence from countries similar to us to find what works and then the committee could devise an alternative to what we have got, which clearly is failing. They should come up with a different system which would be presented to the country as a fait accompli. This is unlikely to happen and so the the present system will limp on, letting down the poorest in society while the better off will buy a superior service for themselves. Which is already happening in dentistry.
Ah yes, a committee, that will solve it!
100% chance the committee will be stuffed with the Blob who will recommend more AI and more victim shaming of the fat, the smokers et al.
The issue needs taking out of the hands of both political parties who use the subject as a way of battering their opponents while nothing changes and the public suffers a deteriorating service.
The model is no longer working but the only way to change it is for united politicians of all colours to present a new model as a done deal to the public, a significant section of which still have a romantic attachment to a system that betrays them.
Surely the progressives are against “fatphobia”?
Of course people have some responsibility to look after their own health! There isn’t all that much obesity in poor countries.
Not optimistic.
Streeting one of the best front bench media performers. He’s quick of thought and evidentially sharp. He won’t be a Frank Field mk2. If anything the problem may be how long he gets left with Health (if Labour win) before an even bigger job.
Author though shows his bias when he refers to Lansley’s reforms falling foul of the RCN and BMA. That wasn’t the issue at all. They didn’t work because they were a bureaucratic shambles that created more structures of uneconomic size, redundancy costs, confusion and with no upside. They were based on a belief a even greater role for a market with smaller groups of GPs calling the tune would work. It was never going to work and cost a fortune. At same time Tories failed to invest in proper long term workforce planning and in infrastructure when interest rates were exceptionally low.
There is though no big Policy ‘magic bullet’ on health in the UK. There will be an important role for the private sector in some elements of care. Streeting knows that. He also knows we must be at forefront of big data, one of the NHS’s unique selling points and advantages, and forefront of AI. But fundamentally the recovery job relates to staffing and esp the demographic timebomb of an aging workforce alongside an aging population.
Starmer and Streeting have got themselves into a position where no one seriously thinks that the Brown/Blair model of doubling funding is going to happen this time, and credit to them for that.
Your last paragraph though is the key one. What all governments have been dealing with really is ageing population. What we are seeing now is the demographic timebomb going off. Covid probably accelerated bad trends, but base of it all is ageing population. That of course doesn’t just affect the NHS, it’s lots of things.
Staffing is a difficult one (and I worked in medical staffing for more than 10 years). The difficulty is staffing, but more specifically it is, ‘staffing in unpopular locations in unpopular medical specialties.’ Importing lots of nurses is great but if they don’t go to the places they are needed in roles they are needed for significant time then it doesn’t solve anything. At worst you end up importing staff for agencies, not the NHS. Money I suspect is not really the answer either. NHS staffing needs a scalpel not a blunderbuss. And I do realise that won’t instinctively have a lot of electoral appeal and it won’t make the professions happy.
Whilst I do think Streeting deserves some praise for being so forthright about the NHS’ place in the scheme of things, I’d just be a bit more comfortable if he’d be a bit more granular when he talks.
I agree with all that SH. One assumes the limited granularity partly because they are still assessing the situation they’ll inherit, and esp the potential financial challenges, and then also a political calculus that to much detail an unnecessary political risk at this moment.
What makes it worse is that a large percentage of the aging population have such a vast sense of entitlement. When Theresa May suggested that some of the trillions of unearned property wealth that boomers have acquired as a consequence largely of Gordon Brown’s incompetence might be used to pay for their social care the loudest howls of outrage came from the Guardian. Tells you everything, really.
I’d go further and back a wealth tax. If money is needed to solve the problems we have, this is the fairest place for it to come from. It’s been a complete gravy train. Now it’s time to give back some of the gravy.
Totally agree. Needs some careful thought where and how but even amongst some of the v rich there is a recognition this is where we need to go. I think Reeves will be cautious but gradually move a bit more in this direction.
Of course there was a ‘howl’ but not so much from Guardian readers HB. The reason it went back in the box was Tory supporters and potential voters squealed. Were it just Guardian readers they wouldn’t have changed course as they wouldn’t have expected them to vote for them anyway.
It probably needs a cross party consensus. Much like future of the State Pension. We’ve had 14yrs of really difficult but vital long term policy issues being avoided. Some of this is understandable, but only so long they can be put off.
The NHS needs to a)restore bursaries for nurse and midwife training with a requirement to work in the NHS for a few years or repay costs. b) stop providing incredibly expensive drugs to extend life for maybe 6 months c) stop all “gender-affirming care” and quite a few other very expensive choice type surgeries. d) train more doctors than the BMA wants to with the same provisos of staying in the NHS for say 5 years. Lots of other tweaks needed but these are a start.
Totally agree, as a heaith professional for the past 35 years.
50% of NHS costs are now in non-patient facing ledgers. Anyone with half a brain could find ullage there, which suggests the problems lie in resistance to change – whether political will, vested interests, etc. Courage rather than expertise may be the order of the day. Sadly, that virtue appears to be woefully lacking in a “just be kind” (irrespective of the outcome) world. Wishing him well.
As above. The NHS seemed to strangely resemble the (mal)functioning of the late Eastern Bloc Czechoslovakia, which I had visited shortly before starting my nurse training in the NHS in the1980’s.
All the glaring deficiencies of socialism in full view. Sadly the virtuous idealism of each generation blinds us as to the bl—ding obvious, when observing the outcome of the Russian revolution of 1917 and that of all other ‘Communist’ revolutions. Sadly human nature/reality will always win uber alles.
The reality of an ageing population is what fills me with dread around the assisted dying debate. The Matthew Paris school of thinking suggests that certain lives (ie elderly ones) are about to become very cheap. Even if one agreed with such an analysis that shift in mentality would put us on the slippery-est of slopes. After all, the discussion is nested within a much bigger trend that elites favour – transhumanism. In short, if we don’t reform the NHS then we face interesting moral and philosophical choices which will affect everyone, irrespective of age. .
Seriously, Peter Franklin, are you still actually listening to what these people say? Do you really think that it has any bearing on reality? Do you really think that anyone, outside of their family and friends, cares what these characters you refer to as “Starmer” and “Streeting” think, feel, and do? Who, apart from Streeting, actually cares if Streeting gets fired, or if Starmer runs out of reformers, or if the reformers turn on Starmer, or if “the Left” revolts, or blah blah blah whatever. Does any of it actually really matter? Seriously?
Put it this way, if “Starmer” and “Streeting”, and whoever their ostensible political opponents are supposed to be, were suddenly replaced with other characters from their silly little pointless, defunct so-called parties do you think that it would make any difference to the defenceless NHS patient who sits at the mercy of an overwrought, overworked, deeply indoctrinated junior doctor at the end of a 20 hour shift and the end of their tether, behind whom lurks the ominous power of a psychopathic tech and pharma industry intent on defending its profit streams at all costs, truth, health, and integrity be damned?
The edifice of our national politics, and with it political journalism, is crumbling. Those of us fortunate to be outside of the bubble, who haven’t written speeches on “environmental and social issues”, can see it the most clearly: pieces like this will not age well. Perhaps, Peter, it’s time to summon some courage and get in to the real world before the journalistic simulacrum that you appear to be living and writing in comes crashing down around you? But who knows, maybe I’m wrong and this dreary wearisome, political journalism will just pootle along as it has done for many a year. Whatever keeps the wolf from the door, I suppose.
From the bits I’ve read, a fairly common consensus seems to be one of the main problems is a simple lack of capacity, especially low level social care for the elderly. You have lots who don’t need full on hospital care, but end up blocking beds for days at a time simply because there’s nowhere else to put them.
This lack of beds then leads to a backlog that sees expensive operations cancelled as you have no space to put the patient afterwards, expensive doctors who should be operating stood twiddling their thumbs etc. and also ambulances queued up outside the doors as they’ve got nowhere to dump the casualties which ties up the paramedics for hours at a time. You can employ all the doctors and nurses in the world, but if you haven’t got the infrastructure and space to move the patients through the system it’s pointless.
Most people are fairly resourceful, if you’ve got the space there they learn how to jiggle things around to make it work. If there’s no beds though there’s nothing the staff can do to keep things moving along
This is the worry. Is Starmer really a strong enough leader to back radical change against resistance?
If he is, then we now need someone with guts to tackle the housing problem.
it is not about saving the NHS it is about developing a type of medicine that is not there for the industry but for the people (see several articles on link between pharma and medicine in the BMJ). This medicine needs to accept that we are complex beings in complex relationships (other people and environment) and needs to have a as a goal fostering health and resilience. (instead of selling potions and diagnoses). This is recognised in the Gujarat declaration for instance. In a reply, when asked what the UK will do in relation to this declaration, I received a waffled response: the ministry for health has not clue about health. It is the ministry of ‘sickness business’…. unless, one day, when journalists and the medical corps really starts speaking and thinking about health (instead of absence of illness) things will get better…
https://www.g20.org/content/dam/gtwenty/gtwenty_new/document/G20-New-Delhi-Leaders-Declaration.pdf
Nobody has mentioned Palantir?
https://www.bmj.com/content/383/bmj.p2752