With Liz Truss’s campaign to bludgeon the public finances temporarily becalmed and Boris Johnson pursing a new career as a spoken-word poet, The Telegraph has been hunting around for a new idol. Such a champion would need to talk tough on the unions, back an agenda of market-based reforms, and be keen to get public spending down. Strong views about the ECB’s mishandling of the County Championship are a plus.
Surprisingly for the Torygraph, the most eye-catching candidate for this coveted position has so far been Wes Streeting, the Shadow Health Secretary. Equal eye-raising is that Streeting is that highly unusual thing in the modern Labour Party: a genuinely canny politician. Raised in poverty by a single mother, Streeting made his way to Cambridge (boo, hiss), chaired the National Union of Students (ditto), and worked for Stonewall (once more with feeling). He entered Parliament in 2015.
That he has been receiving positive press from our party’s paper of record hails from his recent criticism of the NHS. The MP for Ilford North is positioning himself as the critical friend of our national religion. In his role as Erasmus, he told a Policy Exchange event this week that he “is not going to pretend the NHS is currently the envy of the world”, that is “failing patients on a daily basis”, and that the “patient voice is often the quietest in the room”.
To you or I, it might just appear that Streeting is stating the bleeding obvious. According to The Spectator’s excellent data hub, hospital waiting lists are at seven million, and predicted to reach nine million by early 2024. 37, 837 people waiting 12 hours to be admitted to A&E last month – up over 30,000 on a year before. Referrals, surgical procedures, and response times are all worse, and over 400,000 patients are waiting over a year. To say we are not “currently the envy of the world” is putting it lightly.
Nonetheless, Streeting’s words are significant. Not only because they are based on personal experience – he is still waiting for an appointment to get an all-clear after a recent brush with cancer – but because they show a rising star in Labour willing to challenge various articles of his party’s faith. Already he faces accusations of “declaring war” on NHS staff from the left for his criticism of the BMA and he has also spoken positively of the private sector’s role in healthcare under the last Labour government. A Blairite? Moi?
The reference to New Labour is important. It is easier for a party from the left to make these reforms. Their motives are not questioned; they are not accused of creeping privatisation. One can fantasise about a future Labour government being forced by a crisis to declare that a health service based around 1940s’ assumptions about universalism is unsustainable. Like James Callaghan telling his party in 1976 that they could no longer borrow their way out of a recession, Labour could finally say that the emperor has no clothes.
Yet I must disappoint any heretics on the healthcare question who might dimly hope that Streeting could be their man. For all his willingness to raise a few eyebrows, the Shadow Health Secretary’s prescriptions are the same old dross from Labour. He suggests that more money must be matched by “reform”. But his proposals for that so far amount only to suggesting Labour would train more staff and tax non-doms for more cash to shovel down the health service’s gaping maw.
Streeting has not gone as far as Gordon Brown’s recent barmy review and suggest that healthcare free at the point of use should be made some sort of constitutional right. Yet his unwillingness to depart from the shibboleths about the health service’s fundamental structure suggest his comments are far less radical than they first appear. All the while, the Government shovels £13 billion more into an NHS which has many more staff but treats fewer patients than it did before the pandemic.
Perhaps Labour’s golden boy should take the advice of Sajid Javid. The former Health Secretary – and current beard enthusiast – also drew attention to himself this week by suggesting health insurance should be considered to help pay for the NHS. According to Javid, the current funding model (general taxation) was not “sustainable for the future” and that we need an “honest debate” about how it should change. He pointed to France and Germany as alternative systems we could imitate.
Javid is fundamentally right. The NHS cannot, as he put it, “survive many more years” with its current structure. Or at least it should not, if our politics made any attempt to interact with reality. It already is set to take up over 40 per cent of government spending as an aging and entitled population demand ever-more attention. Not only does this further pile pressure on the taxes of us hard-working young folk, but it represents ever more good money being thrown after bad.
The NHS is another way – like the Town and Country Planning Act, the nationalisation of the Bank of England, and the failure to engage with the negotiations on the European Coal and Steel Community – of how the Attlee government burdened up Britain. International comparisons rate it good for accessibility – in principle, at least – as one would expect. But even favourable ratings like that of the left-wing American organisation the Commonwealth Fund still have our health service rated 10th out of 11 for keeping people alive.
Sooner or later, the truth must be admitted, and the emperor arrested for public indecency. James Frayne has often highlighted for us that voters believe there is a large amount of waste in the service. Recent increases in the number of people going private might suggest the tide is turning. But Javid will not be part of any effort to ride that wave. He says more about the prospects for NHS reform by leaving Parliament to have more time for flicking through The Fountainhead than he does by making eye-catching interviews.
Crossing the NHS Rubicon does not have to be left to Labour. As Dominic Cummings has long argued, the Conservatives can only introduce fundamental reform to the service’s structure once they have won voters’ trust that their hearts are in the right place. Post-Brexit, under Johnson, and against Corbyn, the Tories began to draw ahead of Labour as the party most trusted with public services. Nobody noticed, and Covid blew destroyed any chance of making further inroads. The health service was to be ‘protected’, not challenged.
Such a process would require at least two-terms in power: a first where money was ploughed in to win voters’ trust, and a second where the reforms were actually enacted, perhaps after a Royal Commission or other face-saving exercise. Bluntly, that is now off the table. Sunak is reportedly interested in NHS reform, but his priorities are electoral. This is no time for revolutions. Waiting lists must come down before the next election, and striking nurses must not be allowed to blow up the public finances.
That is hardly a manifesto for radical change. Then again, neither is Streeting’s proposition of a few more nurses for a few fewer non-doms. The depressing truth is that an end to our dysfunctional health service remain as distant as ever. Some future crisis may finally force the issue. But putting any faith in Streeting’s tough talk is as misguided as the woolly idealism that has always lain behind Nye Bevan’s greatest folly.