Wes Streeting can certainly talk the talk. Labour’s new Health Secretary promises to cut waiting lists almost immediately, understands the NHS model of health care is ‘broken’, plans to prioritise reform over investment and, for good measure, vows to get to grips with Britain’s ‘sick note’ culture.
It’s an encouraging agenda, especially with its emphasis on NHS reform, which the Tories pretty much abandoned in their final years, as internecine warfare exhausted their energies, leaving no time for public-sector change.
Whether Streeting can deliver is entirely another matter. The Left in his own party and beyond are already growling at his enthusiasm for using the private sector to enhance the medical capacity needed to cut waiting lists.
The powerful vested interests within the NHS are none too happy about that prospect either. We shall soon see if he retreats at the first whiff of grapeshot from the unions and the bureaucrats — or throws himself into the fray.
Health Secretary Wes Streeting promises to cut waiting lists, understands the NHS model of health care is ‘broken’, plans to prioritise reform and vows to fight ‘sick note’ culture
One thing is clear: if he means what he says, he will have a fight — numerous fights — on his hands.
His ambition cannot be faulted. ‘I want to the end the begging bowl culture, where the Health Secretary only ever goes to the Treasury to ask for more money. I want to deliver the Treasury billions of pounds of economic growth.’
Fine words. But perhaps the sort of sentiments ministers express when they’ve barely got their feet under the desk, but then quickly forgotten when the pressures of office start crowding in and what seemed attainable in opposition looks daunting in government.
I suspect the NHS will be rattling its begging bowl at the Treasury door for some time to come. But I see what Streeting is getting at.
If Labour is to deliver its promise to kick start and maintain economic growth, it will need to tackle the 2.8 million people of working age who are classified as economically inactive because they are deemed to be suffering from long-term sickness. They are a drag on growth.
It costs the Treasury billions in terms of lost tax revenue (because people are not working) and extra welfare spending. The number has grown by almost 130,000 in the past year alone and official forecasts have it rising for the rest of the decade to more than 3 million without a change in policy.
Some are seriously ill and cannot work. The welfare state exists to look after them. Others are more marginal. They need to be coaxed, gently but firmly over time, to return to work. Some are simply skiving. They need to be treated robustly.
Prime Minister Sir Keir Starmer and Mr Streeting visit Bassetlaw Hospital in Nottinghamshire to discuss their plans to support the NHS with workers and patients
The Tories used to be strong on ‘welfare-to-work’ policies. They lost the plot after the pandemic. When the last Tory chancellor, Jeremy Hunt, tried to revive welfare-to-work, he was immediately accused of ‘demonising’ disabled people. Streeting will need to gird himself for the same unreasonable onslaught.
The media will pile on, especially the broadcasters. At the moment they’re enjoying a honeymoon with Labour, acting almost like the broadcasting arm of the new government.
But if Streeting is true to his word, it won’t be long before they’re showing ‘hardship’ cases of people supposedly forced back to work unreasonably or prematurely. It could be only a matter of months before the broadcasters start coming at the Starmer government from the Left.
Nor is it clear if Streeting can get the waiting lists down quickly. About 7.7 million patients are waiting for treatment — a disgraceful inheritance from the Tories — including almost 400,000 who’ve been waiting for a year and more than 3 million who’ve been waiting more than 18 weeks.
Streeting says he will create an extra 40,000 appointments a week by getting NHS staff to work at weekends and evenings, plus doubling the number of scanners.
It remains to be seen if NHS staff will oblige, even with the carrot of generous overtime rates. The cost is meant to be met by subjecting non-doms (foreigners who live and work in Britain) to UK taxation on their worldwide income (until now they paid tax only on UK income).
But non-doms are already fleeing Britain for friendlier shores. This is a goose that might have few feathers left to pluck. And even if it does, after all, raise the projected extra £2 billion, that’s unlikely to be anywhere near enough to axe waiting lists.
If an extra couple of billion was all that was required, given the sums recently pumped into the NHS, waiting lists would already be tumbling.
Streeting is on his strongest ground when talking about using the private sector to increase resources available to the NHS. This is, of course, anathema to many in his own party and to most of the powers that be in the NHS. It is always met with cries of ‘privatisation’, a knee-jerk reaction which is never true, even under the Tories, but closes down debate and rational thinking.
It is perfectly sensible to use private medical facilities for NHS patients on a waiting list many millions long if the patient’s treatment is high quality and still free at the point of use.
Who, bar the dumbest ideologue demanding that the state must provide all healthcare, could object to that. Yet only recently that was exactly the position of Streeting’s party. Sensible folk will welcome his break with the past.
Any attempt to reform the NHS by using the private sector for treatment or offering an element of choice — state hospital or private clinic, for example — is always met with privatisation claims and accusations of moving to an American-style private system. It has stymied serious debate and hindered real reform.
The American and British health systems are, in their own ways, the two worst health systems in the rich world. Nobody has ever copied them. Nobody in their right mind would.
Europe provides plenty examples of systems which still provide health care regardless of ability to pay but attract extra money though co-payments (small upfront charges), top-ups and the like, which result in better health outcomes.
Labour is packed with Europhiles who often prefer European ways to our own. Except, because of a blinkered view of the NHS, when it comes to health.
Streeting claims Labour’s reform agenda ‘will turn the NHS on its head. From a service focused on hospitals to one providing more care in the community, analogue to digital, sickness to prevention’. All sound sense. But the powerful vested interests of the NHS will resist much of what he proposes.
Just imagine the rows to come when funds are moved from hospitals to community health services. Or the union backlash when new technology makes thousands of NHS jobs redundant.
Artificial intelligence (AI) has the capacity to revolutionise health care, from testing to diagnostics to supply chains. But ours is a health service which wasted £10 billion on an IT system to digitise patient records which was abandoned without ever being introduced.
That the NHS will somehow be in the vanguard of AI does require a leap of faith which past experience does not justify.
The NHS now employs more than 2 million people, up from 1.56 million when the supposedly anti-NHS Tories came to power. The workforce will pass 2.5 million sometime in the next decade.
It already accounts for one in three public sector workers, it’s annual budget now more than £180 billion, up £50 billion since 2010 — and still rising because no amount of money is ever enough. It has become a behemoth almost beyond reform or even political control.
Wes Streeting has the right instincts. He knows, broadly, what needs to be done. I wish him luck. He’s going to need it.
