18 December 2022

Weekly Briefing: The season for NHS heresy


In the spirit of festive generosity, we ought to give Wes Streeting his due. For a Labour politician to say, as he did this week, that we should not ‘pretend the NHS is the envy of the world’ takes a degree of guts and political self-awareness that has been sorely lacking in the opposition for most of the last decade or so.

The Shadow Health Secretary’s critique was also notably broader than the usual platitudes about ‘underfunding’ or dastardly Tory ministers making the wrong decisions.

‘We cannot continue pouring money into a 20th-century model of care that delivers late diagnosis and more expensive treatment’, he argued, before calling his leftwing critics the ‘true conservatives’. As a piece of ‘heir to Blair’ political messaging it could only have been clearer if he’d delivered it at a well-known rightwing thinktank – which is exactly what he did.

He has a point too. Even the most devoted NHS religionists would struggle to argue that the service is fit for purpose. The pandemic hangover means the waiting list now stretches beyond 7 million and stories of people waiting hours upon hours in A&E, of backed up ambulances and patients on trolleys in corridors are now so commonplace we’ve become inured to them.

It’s no longer accurate to call this an ‘NHS winter crisis’, which suggests something out of the ordinary. This is simply what winter looks like every year – this time with added strikes and steep inflation. Clearly, many of these problems have been hugely exacerbated by Covid-related demand, but the pandemic alone is not responsible for the NHS’ woes.

We often discuss the service in cliched terms about ‘breaking point’ or, for some leftwingers, ‘creeping privatisation’. But for an increasing proportion of the public the service has already broken and they have privatised their own healthcare out of sheer necessity. As the FT reported earlier this year, out of pocket spending on healthcare, even among the poorest Brits, has shot up in recent years. Against this bleak background, what does ‘reform’ really mean?

Streeting’s plan involves a sharp increase in medical student places and community health workers, improved terms and conditions to stop so many staff leaving the NHS and – most sacrilegious of all – using the private sector to deal with the enormous treatment backlog.

Now, none of that is particularly objectionable, but nor does it sound like root-and-branch rethink of the service. If we look at staffing, as Fiona Bulmer noted on CapX this week, there has already been a significant increase in nurse and doctor numbers since 2019, but the productivity in the service has not improved commensurately.

Likewise, using the private sector to reduce the backlog is all well and good, but teh more difficult conversation is whether that needs to be a permanent shift in the way we provide care, with a much greater role for non-NHS providers (while remaining free at the point of need, in case anyone accuses me of wanting the dreaded US system).

Still, we should welcome Streeting’s speech as a welcome step in de-religifying the debate about health provision in this country. But if we want to have an honest conversation about the future of the health service, whoever is in government, there is a lot more heresy still to come.

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John Ashmore is Editor of CapX.