For years, Wes Streeting has spoken about the need for NHS reform but it was never clear if he had an agenda, or this was just verbal positioning. The NHS has more staff (1.4 million) than many countries have people. Plans to reform it need to be laid out carefully, taking years to design and to implement. Getting results by Year Five of a Starmer government would mean serious action at the very start. So far, with Streeting, that is precisely what we have got.
We are barely 48 hours into a Labour government, but on health the omens are as better than they have been for quite some time
Within hours of becoming Health Secretary, he declared that ‘from today, the policy of this department is that the NHS is broken’. Not since John Reid’s declaration that the immigration department was not ‘fit for purpose’ has a minister signalled such intent to reform. None of this Tory pom-pom waving, no blue vans with ‘NH-yes’ written on them (Andrew Lansley) no wearing NHS badges to work (Jeremy Hunt). The Tories were never trusted on health so positioned themselves as NHS fans – and, as a result, poured money into a failing, unreformed system. Labour is more trusted on health, and Streeting seems determined to convert that trust into action.
The return of Alan Milburn as an adviser to Streeting, as reported today, is significant. In truth, Milburn, now 66, has always been close to Streeting (who is a Blairite) and no one is in a better place than Milburn to offer advice on how reform works in practice. Well, perhaps one other person: Simon Stevens, the recently-departed NHS chief executive who worked with Milburn when he was an adviser in No. 10 and is now in the Lords. Enlisting Stevens as an adviser would make a formidable reforming team (albeit one that would have to be assembled when Amanda Pritchard has been ousted as NHS chief executive, which looks likely).
I interviewed Milburn several times when he was in power, both for the Scotsman and The Spectator, and he spoke more radically about health reform than any Conservative later dared to do.
‘The Tory health policy, such as it is, is about backing doctors and nurses. But in the end, as I found out as health secretary, you are there to represent patients.’ Mr Cameron, I say, rejects this idea of a conflict and says doctors should be trusted to guard the interests of patients. ‘Yes, I’m familiar with that argument,’ he sighs. ‘It’s the one that failed Labour in the 1980s. We’d be on the side of the doctors, the teachers, the local authority staff. Problem is, there are more citizens than public-sector workers….The public want control in their lives, and they are usually ahead of politicians. The question is which party will satisfy this demand. And I’m in no doubt that the answer is Labour.’‘
Milburn didn’t say this because he is a closet Tory. He’s a former communist who once ran a hard-left book shop called Days of Hope (nicknamed Haze of Dope). His radicalism converted into a belief that Labour needs to take radical steps to help and empower ordinary people. And that means recognising the conflict of interest between the producers and users of public services – and siding a Labour government with the users. In NHS terms, this is the ‘purchaser-provider split’. Milburn always suspected that the patrician Tories are more likely to side with the providers: the few rather than the many. So his is, very much, a left-wing view. He regards it as the radical centre.
‘We haven’t got a health policy,’ Tony Blair told Milburn when he made him health minister days after the 1997 victory. ‘Your job is to get us one.’ Blair messed about with Frank Dobson for ages before realising he had no more time to waste. As Health Secretary, Milburn wanted to move towards more of a decentralised, continental model with a variety of providers to an NHS system. He wanted to encourage US health firms to set up in the UK seeing this as a long-term change, but was thwarted by Gordon Brown. Now, it seems, Milburn could be back in business.
At first, Milburn’s main mission was to get NHS funding up above the European average – but that was 20 years ago. Now, the UK has one of the highest rates of health spending in the developed world.
Ironically, cash is less of an issue after 14 years of Tories than it was when Gordon Brown was begrudging the extra spend. The money is there, but is failing to deliver into results because what Streeting says is true: the NHS system is broken.
'When we were last in office, we worked hand in hand with NHS staff to deliver the shortest waits and highest patient satisfaction in history,' he said in his opening speech. 'We did it before, and together, we will do it again.' But it’s how they did it before that matters: they used market-based reform to an extent that no Tory government since dared to do.
Even if Streeting does share the Blair/Milburn vision, he’d be unwise to talk in producers vs provider terms as it’s needlessly antagonistic to the BMA which will, I suspect, do its best to destroy him before Christmas. But if Starmer takes a Blair-era 'what’s best is what works' approach and thinks he needs to show NHS results within five years, then his best policy is to encourage Streeting to get the best-quality advice he can and move full speed ahead. We are barely 48 hours into a Labour government, but on health the omens are as better than they have been for quite some time.
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