Is Wes Streeting the Hamlet of the Health Service? Is this undoubtedly talented and thoughtful young Labour prince fatally irresolute when it comes to doing what he knows must be done?
Few politicians have articulated so clearly the need for reform of our healthcare system. Streeting’s insistence that the NHS should be a service not a shrine angered all the right people, which is to say the BMA. It marked a welcome departure from the treacly displays of affection which have hitherto characterised ‘debate’ about the health service. More recently, the Health Secretary has frankly admitted that the NHS is letting patients down and acknowledged its manifold inefficiencies. The need for change has been recognised. The case for reform is urgent. The sickly patient lies before us, the vital signs deteriorating. But instead of action, this week we have been offered a National Conversation; in place of reform, procrastination. The native hue of resolution has been sicklied o’er by the pale cast of an internet suggestions book.
There are no alibis for this inaction. Streeting shadowed his current role for more than two years
What does Wes need to know that the cold facts cannot already tell him? British citizens have the worst rate of life expectancy in western Europe. We have higher avoidable mortality rates than our neighbours. Survival rates for breast, cervical, rectal, lung, stomach and colon cancer are lower in the UK than in comparable jurisdictions. NHS patients who suffer heart attacks or strokes are more likely to die than in France, Spain, the Netherlands, Canada, Italy and New Zealand.
More than seven million people are on waiting lists for NHS treatment. Every month tens of thousands wait for more than 12 hours for treatment after being admitted to accident and emergency wards. It is then no surprise that the number of (wealthier) patients opting to pay to be treated privately is at a record level – more than 800,000 every year.
So we have a two-tier health system in this country in which the rich secure the best care, those in pain wait in agony and those with life-threatening conditions know their treatment would be better in Marseille or Madrid than Manchester or Middlesbrough. What more warrant for action is required?
And yet the launch of Labour’s ‘Ten Year Plan’ for the NHS this week amounted to no more than a declaration of three principles to guide the future which make motherhood and apple pie seem novel and contentious.
The government’s ‘new’ commitment to move the NHS from hospital to community, analogue to digital and sickness to prevention is no more than a recital of the bleedin’ obvious masquerading as a roll-call of revolutionary changes. Did any Tory health secretaries argue we should have more inpatients and fewer outpatients, more bedblockers and less efficiency, refuse to embrace new technology and display wanton indifference to the spread of disease?
There are no alibis for this inaction. Streeting shadowed his current role for more than two years, during which the doors of every thinktank were open, the testimony of every professional was at his disposal and he had generous room and time to reflect and plan. He had the experience of previous Labour reformers such as Simon Stevens and Alan Milburn to draw on. They will have told him that the Blair government wasted its early years ducking reform and embarked upon necessary change only after political capital had been depleted and public trust eroded.
The nature of the reform required is clear, though certainly not easy. In running any health service, politicians must arbitrate between the interests of patients, the tax-payer and those who work within the system. A reforming government should be putting patients first, watching expenditure carefully and requiring greater accountability from professionals. Unfortunately, the revealed preference of this government so far is to privilege producer interests by pumping in taxpayers’ money to inflate salaries without securing improved patient outcomes. Acceding to union demands may have ended strike action but it has not been accompanied by any measures to improve productivity.
The number of GPs working full time has fallen from around a third in 2017 to just a fifth today. Nurse recruitment is impeded by the trade union insistence on degree-level entry. Consultant management of waiting lists and operating theatres reflects professional incentives rather than the highest Hippocratic ideals. The mission to heal and the vocation to care are noble ideals but, as the New Labour thinker Julian Le Grand has pointed out, one cannot run an efficient public service on the idealistic premise that everyone working within it is without a shred of self-interest. Or on the assumption that the BMA, RCN and other health unions exist only to advance medical knowledge and regard talk of terms and conditions as unpardonable vulgarity.
Reform of the NHS requires ministers to challenge poor performance, demand accountability for actions, provide incentives for improvement and, inevitably, introduce greater choice and contestability. Until we see weak NHS managers sacked, recruitment reformed, GP contracts overhauled and new providers brought in, the change needed will not happen. And Streeting’s NHS reform plan will be Much Ado About Nothing.
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