Wes Streeting interprets his job as shadow health secretary as being a ‘public service role and an economic role’. ‘There is a direct relationship between the health of the nation and the health of the economy,’ he told a Policy Exchange event at the Labour party conference on Monday. Echoing the sentiment of his shadow chancellor Rachel Reeves, Streeting makes clear that while a Labour government would work to preserve the health service, it would approach NHS funding with iron discipline. And it doesn’t really seem like Labour would have much other choice. As one Tory MP remarked during the Conservative party conference: ‘What can Labour offer? They can’t offer more money – because we’ve spent it all!’
Resurrecting the NHS is possible, Streeting believes, and it isn’t about altering the funding system. He was careful about his language; rather than ‘reform’, Streeting eased into the conversation by discussing the need to ‘rewire the way we do healthcare in this country’. ‘There is huge waste and inefficiency built into the way that our model of care is structured,’ he said. From an inadequate level of diagnostic testing to late-stage treatment to the high prevalence of chronic disease and an ageing population, the shadow health secretary didn’t attempt to sugarcoat the challenges facing the health service: ‘We’ve got a fundamental existential crisis for the future sustainability of the system.’
Reading between the lines, the shadow health secretary is trying to gradually shift the public discourse around the NHS. Streeting wants to make the prospect of reform more palatable.
But would a Labour government have all the answers – especially if Streeting would rather focus on ‘rewiring’ than rethinking the funding structure? His solutions can be clumped into ‘three big shifts’. The first is a move away from an ‘excessive focus on acutes’ (hospital patient care) to primary care in the community, like general practice. This isn’t a particularly new way of thinking: NHS England set out a ‘five year forward view’ plan in 2014 that focused on expanding and improving GP services across the country and directing patients to other community health workers, like pharmacists.
Yet particularly since the pandemic, general practitioners have faced extraordinary backlogs and patients are more likely to attend A&E if the alternative is to wait for an appointment. While not altogether original, Streeting’s focus on primary care is welcome. An NHS update in 2017 foreshadowed the stagnation the health service is currently facing, reporting that ‘general practice is undeniably the bedrock of NHS care… if general practice fails, the NHS fails.’ So if a Labour government were to pull the country’s flailing primary care services back to their feet, does it then follow that it could prevent the desecration of the NHS? At the moment, Streeting’s big ideas need a little more detail.
Streeting’s second shift would be from analogue to digital; in essence, bringing the NHS into the 21st-century. His third is more broad: to focus, as a government, on the social determinants of health — on things like housing, working conditions, education and unemployment. There are echoes of Steve Barclay’s vision in here: the current health secretary spoke at Tory conference about the need to catch disease early and focus on preventative medicine. Streeting had no kind words for his Tory counterpart, however: ‘If I had been as negligent and complacent as Steve Barclay, I don’t think I would be in a job with the Prime Minister.’
Would Streeting have better luck with striking doctors then? He is thought to get on well with the BMA, though admitted that the general public’s sympathies are less likely to lie with striking consultants than cleaners and porters. Addressing Rishi Sunak’s recent comments that striking healthcare workers were putting ‘politics before patients’, Streeting criticised the Prime Minister for pursuing a ‘deliberate strategy’ where he would rather ‘scapegoat NHS staff’ than ‘provide a solution to the strikes’. Labour’s shadow health secretary was, however, careful not to put a figure on what he would offer striking medics across the country.
His solution to the workforce crisis is to offer up more medical school places – to British students, in particular. It’s ‘wonderful’ that the ‘children and grandchildren of the Windrush generation now proudly work in the NHS’, Streeting said, ‘but it shouldn’t come alongside turning away straight-A students from studying medicine at university because we’ve been too short-sighted to provide the places for 13 years.’ Yet as too many of Britain’s doctors continue to leave for Australia, the issue of staff retention remains an issue Streeting hasn’t fully addressed.
Reading between the lines, it’s clear that the shadow health secretary is trying to gradually shift the public discourse around the NHS. Streeting wants to make the prospect of reform more palatable — despite the language on health service improvements becoming ever more politicised. ‘The relationship between the Treasury and the department of health and social care and NHS England has been terrible for years now,’ Streeting told his audience. ‘There’s a reform element and you’re not going to get anything for free from me or Rachel Reeves.’
Streeting is young, energetic and, most importantly, presents a change. His vision sounds reasonable and his ambitions pragmatic. He is hyperaware of the need to manage expectations. The NHS is a sacred institution in the UK and the idea of reform remains controversial. Streeting appears determined to save the NHS with a mix of common sense and tight pursestrings but he has a long road ahead of him if Labour is successful — one that will certainly require more than five years’ work.
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