Wes Streeting: how false comparisons and magical thinking undermine the NHS

Keep Our NHS Public

Wes Streeting has had an another bright idea. He wants the NHS be the same as the health system in a country with a population only two thirds the size of London and many times richer than the UK…

Last weekend, Shadow Health Secretary Wes Streeting was interviewed by the Sunday Times about his ambitions for the future of the NHS should Labour win the next general election. In the piece he championed Singapore as an example of best practice ‘a system that is designed around patients’ –– and condemns the NHS:

‘The NHS is perfectly capable of arranging appointments in a way that maximises the convenience of patients — it just often chooses not to, or the system isn’t wired to think about that.’

Apples with pears

Although Singapore General Hospital is ranked by some outlets as one of the best hospitals in the world, Streeting is not making a fair comparison. Singapore is a country with a population of only 5.6 million, two thirds that of London. It is in the top three richest nations in the world for GDP per person, with the UK at 27^th.  The two countries fund healthcare very differently and in Singapore only 25% of the cost of healthcare is covered from taxation: individuals and employers pay the rest and patients pay to see a doctor.

Within the last decade, Singapore government per-capita health spending more than doubled (shown here).  Contrast this with the UK spend (£3,055 per person) falling away to 18% less than the EU average (£3655 in 2019) following a 10-year period of flat-line funding prior to the pandemic. And the NHS and social care are facing the prospect of planned spending between 2022/25 increasing way below the minimum 4%, by an average of only 0.1% a year in real terms.

Streeting is enamoured of automated patient access to appointments and DIY blood pressure and weight measurement at this rich hospital, but few would argue that implementing appropriate technology to streamline clinical process, where it doesn’t risk quality of service and offers real benefits to patients, isn’t something to aspire to. However, simply labelling the NHS ‘slow to innovate’ when it has been forced to cut its IT and innovation spending in order to balance its budget, highlights either ignorance or worse, contempt.

For years governments have continually demanded so-called ‘efficiency savings’ and senior NHS managers have been forced to cut in the areas least likely to dramatically impact patient care. Local health boards (ICB) face £12bn ‘savings’ by 2025. Saying that the NHS ‘refuses to maximise convenience for patients’ as if the staff are somehow choosing to deliver a worse service than what is possible, will be deeply upsetting to many who already feel undervalued.

Streeting says ‘the NHS is going to have to get used to the fact that money is tight…’ as if NHS workers haven’t already realised this after many years of having to fill rota gaps, losing 10-20% of wage value, and working unpaid hours whilst dodging buckets in corridors catching the drips from leaking hospital roofs.The backlog maintenance bill in hospitals now stands at a staggering £12bn – how does this compare to Singapore?.

Streeting has been clear that if Labour is successful in winning the next election there would be very little in the way of new money for the NHS and his various comments seem to be an attempt to manage expectations. However, failing to compensate for the 13 years of underfunding the health service has now suffered is a false economy, as a well-funded NHS directly contributes to a strong and thriving economy.

Unprovoked attack

Streeting goes on to dig himself into an even deeper hole by insulting staff further:

‘I don’t think it’s good enough that the NHS uses every winter crisis and every challenge it faces as an excuse to ask for more money.’

The winter crisis is not the fault of a health service that prepares months in advance and as well as possible for every eventuality and is somehow expected to paper over the cracks with less money every year relative to need, whilst at the same time juggling a waiting list of nearly 8 million people. Every year government is far too slow to act in allocating additional funding, even when modelling predicts a surge and, this year at least, NHS trusts were promised several hundred million pounds in additional funds for frontline care that the government have now reneged upon.

Former NHS manager and journalist, Roy Lilley points out in his blog that Streeting’s ‘apparent ignorance of systems, history, legacy and his inability to ask “why” betrays his inexperience and unsuitability to take on the custody of the NHS…It seems to me, his go-to position is to be abusive’. 

The online medical community as a whole unsurprisingly did not react well to Streeting’s comments. Palliative care doctor, Rachel Clarke, also took to social media platform X that Sunday to voice her frustrations with the shadow health secretary. She pointed out that the NHS does very well considering its below average funding, lack of hospital beds and significant staff vacancies. She said:

‘When you [Streeting] insinuate to the public that NHS staff “use” the grotesquely awful winter conditions we – patients & staff alike – endure every year to demand more funding, you are quite openly & deliberately undermining public trust in the NHS…whether you intended it or not, with that insinuation you’ve given NHS staff the most massive kick in the guts. Do you have any idea how hellish it is to work in an NHS A&E over winter? How much staff give in those horrific conditions? How dare you insinuate they’re somehow “using” those conditions for their own ends? Show some respect, please. Because the one thing we really, really don’t need this winter is being treated as a political football by politicians who care more about currying for votes than the destructive, demoralising impact of their words on burned out, broken staff. Thanks a bunch, Wes.’

What does the NHS need from a change of government?

Instead of verbally abusing the NHS and by association, its workforce, Streeting could pour his energies into addressing the immediate issues it faces.

Ditch the private sector

Labour has announced its plans to utilise the private sector alongside the NHS ‘more efficiently’ than the Tories, but this approach is inefficient, and costly for the taxpayer. The vast majority of clinical care is thankfully still in public hands, but it is being threatened by underfunding of NHS services. The majority of reputable thinktanks and experts consider the NHS model to be robust, safe, effective and efficient – when funded adequately. The rational choice is that a public service should be funded to succeed not underfunded to fail. Furthermore, the idea that the private sector somehow alleviates pressure on the NHS is a fallacy. Staff work across both services so there is no ‘spare capacity’ in the private sector that does not further undermine the NHS.

Community-based care with better hospitals

Policy drawn up by McKinsey for New Labour and adopted by the Conservatives in 2010 called for A&E closures and a refocused priority on community care to dramatically cutcosts. McKinsey made the totally unevidenced claim that 30% of hospital care could be performed in the community. ‘Care in the community’ can be used as a smokescreen for refusing to invest in hospitals. A comprehensive and safe NHS absolutely needs well-funded hospitals in partnership with well-staffed community, GP and mental health services, social care and local authorities. When that is achieved, we can truly talk about safe community care.

Tech cannot solve all our problems

As Streeting observed in Singapore, there can be very real benefits from employing technology in healthcare. However, this requires investment and it should never be a substitute for skilled NHS staff. The quality, safety and effectiveness of the NHS is founded primarily on its staff. Advances in AI and data systems must serve the needs of patients and staff. Patient data should be held in trust by the NHS, not monetised and sent abroad for commercial exploitation, whether by Palantir or other corporations.  The priority for a new government is to value NHS staff, give them pay justice, restore safe staffing levels, restore staff morale and retain those skills. And bring back the NHS student bursary.

Social inequalities and public health

The lethal impact of health inequalities was laid bare by Covid. We must recreate a strong national and local public health service, alongside a rebuilt and expanded public NHS. Alongside this, a national care, support and independent living service must fix our broken social care system, giving dignity to the people it supports and alleviating pressure in hospitals. The assault on the rights and benefits of disabled people must be reversed.

Hope for the future…?

It is very disappointing that, for all his ideas for radical innovation – many of which, if funded, would have real merit, the way Wes Streeting seeks to present them to the public shows a lack of forethought and respect for the people who will be relied upon to deliver his vision:

“At the moment, I think we get the worst of all worlds, which is poor outcomes alongside poor value for taxpayers…that’s the tough love that people can look forward to if I become the health and social care secretary.”

In reality the NHS is considered by many health economists to be very efficient in its use of resources, and the idea that there is massive waste that could be rectified to free up funds is simply wrong. Focussing on prevention and addressing the social determinants of health are essential, but both are long term projects in terms of reducing pressure on the NHS, and themselves require investment. After 13 years of crisis management, severe understaffing and underfunding and the trauma of having to work through a major pandemic, NHS staff haven’t exactly been mollycoddled up to this point. What they really need is some understanding and a health secretary that will work with them, show them respect and value their contribution to caring for us all.

After 13 years of horrific mismanagement by successive Conservative governments there can sadly be no short-cuts to a well-functioning NHS. Any incoming administration should not squander the opportunity to rebuild our health and care service. A commitment to funding, restoring and expanding the NHS, and an end to outsourcing NHS services to private healthcare, alongside investment in social care and education, would re-establish our country as one of the best healthcare providers in the world.

Keep Our NHS Public