Jacky Davis, Keep Our NHS Public
Co-author/co-editor of NHS Under Siege, NHS for Sale, and NHS SOS
Wes Streeting’s plans for the NHS: Labour Conference 2023
NHS campaigners have watched successive Tory governments run down the NHS over the last 13 years and might be forgiven for looking forward to a possible change of government next year. But many will have been bitterly disappointed by Wes Streeting’s speech at the Labour Party conference on Wednesday.
‘It’s our mission to get the NHS back on its feet and fit for the future. Achieving our mission will take time, investment, and reform. Reform is even more important than investment. Because pouring ever-increasing amounts of money into a system that isn’t working is wasteful in every sense’.
It is difficult to know how to start unpacking this statement. We know that experts are consistent in defending the NHS model as rational and successful, when well-funded and publicly provided. The model doesn’t need reforming – it has been failed and undermined by successive governments. The NHS model needs urgent funding, its staff and public services supporting, and capacity expanding.
The NHS isn’t working because it has endured 13 years of Tory misrule, and successive Tory governments certainly haven’t poured ‘ever-increasing amounts of money’ into it. Streeting’s big idea for rescuing the NHS – ‘reform’ – is an old chestnut, put forward by every health minister devoid of ideas about improving the service. Similar views were expressed in the ‘Five Year Forward View’ in 2014, which recommended a rapid upgrade in prevention and public health, placed an emphasis on new technology and called for more care delivered locally. In other words, there is nothing new here that the Tories haven’t proposed already. Tellingly Stephen Dorrell, once a Tory shadow Secretary of State for Health, commented that he could have given the same speech.
Streeting made no attempt to define ‘reform’ so perhaps he is yet to decide what it should look like. But the NHS needs inchoate ‘reform’ like it needs a hole in the head. It has undergone a re-disorganisation every few years for decades now and each time reform only serves to fragment the service, bring in more of the private sector and makes life more difficult for staff. The latest in July 2022 saw the Health and Care Act legislating for the fragmentation of the NHS into 42 separate ‘integrated care systems’.
Streeting’s other big idea was ‘technology’. Of course, the NHS is always looking to adopt new technology and certainly doesn’t need to be told to do so. It just lacks the money and time needed.
Even worse than his threat of reform is the fact that Streeting failed to identify the two most serious problems facing the NHS – the damage done by 13 years of underfunding (and the accompanying chronic shortage of staff) and the increasing reliance on private hospitals and investigation centres, with diversion of NHS funding to the private sector. His claim that reform was ‘more important than funding’ shows a complete failure to understand the problems of the NHS. The health service urgently needs to be funded to the level of comparable systems such as France and Germany, and the backlog of underfunding needs to be made good to deal with problems such as the literally collapsing infrastructure.
Increased funding would also go some way to correcting the serious loss of front-line NHS workers under successive Tory governments. There are currently almost 130,000 unfilled posts in the NHS, and these vacancies throw further strain on staff. Recruitment and retention of NHS staff need urgent attention but he didn’t refer to them. Labour could score a quick win by committing to fair pay and to restoring nursing bursaries for example, but again he made no mention of them.
His emphasis on primary care seemed to come at the expense of the hospital sector, which makes no sense. There is now a waiting list of 7.8 million for hospital care and patients are dying in ambulances because there aren’t enough hospital beds. Primary and secondary care can only deliver when they work together, and with community and mental health services, and all are in urgent need of support.
As for the emphasis on prevention, again a no-brainer. But even with the best preventative care people will always need hospital beds and there just aren’t enough of them after years of bed cuts.
When I look at leading health systems across the world, the fundamental problem with the NHS becomes obvious. We have an NHS that gets to people too late. A hospital-based system geared towards late diagnosis and treatment, delivering poorer outcomes at greater cost.
But there was nothing in his speech about health inequalities, social determinants of health or the fact that promoting social justice, addressing poverty, low pay, poor housing is fundamental to improving health.
Cancer outcomes for example are often used to show that the NHS ‘gets to people too late’ but the role of adequate staffing, investment, and up-to-date equipment is ignored.
Finally, and tellingly, Wes Streeting rehearsed the fundamental principles of the NHS in the speech…
Labour will never abandon the founding principles of the NHS as a publicly funded public service, free at the point of use. I make the case for reform not in opposition to those principles but in defence of them.
… but omitted to mention that it should be publicly provided. This was not an oversight. He has committed to using the private sector’s ‘spare capacity’ more efficiently than the Government. He says that the partnership with the private sector is important. Streeting has made clear his enthusiasm for using the private sector. He has also accepted donations from private health care interests.
This is not the speech that health campaigners were hoping for from a future Secretary of State for Health and Care in a Labour government. Indeed it contained significant red flags for those who fight for the re-establishment of an integrated NHS which is universal, publicly funded, publicly delivered and publicly accountable – principles of the NHS model, previously and unanimously supported at the 2017 Labour conference, and which will require legislative change at some stage to securely re-embed. We should demand nothing less from the party of Aneurin Bevan.
This is not it.
Jacky Davis, Keep Our NHS Public