The Independent View

The NHS needs to be open to a course of tough love as prescribed by Labour

Editorial: If the NHS embraces change as outlined by Wes Streeting, it can do more with the resources it is provided with. Labour’s ambitious plans could eventually help the NHS achieve the levels of satisfaction it enjoyed before the Tories took office

Monday 08 April 2024 19:17 BST
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Labour leader Keir Starmer and shadow health secretary Wes Streeting visit King’s Mill Hospital in Sutton, southwest London, on Monday
Labour leader Keir Starmer and shadow health secretary Wes Streeting visit King’s Mill Hospital in Sutton, southwest London, on Monday (PA Wire)

Labour’s perpetually combative shadow health secretary, Wes Streeting, has never shied away from unarmed political combat, but to launch himself into an attack on his own party’s core support is, even for him, veering into dangerous-dog territory.

In what the police would, in a different context, term an “unprovoked attack”, Mr Streeting gave little more warning than a cursory snarl about Labour’s investment in the NHS being “linked to reform” before sinking those sharp centrist fangs of his into the soft flesh of the Labour movement.

Pouring more money in without reform would be like pouring water into a leaky bucket. We will also use spare capacity in the private sector to cut the waiting lists. Middle-class lefties cry ‘betrayal’. The real betrayal is the two-tier system that sees people like them treated faster – while working ­families like mine are left waiting for longer.” Constituency Labour parties and Unison branches across the land were left needing stitches.

That Mr Streeting’s assault on their sensibilities was carried out in the pages of The Sun can only add insult to injury. But stepping back from the rhetorical flourishes, Mr Streeting surely has a fair point to make. It is a shame, from his point of view, that he has felt the need to tear chunks out of people who should be sympathetic to his argument – but maybe he just can’t help himself.

In any case, what Labour – and, indeed, the country – has to face up to is that, against the backdrop of Britain’s post-pandemic, post-Brexit, deglobalising economy, there may be minimal growth in the national income for some years to come. The priority for the nation has to be investment in its productive capacity.

The limited additional funds Labour has earmarked to cut waiting lists, provide emergency dental treatment, and recruit more staff in mental health services are going to be paid for by already-announced increases in taxation on the better off.

Using the private sector to add capacity and get patients out of pain and back to work isn’t sinful or a betrayal; it’s what was done during the Covid pandemic, and under New Labour. It sits within the context that the NHS has always used private-sector services – not least the mostly self-employed general practitioners. Yet it is expensive to do so in the longer term, and the NHS does need to build resilience and capacity.

One of the best ways to achieve that is by making it more efficient. Ramping up taxes, even if it were a good idea in principle, is politically unrealistic. So reform it must be.

To be fair to the government, ministers such as Jeremy Hunt also recognise this – but it is Labour that seems the more determined to push through change. As Mr Streeting’s words suggest, it is overdue. As he says, far too many NHS services and procedures are paper-based and rely too much on human labour.

Digitisation and the deployment of artificial intelligence could, indeed will, revolutionise healthcare worldwide. It is right that the UK’s NHS, with its unrivalled database of patient health, uses that data more efficiently and makes it available for medical research – and yes, for private-sector use, in strictly anonymised form, to raise money.

AI is already proving its worth in screening for signs of trouble in MRI scans and X-rays. New vaccines for heart conditions, and even for some cancers, will also prove transformative. These are exciting developments. If the NHS embraces change for the better, it can do more with the resources it is provided with, and all of it free at the point of use and distributed on the basis of clinical need rather than wealth or income.

Mr Streeting is right to place the principles of the NHS and its patients at the centre of his ambitions, and to demand that the right changes are made – not to make dedicated NHS staff work harder for the same pay, but to ease their burden and thus help protect staffing levels and pay scales. That would mean that at least some of the chronic shortages in staff levels could be remedied.

If implemented successfully, then Mr Streeting’s ambitious plans could eventually return the NHS to the record levels of satisfaction it enjoyed before the last Labour government left office.

The one obvious danger is that almost every public-sector digitisation programme, including earlier models used by the NHS, has turned into a financial and technological disaster. So, without being quite as vindictive as Mr Streeting sounds, it is right to say that the NHS needs some tough love, and to be treated as a public service. It will need to reform or die – and in the process, to lose some of its status as a national religion.

All that said, however, the huge and growing area of adult social care, which has been neglected for so long, is in such a chronic condition that it threatens not only to fall in on itself but to bring down the NHS and the local authorities with it. One reason why the hospitals have so much difficulty coping is that the collapse in social care is driving longer stays and restricting access to beds. That, in turn, means longer waits in corridors, and for patients in ambulances – and more unnecessary deaths.

Social care is labour-intensive and nobody wants to pay for it. Mr Streeting suggests a cross-party approach, but he also knows he cannot rely on that. He needs to win the argument for a popular plan for the care sector, too.

Mr Streeting is bright enough and tough enough to take on these challenges, and the NHS deserves fresh ideas and leadership. But he is also warning those who devote their lives to the NHS that they will need to work with him, rather than against him – and that there won’t be that much money to go round. Mr Streeting, indeed, will find that the demands for higher pay won’t disappear with the Tories – and, with his radical agenda, he may end up with even more strikes on his hands than his Conservative predecessors have had to deal with.

Despite some initial goodwill on all sides, it remains possible that, if Mr Streeting does become the secretary of state for health and social care, things could turn quite vicious.

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