It is Labour, not the Tories, with a vision for solving the NHS crisis

Editorial: The health service has always had to change to survive, and it will do so again. At the moment, it looks like the opposition party is devoting more creative thought to this than the Conservatives

They do not betoken a PM fizzing with radical ideas to ensure the NHS functions as the people expect it to for the next 75 years of its existence (PA)

It is a startling and rather shaming thing that after nearly 13 years in government, it is the opposition Labour Party rather than the Tory government that seems to have the policies and radical ideas about the NHS crisis.

Indeed, in his BBC interview with Laura Kuenssberg, Rishi Sunak refused to even acknowledge that what the NHS is presently experiencing is a crisis. As with this refusal to say whether he himself bypasses the NHS and uses a private GP, it is plainly a matter of great political embarrassment to him that people are asking, as Laura Kuenssberg put it, “how did you allow this to happen?”

How indeed. Mr Sunak likes to project the image of a results-focussed technocrat, and his well-publicised Downing Street NHS summit last week about the (non) crisis was meant to underline that. But there was nothing new that emerged from that very large meeting, and what there was seemed modest indeed.

Concerned patients and voters (eventually aligning to the same thing) will look sceptically on severe respiratory illnesses being treated at home via “virtual wards”, putting patients awaiting discharge into care homes (which are under pressure already) and paramedic crews conducting triage, rather than emergency department medics. These may be good plans, and the funds Mr Sunak is putting into the system very welcome; but they do not betoken a PM fizzing with radical ideas to ensure the NHS functions as the people expect it to for the next 75 years of its existence.

Almost needless to say, Mr Sunak also gave scant hope for a pay settlement for the nurses and ambulance crews, and thus an end to the strikes. Ominously, the BMA is balloting doctors on strike action that will take place in March. Mr Sunak seems to face continuing chaos with equanimity. He must imagine that his new industrial relations laws will successfully conscript medical staff into working.

Contrast that with Keir Starmer and Wes Streeting, Labour’s ever-combative shadow health secretary, also touring the TV studios. It may be that they are indulging in some wishful thinking when they declare that they would be able to negotiate an affordable pay settlement, but their line about “getting around the table” is a serviceable one, and they’ve made Mr Sunak, and the scarcely visible health secretary Steve Barclay, look stubborn and evasive.

Where Labour is starting to score is on advocating for longer-term changes in the NHS. The boldest is the move to reform GP practices, running down the remaining self-employed partnerships and replacing them with more salaried local doctors, just as with many junior doctors and consultants in a hospital setting. It would accelerate a trend that is already underway, and be an even wider shake-up of access to primary care, deepening local primary care-based treatments for relatively minor complaints, and thus reducing the flow of referrals to hospitals and consultants.

Mr Streeting said that he wanted to consult on the proposal – he’ll have little choice when the powerful doctors’ lobby swings into action – but it shows a willingness to revisit arrangements that date back to 1948. It was, even then, an unhappy compromise in the creation of the NHS, and the relationships between private practice by GPs and consultants and NHS facilities and funds have never been satisfactorily regularised.

It was Nye Bevan, creator of the NHS, who complained that he found the BMA’s hospital consultants so recalcitrant that he “stuffed their mouths with gold”. Labour successors such as Barbara Castle and Alan Milburn haven’t enjoyed much more luck. Mr Streeting seems intent on succeeding where they failed.

The NHS has always had to change to survive, and it will do so again. The danger is that through underfunding and mismanagement – “keeping it on a diet” – it deteriorates so that those who can afford to opt out then do so. This is one reason why the prime minister’s reluctance to discuss his own use of a private GP is so damaging. If a two-tier health system develops, then the NHS will fail.

Reform is necessary, and at the moment, contrary to the form book, it looks like Labour is devoting more creative thought to it than the Conservatives. Yet the NHS should not be talked down. Despite the difficulties – indeed because of the difficulties – everyone involved is doing a superlative job in providing care and hope to the sick and vulnerable, including those forced to take industrial action.

Somehow the nurses are covering for 47,000 vacancies, and with little reward. During the pandemic and again now, the nation has been well-served by its NHS. It is a precious national asset, and one of the most cost-effective systems in the world. It’s worth looking after.