I posted this reply to tweets Wes Streeting posted in response to the questions I posed here yesterday on Twitter this morning. For those not familiar with Wes Streeting, he is shadow Secretary of State for health and is widely tipped to be a future Labour leader:
This thread is a reply to @westreeting. He responded with a series of tweets to comments I made yesterday. I am responding with a thread. If it appears to stop midstream click the last one you can see and the rest will appear…….
First, it's a shame you started by calling me hysterical when very clearly the questions you responded to show that I am not. I attach the definition of being hysterical. I clearly am not what you described me as. Might you drop the hyperbole?
Second, it's a shame your tweets are really hard to follow as they do not form a thread, which you could only have delivered by quote tweeting rather than replying to me. It's a trick worth learning.
Third, it's also a shame that as far as I can see you have answered none of the points I raised in the logical way I raised them. You have instead made up an answer to other questions that you preferred. But let me answer your points anyway, and then I hope you will answer mine.
Your first response tweet is attached to this one. This is the one where you repeated that I am hysterical. I'd quietly suggest to you that feeling that there is no political party that currently represents your political desires is not evidence of hysteria.
Let me summarise those hopes that I think Labour does not address for me and very many others:
- A hoped-for return to the EU
- Restoring the free movement of people
- Basing economics on a proper understanding of tax, money, borrowing and government funding
- Restoring our public services
- Properly paying our public servants and others so we do not have continual employment crises in them
- Properly tackling the climate crisis (£28bn is not enough)
- Delivering PR
- Respecting the voluntary nature of the Union
- Respecting Labour's membership, many of whom agree with me on many of these issues but who are consistently ignored by you and the Labour leadership
- Respecting trade unions and their rights
You might think it hysterical to disagree with you on these issues, but most people (maybe half the country) feel as potentially politically unrepresented on these issues as I do, so please don't insult them as well as me by calling us names. Might we agree on that?
And whilst doing so might you suggest who I and others might vote for since you refuse to address these issues which are of massive concern to most who think themselves anywhere on the left in this country and we're concerned Labour totally ignores us?
Let's move on to the second blog you referred to. If you think I was hysterical for suggesting Keir Starmer's comments about foreigners working in the NHS were inappropriate can you explain why so many others also took offence? Look at what @shelaghfogarty had to say, for example.
Let's then move to your second tweet. I attach it so people can see what I am talking about.
I am baffled because there is nothing here that differs from the 20th-century model of the NHS. Prevention, tackling chronic disease, intervention and massive technological adaptation. That's what the NHS has always done. But you have said you want to move on from that model.
Or is it that what you were actually saying was that the 20th-century model of the NHS was persistent underfunding leading to late diagnosis, delays etc? If so I'd remind you that your own party had solved all that by 2010, with a good slug of government spending.
So, is what you are now saying is that the spending on the NHS that got it in good working order by 2010 was wrong and you now want to do something else? If so, what is it? Please explain.
I now attach your third tweet. This suggests that there's some policy decision made here but not elsewhere to overspend on late-stage issues in the NHS at cost to primary care and other issues. Tell me if I have got that wrong, but you certainly imply this is a choice.
Except that's not the choice. We just do not spend enough on healthcare. A quick search suggested that in 2017 (before Covid) that in the G7 countries the USA spent 17.1% of GDP on healthcare, France 11.3%, Germany 11.2%, Japan 10.9%, Canada 10.7% and the UK spent 9.6%.
The undeniable reality is that if only we spent more we could do all the late-stage stuff (like managing terminal care, as people are always going to die) as well as all the prevention stuff needed to defer that for as long as possible, which you (and I) want.
It will simply cost more to do this. This is where the questions I asked you about money came in. So let me go to your last tweet (attached). I agree there are broader issues. A generous benefits system, great education, good housing, low unemployment, and more all matter.
They all also cost money, of course. But as I noted in my questions to you, the real questions (given your self-imposed constraints) relate to how you will fund the extra resources the NHS will need to deal with an ageing population.
You say Labour has learned it cannot spend more money. I disagree, but that's not the point. Instead, you say you can deliver everything the NHS does now and more (the waiting list proves more is needed). I asked from the outset how you will do this. Might you explain now, please?
And thanks for engaging, but can we now do so on the issues I actually raised as well as those you have thrown in to which, in view of your rather abusive comments, I think answers are needed?
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Thanks for all these salient questions, points and admonitions. As ever, you so eloquently express my concerns and answer some basic and more complicated questions.
I am especially grateful that you mention here how unrepresented those of us on the left feel and are, by the present Labour leadership.
Absolutely agree with hyperNorm. I feel the Labour leadership simply fails to acknowledge the despair many of us left leaning folk feel at the total lack of representation we expect and deserve from the LP. Who represents us if not the LP?
His suggestion is, I think that we could and should spend more on primary care and early diagnostics, and so on, and that will catch maladies that can be treated more easily and more cheaply than if that investment was not made. He thinks that shift should save some money in the long run. But I expect it will require increased spending in at least the short run, because we will still be dealing with the legacy of failure for the last 12+ years. And it may well (indeed should) catch some things that are not treated at all currently, including some false positives, which will increase cost.
Similarly spending more on social care should free up space in the NHS to get more out of the existing health resources (not least, the time of the people). That will nakedly require increased spending, but it will still be cheaper than the spending required to achieve an equivalent increase in health capacity.
Dare I say it, but short tweets on Twitter, even twitter threads, are not the ideal medium for conveying and debating complex issues. Yes, it can be a hook, but you need more space to consider different aspects.
Of course
But opportunities have to be taken
This is unreadable.
4th para under wesstreeting tweets.
I can’t identify which one
Richard, I will leave it to you and others to try and smoke out the majority of Labour’s health policies but one area I would like to comment on is the health of the elderly.
I would suggest that the current situation largely results from four trends. The first two of which are the result of Tory government choices, largely left unchanged by New Labour.
1 The almost complete loss of any sense of the purpose of the NHS to be a service promoting health within the community to being an Illness service. Look no further than Margaret Thatcher’s belief that there is no such thing as society and the Tories always comical opposition to a “Nanny State” for a reason why.
2 The promotion of an economic model based on the transfer of the wealth that this country creates from those that create it to a tiny rentier class. It creates increasing poverty and increasing poverty creates ill-health, especially amongst the elderly.
3 The consistent underfunding of the NHS by successive Tory governments who ever since its inception have opposed the whole concept of the NHS. A situation that they make even worse by consistently lying about the causes of problems in the NHS to cover up their underfunding
4 The tragic misuse of the constantly improving state of medical science to turn the most natural of human processes i.e birth, ageing and death, into illnesses and I should make clear here that I am no “natural alternative medicine” nut, but I do believe that there is a better balance to be had between prevention and cure.
In summary, simply believe that in almost every way conceivable the best way to promote a healthy population of over-sixties is to promote a healthy population of under-sixties. Something that the Tories oppose root and branch.
At least Wes Streeting seems prepared to begin to engage about all this, however inadequately, which seems more than Starmer and Reeves have been prepared to do on money – (tax/spend/borrow/create – ). Yesterday ,, while condemning JustStopOil Starmer was happy to parade his ignorance – suggesting that carbon capture and storage is the answer , contrary to overwhelming scientific opinion. No challenge to govt to get on with the billions of renewable investment now basically stalled.
Could your exchange with Streeting morph into a group exchange, say with you, Blanchflower, Sikka, someone from Kings Fund, Health Foundation, NHS etc, two or three senior Labour figures, maybe a Lib Dem & Green and a Tory from the Health Select Committee etc? After all the NHS was originally the result of a cross political debate – Beveridge.
I heard a US pundit today talking about two candidates and he came up with a quote which I will transpose into the sad political
situation we find ourselves in now “Labour and Conservative parties are just strains of the same virus” Nails it for me and touches on virtually every question posed on here every day. When will we see daylight between our two main parties. Streeting’s and Labour’s stance on almost everything right now disgusts me
A decent plan for getting the NHS functional again is a political need that can’t be summarised in a tweet. As you say, there are two elements: getting urgent care back to where it was under the last Labour government, and then looking to see if there are ways in which healthcare is provided which would be more suited to current needs (in that limited sense there is a case for saying as Streeting does that provision needs moving on from the twentieth century).
The first needs money, which is the real topic of your blog. And so does everything else, the Conservative administration since 2010 has underfunded most public services without any compensating economic gain. Your solution is the constructive one, but from the position we are in now any mechanism of increasing funding comes with risk.
The second issue doesn’t need a wholesale restructure of the NHS – the one under Lansley and Hunt sucked tens of billions of pounds out of healthcare provision to achieve nothing. But it does need changes of emphasis. For a start there is the changing demographic, the specialist requirements of an elderly patient population are poorly served. There are some areas, like mental health, where there is not just chronic under-funding but a failure to deal with things early; GP practices as currently constituted are poorly placed to manage those conditions. There are the technological advances which provision hasn’t been adjusted for. The removal of regional strategic oversight of public health was shown up by Covid as having been a mistake and it needs restoring. There is the need to train more staff, and ensure a work environment that makes staff feel valued and supported so they don’t leave. And in my view the current disparate nature of primary/community health services needs better coordination for the benefit of patients.
In the end the NHS is a large complex organisation, and it is inevitable anyone so inclined can find elements that aren’t working “efficiently”. But the answer isn’t to ask for “efficiency savings”: as anyone who has ever worked in any organisation asked to achieve savings knows, what results is freezing of posts (too few clinical staff) and cutting investment (fewer ambulances for example). That doesn’t solve the problem it makes it worse. Politicians should focus on making it better.
I presume:
1. you are aware that Public Health was moved in to Local Authorities with the LLansley “reforms” – or more accurately destruction. and have had their budget cut every year since and the whole structure detroyed.
2. Much of community health is provided by private providers eg Virgin healthcare as was but now taken over by a private equity company – who take out “profits” and so surprisingly have radically reduced the number of qualified staff delivering the care
3. Many causes of ill health are largely beyond the NHS. eg steep rises in type 2 diabetes mainly diet related – but it seems that we fear the nanny state too much for he Government to do anything about it.
Personally I really don’t understand this “must move on from 20th C model” – in what way? We still need hospitals – what they do and how they do it has been constantly changing as new techniques arrive eg much better anaesthesia / new equipment / better forms of diagnostic methods/ new techniques eg stents etc etc. More treatments are done as day care and more testing can be done in primary care settings. The use of monitoring key functions eg BP and sending down a mobile phone from home is also increasingly used – BUT what the NHS needs is more money to invest in.
The NHS has never been short on the ability to innovate and change- see the speed of response to Covid- what it lacks is MONEY and some stability instead of constantly being reorganised. and now it is desperately short of enough staff to do anything.
I agree with so much of this. So much destructive stuff has happened to health and social care services in the last decade which is simply not acknowledged by ignorant politicians (even though they are responsible for what’s happened) the arguments they pursue and the remedies they recommend are beside the point.
Totally agree AliB. The separation of community care, and increasingly GP surgeries, from the NHS is a serious problem with an aging population. Better integration is needed. Constant relapsing due to poorly motivated and resourced care home staff, with a high turnover, working on a minimum cost approach, reduces quality of life and passes cost (in time and finance) back to the NHS. (P.S. I know there are also many very dedicated and caring people working in care homes.)
Mr Streeting may have seen your thread today, or he may use the excuse that you missed an ‘s’ in his Twitter handle when you said – “This thread is a reply to @westreeting.”.
Might be worth a retweet with the correct handle?
The bog had the right handle in it
A lot of people retweeted it with the right handle
It will have been seen
Freudian slip, the bog has the right handle?
What I noticed is that Streeting has been reading a lot of your blogs, as he mentions not just the NHS but economic justice and climate justice. I hope he’s passed his reading of your blog onto his masters in all departments, as well as Starmer.
He obviously doesn’t see the way you see economic justice, but he might in time.
By the way, I like the way you do twitter threads then post them on here. I have never joined twitter, but like the way your points follow on in twitter style. It makes things easier to read, so I hope you carry on.
Must be something to do with my advanced age.
Thanks
I suspect Wes is not alone in Labour in reading this
The first thing that is required is an acceptance that health spending should be always increasing as a share of GDP. At present, this is called “unsustainable”. But, as we get wealthier and older, and new treatments emerge for previously untreatable diseases, it is inevitable and desirable. What better way to spend our money than keeping healthy?
The second thing is that, with limited resources (not money but people and materials), we must have less of something else than we otherwise have had. (It would not necessarily have to be the case in absolute terms if we assume that trend growth is greater than zero).
I think these are fairly uncontroversial facts that almost everyone should embrace….. but none of the main political parties will say so.
Only when this is widely accepted is a debate about how those resources are applied possible. At present everyone is promising “more for less” and it is not possible except in a few areas of healthcare.
There IS a debate to be had about how healthcare and social care is financed. I have my view about what is best but other views are allowed and should be debated. But we MUST get consensus on my points 1 and 2.
My concern is not that Streeting (or Starmer and his minions) aren’t Old Labour anymore, nor even rehashed New Labour (viz restricted spending, Tory-lite policies) but that they all seem incapable of fleshing out the vague assertions they make. They also parrot Tory false memes (household fallacy etc). It seems to be “we’re not the UKIP/Tory lot, vote for us”, while not being honest or detailed about HOW they differ, and how they are going to realise these differences. The more I listen, even at local level, the more it resembles a con-job like the LibDem 2010 manifesto, but without specific promises.
At the risk of arguing about history rather than dealing with the present, the Lib Dem manifesto in 2010 was a 100+ page document. Here is a link.
http://www.maniffesto.com/documents/liberal-democrat-general-election-manifesto-2010/
Which aspects do you consider a “con-job”, John?
They won 6 million votes in 2010, but actually lost seats (62 before the election, 57 afterwards). Both major parties were short of a majority, and the Lib Dems and Labour together would still have been a dozen short.
We can certainly argue about which policies the Lib Dems should have insisted were carried through by the coalition – perhaps electoral reform, and reform of the House of Lords – and which ones they should not have compromised on – perhaps tuition fees – but It is the nature of a coalition that neither party achieves everything they want (you can see how the Conservative Party’s wheels fell off after 2015, and we fell down a Brexit rabbit hole). Does that make the 2010 Lib Dem manifesto a con?
I got a general anti avoidance provision into law by getting it into that manifesto via Vince Cable
It may be that Les Streeting wants to create the impression that he is full of ideas for a 21c NHS but dares not expand upon these because either he has not fleshed anything out yet but more probably Labour does not itself have a clear health policy programme agreeed by the NEC and Keir Starmer. He doesn’t want to stick his neck out too far in case Starmer gives him the chop for being too uppity. On the crucial question of funding, no one in Labour’s highest echelons wants to admit that the government can create as much money as it wants but dares not for fear of the Tory taunt of Magic Money Tree. On the question of accusing Richard of hysteria, this puts him in the same category as Gavin Williamson
It doesn’t matter what the NEC agrees on, if Starmer disagrees he wins. If a member of the NEC disagrees with him, he will find any excuse to remove that member.
Moving on from C20th models of provision is just code for moving away from state provision to greater private sector involvement. Labour in its current guise are true believers in the neoliberal orthodoxy of market good, public sector bad when what is needed in health as in so many other areas is for us to reclaim the (courageous) state as a force for good
We as voters have the right to now what Labour are proposing.
It is not enough for the Tories to just lose the next election. Even Tory voters are telling me that they can’t see them getting again.
I happened upon this analysis of what the NHS needs in comparison with what has happened under the Conservatives. Worth reading.
https://yorkshirebylines.co.uk/news/health/the-bad-economics-behind-the-nhs-management-crisis/
If the Yorkshire Bylines article is correct and the Government is “reviving Payment by Results for elective care, which could mean Trusts being paid purely for each unit of activity delivered, ” – that is of course the perfect set up for private providers and for charging patients.
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