On 5 July, it is very likely that Wes Streeting will become Right Honourable and will be promoted to the Cabinet as Health Secretary. That will be the proudest day of Wes's life.
And then he will go to his new office, and he will have to deliver.
He claims he can deliver 6,000 new GPs, eventually. Labour is going to train them, he says. That will take a decade or so.
And, he says he can deliver more than 2 million more medical appointments a year. That is maybe two per cent more than now and within the range of normal annual variation in appointments supplied by the NHS, depending on demand variation. He says these appointments will be supplied by doctors working at weekends.
Those are his big ideas to solve the NHS crisis. Well, those two, plus a refusal to back down on junior doctor's pay, which refusal is going to drive many more of them out of medicine.
What can be said with certainty is that these 'ideas' (it seems absurd to afford them that description) will solve no known problem within the NHS. They are too small, too long-term, and too petty to come close to doing that.
However, Streeting could solve a great deal of the NHS crisis overnight. He could put England's unemployed GPs back to work in the NHS.
The NHS has around 6,300 GP surgeries in England. Streeting is not responsible for care anywhere else.
There are around 37,000 GPs in England, the equivalent of around 27,000 full-time employees, as they do not all work full-time.
Around one-third of GPs work as locums—although no one is quite sure. That may be a little over 11,000 in total in that case, but they provide a lot fewer full-time equivalents. Let's call that figure 7,000 or so.
And what we now know is that around 80 per cent of these locums are now finding it exceptionally difficult to find work.
There are two reasons why it is thought that 6,000 or more GP locums may now be out of work and doing jobs such as Uber driving. One is that there is a refusal to provide any budget to employ them. The other is that the only budgets that are being made available to practices must specifically be spent on under-qualified, partially trained physician associates, who have just two years of training in medicine and who are a legal nightmare in the making for the NHS.
So, what we know is that Treasury dogma and the dogma of the market - which is that productivity must be raised by employing cheap, under-trained staff - are the reasons why we have an NHS crisis.
The reality is that, near as makes no difference, every GP practice in England could have a new GP working in it without having to train a single new doctor: all that has to happen is that those GPs who already exist and who want to work be offered jobs. It really is that straightforward.
There would, of course, be a cost. It would be at least £1 billion a year. Less, then, than the value of out-of-date PPE being burned by the NHS each year right now. But as a result, 42 million new GP contacts (some, undoubtedly, phone calls, because they can do on occassion) would be created a year.
People would get the care they need.
People would get back to work, which is Labour's obsession because, for them, we only exist as economic units of production.
And those GPs and their employers might pay coming up to half the cost of employing them in additional PAYE, by the way. The rest could be won back time and again through productivity gains in the rest of the economy.
So, will Wes announce on 5 July that he is going to offer all trained GPs in the UK the jobs that they want at a fair rate of pay and deliver the most dramatic improvement in health care that Labour could ever supply on day one of it being in power?
I'd like to think he will.
But I really can't see it happening.
Why not? Dogma won't let him do so.
Do not doubt that what I suggest is possible.
The money to achieve this outcome can be created.
The people to do the work exist.
The well-being they could create is available to us all.
But Treasury dogma will not let it happen.
And if it does not, we'll know we are in for a period of miserable Labour government.
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I see you are equally frustrated by the thought of a supposed landslide of a Starmer Labour government.
I despair of our country and am beginning to think we get what we deserve. I have watched the Labour Party metaphor into the Party it will defeat for no other reason than there is nothing else to vote for as it’s a one party state. I wish we could have someone like you as Chancellor . There will be no
joy on 5th July just another sentence of much the same.
Alex Cole-Hamilton, the Scottish Liberal Democrat leader has placed bets on the election. They appear not to be clouded by Gambling Commission examination. He defends the practice because this isn’t North Korea. The comparison is an indication of how low, banal and stupid our politics has become.
Allow me to spell it out. ‘Insider betting’ is, or should be corrupt. That is obvious. Politicians betting in elections without inside knowledge raises other problems.
First, politicians betting on elections in which they participate is tawdry. Worse it creates real problems, if any thought is given to the problem. How does a leader faced with a candidate voting against his own Party make a viable distinction about what is allowable? I know nothing about football, but I understand that the football authorities take a broad approach to handling footballers betting on football. They can’t, and there are no exceptions; presumably because the exceptions would be impossible, practically to manage or control. A simple exclusion is clear, unambiguous and unarguable.
The fact that Cole-Hamilton does not see the problems surrounding his weak personal indulgence tells you all you know about the standard of the cohort of politicians we have at our disposal. The person who asked Starmer and Sunak whether they were the best the electors can be offered to lead the country, hit the nail on the head.
No politician should be allowed to bet on an election their party is involved in. Full stop.
“On 5 July, it is very likely that Wes Streeting will become Right Honourable”
Are you implying this Streeting person will be joining the House of Lords?
No, the Right Honourable means he becomes a member of the Privy Council – a lifetime honour gven to anyone who servcies in Cabinet and others, at the Prime Minister’s discretion. There are around 700 of then, because the Tories got through so many ministers. There will be quite a lot of new ones on 5 July. It is pretty much an honorary title.
Streeting will deliver what his paymasters have paid him for: a privatised NHS. Oh it will be wrapped up in yet more faux hand wringing and faux regret “there’s just not enough money”. And “it’s all those sick people causing a drain on our society”. It will be every ‘customer ‘ for themselves so sharp elbows or ££££ will get the trained professionals and the rest of us will be reduced to St John’s Ambulance- no disrespect to the brilliant work they do within the bounds of first aid, etc.
Monbiot in the Grauniad today has a brilliant but chilling explanation of the state we are in and the thinking and programmes needed to restore equality of access and distribution.
Things are not going to get better as long as oligarchs rule the roost in our democracies | George Monbiot https://www.theguardian.com/commentisfree/article/2024/jun/27/oligarchs-democracies-britain-1945-economic-powers?CMP=share_btn_url
Here in Scotland our underfunded NHS will be further ruined by Streeting and the few key levellers up like free prescriptions will be removed in order to level we ‘parasitic’ Scots down to English pauper level.
Independence has never been more urgent – and MacArthur programme (cf Monbiot) is the way to go to restore public services. Mind – you need competent government to deliver it. Hmmmm.
@Vicky G
I commented yesterday on the need to tackle the global clique aka oligarchy holding extreme wealth at their capital holdings level, as well as ‘ taxing wealth’ at the revenue level.
These are the people in whose interests government operates. Nice that Monbiot agrees.
Here in Scotland Povlsen owns 220,000 acres and his sister’s another 100,000 acres.
Just 433 persons hold 50% of rural Scotland, and that number is falling, so the concentration of property ownership is increasing.
We have no ownership restrictions, and the number of non-Scots property developer and speculator multi millionaires buying estates as ‘investments’ is still increasing.
I would hope and expect that there would be major land reform post Indy. Andy WIghtman has sowed the seeds of reform.
We really can do so much better, (though maybe not with the current SNP shower).
I agree, Scotland really does need this issue to be tackled
I think the only answer to the issue of people owning such vast amounts is to have a legal limit on how much land anyone can own. There is no need for people to own that much. Taxation is not the answer as I suspect many of these people will somehow avoid such taxes and a lot will have an income which they can use to pay taxes. A figure of 85ha or 209 acres? (Could use adjusted acres to account for different production levels.
“Here in Scotland Povlsen owns 220,000 acres and his sister’s another 100,000 acres.
Just 433 persons hold 50% of rural Scotland, and that number is falling, so the concentration of property ownership is increasing.
We have no ownership restrictions, and the number of non-Scots property developer and speculator multi millionaires buying estates as ‘investments’ is still increasing.
I would hope and expect that there would be major land reform post Indy.”
—-
Not long before the Sottish Indy’ ref’ there was a news piece on land ownership in Scotland, mainly centered around Scottish farmers. To give you the short of it, they pointed out various things including those you mention and that when E.U. had increased subsidies to farmers the landowners had increased the rent to exactly match that increase in subsidies. They interviewed the estate manager of one of the large landowners and he came across as _completely_ unapologetic, bordering even on entitled.
They pointed out that the SNP was quite happy with this and when they mentioned the SNP’s position to a couple of hardcore SNP supporters they pulled a face like they were swallowing a cactus.
Don’t get your hope up that the SNP will harm what is probably their biggest donors. You’ll need to switch to state funding of political parties and ban donations from vested interests first, and I can’t see that happening.
Has not this discussion been ongoing since 1914 when the Duke of Sutherland (largest Scottish landowner at the time) sold almost all of his land and/or estates on Scotland?
@ Mat
Yes, indeed, hence my last sentence.. “maybe not with the current SNP shower”
The SNP is an uneasy alliance and the NE Scotland rural grouping, which includes the forelock touching Tartan Tories, have done nothing to reform land management and everything to maintain the status quo.
People like Fergus Ewing lead the SNP’s dinosaur faction.
Scotgov has full powers to amend grouse shooting moorland practices as we have our own farm subsidy system – which is a bit of a boorach in reality.
The rewilding lobby meets the climate change lobby here, as both want major changes in upland moorland management practices, especially muirburn, for biodiversity and carbon sequestration purposes plus in meeting net zero targets, which we are conspicuously failing to do.
The SNP have done nothing, despite having their own binding targets for increasing woodland cover and biodiversity, and lobbying.
Deference to large landowners and traditional estates is seen as a major factor by those wanting real change.
There is a linked issue in that the Grampian upland river catchments are poorly managed in hydrological terms, another huge fail, as there are serious flood risks in Aberdeenshire and Angus rivers.
SEPA’s apparent complicity here is another oddity, but their budget has been stripped out by Scotgov by 26% in real terms, though the EA in England have had an equivalent 70%+ cut, and they are seriously understaffed for existing compliance.
You are right, the SNP has flattered to deceive, then blaming the Greens for any pushback against essential environmental policy changes, regardless of the ownership issue.
Personally, I’d endorse very strict holding limits, with residential and other qualifications, even more than the Danes have, and regulate rents too.
The SNP has strong neoliberal elements
I think it was in 2015 when I choked on my island malt reading that Cameron’s father in law likened Nicola Sturgeon’s land reform plans to a “Mugabe style land grab.” If only…
https://www.huffingtonpost.co.uk/2015/05/21/david-camerons-estate-owning-father-in-law-snp-mugabe-style-land-grab-rural-scotland_n_7349918.html
It’s obscene that foreigners can come here and do what they are not allowed to do in their own country by buying up huge acreages.
In the recent SG consultation on Land Reform I said that land belongs to the Scottish people and that the people should own it, through their government or other body, and how it is used, managed etc should be for the people to decide through local and national forums.
Povlsen is frequently lauded for “rewilding” in Glenfeshie, which may or may not be a good thing, but it should not be up to the whim of a billionaire to decide how the estate is managed and nobody else has a say.
Where I live I am surrounded by Buccleuch (pron. bucklew) estates, previously the UK’s largest landowner, whose ancestors were given extensive lands for services rendered to some thug who called himself “King” and augmented by a Mugabe style land grab aka “the enclosures”. (See Wightman The Poor had no lawyers)
Excellent article from Monbiot. I can well understand that the oligarchy aim to maximise their wealth at everyone else’s expense, pushing ever more people into poverty at subsistence wages and decimating the middle class.
However, this time they will discover a problem of their own making. The modern world is totally dependent on highly sophisticated science, technology and engineering. This includes everything the wealthy believe their wealth entitles them to – mansions, cars, yachts, planes, exotic food from around the world, advanced healthcare, etc. We are all far more dependent on advanced technology than any time in history.
And who builds and delivers this technology? The educated middle class, working for decent salaries. Also, many modern tech products only exist because of economies of scale, micro-chips being the ultimate example. It’s only because billions of people buy things like smartphones that it’s possible to make the chips at all. Those chips in quantity are what power everything from AI to the Webb telescope to medical scanners and so much more. Without a global population able to afford the enabling technology, development and manufacturing will dry up.
If the oligarchy eviscerates the middle class and impoverishes everyone, they will find the things they covet in increasingly limited supply, and very little progress. It will be on their own heads.
@ Rick
This is neo-feudalism.
But the oligarchy recruit a praetorian guard of technocrats who insulate and protect them, and feed their egos.
The irony is that is Streeting were to make such an announcement and, of course, follow through with it, then that alone might be enough to ensure a Labour victory in 2029.
Labour could not lose this election, but they could lose the next one, and, if they do no more than make a few cosmetic changes, they will lose it.
“There would, of course, be a cost. It would be at least £1 billion a year.”
I guess this would be mostly on wages?
Making things easy, lets’ assume £1.2bn or £100m/month. But in fact at the end of the 1st month it would be £65m/month (cos circa 35% flows straight back as PAYE tax & NI). Feel free to adjust the number as you see fit.
£65m/month seems to be pretty cheap to get a load of doctors back to work. Not forgetting that probably another 10 – 20% would flow back to the Treasury pretty quickly in the form of other taxes, so we are in £45 – £55m/month territory.
Won’t happen.
There will be a much higher payback because if employer’s nic and Nhs pensions work
Employer’s NI, 13.8% on all earnings above c£9,500, including for those over state pension age. I have often wondered why civil service and other state employers, like the NHS, have to pay it. It is a huge amount of money which just goes round in a circle.
Because the state / private sector comparison in these cases is useful
Here’s my attempt to put Wes Streeting’s behaviour into a broader context.
Outside of the need to obtain energy it ought to be obvious that life in the universe operates on a duty of care both to self and others and that binary state in turn requires continuous conscious effort to achieve an optimum balance. That said it is obvious human beings have a problem some don’t want to work at that balancing and we see this especially in the rich who constantly promote scam ideology in the form of beliefs or ideas to justify, maintain and increase their wealth and regularly at the expense of the majority.
The two main scam beliefs are firstly there is no such thing or reality as fiat money where governments and licenced banks are able to create circulating money from nothing by an electronic double-entry book keeping system. Furthermore there is the denial this can only happen in maximum stable form with government created money having a superordinate role and the licenced bank created money a subordinate one. Indeed in relationship to this there is little understanding amongst the public what the word “fiat” means which is associated with its decline in usage in the UK as a word since the 19th century. Dictionaries usually tell us it derives from Latin and means “let it be done or made.” As far as money is concerned we can say it means “let it be created” but given we accept the above duty of care to self and others it should be obvious we use money for caring therefore we can say that the word “fiat” can mean “let there be caring.” Indeed what else was the bail-out of banks in 2007/2008 with superordinate (government) created money other than a form of caring?
The second scam belief that is relentlessly pushed by the rich is that only the market can adequately and efficiently satisfy all the needs of a country’s population. This idea has wider understanding as “market fundamentalist” ideology and accompanying it is the idea that government is fundamentally useless at being caring except for a limited number of functions. Repeatedly, the market undermines this belief in monopoly situations where the public has no ability to rapidly switch away from businesses that fail to adequately deliver. The water and sewage companies shameful performance in England is a classic example of this. Healthcare and education also if you bother to think about it carefully have monopolistic attributes.
In conclusion it seems to me reasonable to say that currently in the UK we have what can only be described as Scamland because all of its political parties do act as shills for the rich pushing in particular one or both of the above scam beliefs or ideologies. Even the Green Party (which ought to know better) supports the Positive Money idea that the government can decide through a small committee how much money government and licenced banks can create. The example of the Bank of England destructively keeping base rate high and the failure of regulatory authorities to act in the UK clearly reveals how such committees or agencies can be rigged by the rich by removing them from the disinfecting accountability sunlight of direct democratic process.
https://www.merriam-webster.com/dictionary/shill
I don’t disagree with your characterisation. In summary: Streeting is stuck in a neo-liberal utopian fantasy land where, regardless of the question, the answer is markets. I know we are both familiar with “Late Soviet Britain” which is a line by line demolition of what passes for “neo-liberal thinking” (is that an oxymoron?). You could call it scamland – but, if I may, this diverts attention from neo-liberals and the reality that they believe in a utopian fantasy.
I think Mike the rich and those who aspire to be so can be scammers both for greed and fantasy ideology.
Streeting yesterday referred to using ‘the independent sector’ to solve NHS problems – sounds better than the ‘private sector’ or ‘profit making sector’.
They are determined to bludgen their way to July 4th – gaslighting the IFS ‘financial black hole’.
It does seem impossible to conceive he will do as Richard says he should – get GP’S to back to work etc etc , given his massive donations from the private healthcare sector.
Corruption.
But the profit-making sector still needs doctors. Currently they use NHS specialists who do private work in their ‘spare’ time and doctors in the early stages of their training to provide basic 24 hour cover. There was a lot of publicity about the poor treatment of those doctors, many of whom had trained overseas and came to this country expecting to further their training.
If the NHS cannot produce enough doctors, the profit making sector has a problem.
The obvious difficulty that Healthcare, Schools and Pubs suffer from is that we have all been involved with them so believe we know how to run them…….
May I firstly add nurses & dentists to your plan so that any UK trained healthcare professional can have a job in the NHS as part of this queue busting exercise.
Then drawing a MASH metaphor, where are the Radars and Klingers who make the place work, who find patients for cancelled appointments, who free Doctors and Nurses from having to chase records, drugs, etc?
Finally what can we do in the short term to reduce demands on the Health Service? During Covid the Manx Government imposed an Island wide 40mph speed limit because as they rightly said they didnt want overstretched medical services having to deal with p***s who had driven into a tree.
“Those are his big ideas to solve the NHS crisis. Well, those two, plus a refusal to back down on junior doctor’s pay, which refusal is going to drive many more of them out of medicine.”
Are the junior doctor leaving medicine or just leaving medicine in the UK? I know of two requirement firms in Florida that are actively recruiting English speaking Medical Interns (Yank term for UK term of Junior Doctor) to complete their training in Florida Hospitals, acquire medical certification to practice in Florida and work for Florida hospitals.
They are leaving the UK
Should be “recruitment” not ” requirement”. Sorry for the autocorrect!
I’ve just had a terrible vision of coming to in Hospital on the edge of death and being attended to by Harry Hill and Jo Brand
One former neurosurgeon and one ex- psychiatric nurse.
An interesting choice of deathbed comic relief..
Streeting promises us herds of unicorns grazing on the sunlit uplands, and those of us with eyes to see know that to be a fantasy. Does Streeting know it to be a fantasy? Does Starmer? Or do they now actually believe their own rhetoric? Either way, Streeting’s promises will not come true. The “Change” tag, presumably dreamt up by a focus group and packaged by a PR company, will turn out to be nothing of the sort. Without significant investment in the NHS – and I mean significant – the damage done to it will be irreversible. It almost is anyway.
This is the point most people miss (politicians, Labour specifically). The fundamental purposes of a health service are a. to assist us to nurture our good health; b. to prevent us becoming unwell, and c. to catch us when we do become unwell, and return us to the best health possible. In that regard, it is not simply a “public service”, like roads or buses. Good health is a fundamental necessity for humankind. Without it, we cannot contribute effectively to our society, our communities or our families. When we cannot work, we are unable to increase productivity; indeed, we are very likely to lessen it by requiring financial and medical support. Furthermore, it is ethical, moral and compassionate to protect us from poor health – by deliberately choosing not to do so, a Government fails us at a time we are most vulnerable.
Investing in our health – YOUR health, MY health – is precisely that. An investment. Without that investment, it is not just our health that will suffer. It is our society; our communities; our families. As our health fails, so will the economy. Productivity is already declining. Long term sickness is at a record high, increasing the welfare bill exponentially.
Labour’s much-touted “growing the economy” will never happen unless Streeting, Starmer and Reeves recognise this very quickly. No health? No wealth. Timid tinkering and tossing the NHS tiny titbits simply will not work. And then nor will the workforce.
Thanks Hannah for a beautifully written piece. It encapsulates my
reasons for always believing that the NHS is more than just one of our public services. It is not a political football game It is the reason I first heard Corbyn speak ten years ago when he was saying just the same as your post. This current Labour government has no
intention of delivering the paltry offerings and is devoid of vision and values for the people of our country.
The 99% Organisation has produced what is probably the best analysis of why funding the NHS is essential for the economy – an investment, rather than simply an expenditure. The report is apolitical (as much as it can be) and evidence based. Perhaps THE most important element demonstrates that the NHS model itself is sound. People who say it’s not fit for purpose are incorrect; not least because a 12% vacancy rate will render any organisation inefficient. It is dangerous to get rid of a model which so obviously has worked for over 70 years without bringing it back to full staffing first. THEN if it isn’t working, and only then, think about changing it.
It’s called “The Rational Policymaker’s Guide to the NHS”
https://99-percent.org/the-rational-policy-makers-guide-to-the-nhs/
Part of intro:
“The report further shows that the funding required to return the NHS to its pre-eminent position in relation to other leading healthcare systems need not involve punishing tax rises or risk inflation. After a short period of re-investment, ongoing levels of funding in the NHS will gradually return to 9% of GDP; in line with – or in fact below – most other advanced economies. The report also demonstrates that popular ‘fixes’ for the NHS, such as insurance-based funding or privatisation, are certain to fail to deliver what is needed – either for people or the UK economy.”