Wes Streeting MP, Labour's shadow Health Secretary announced his plans for NHS reform last Friday, but you have to work very hard to find any reference to them in the mainstream media. The best report that I came across was on Yahoo and as a result, I rather suspect that this was based upon a press release.
If I read the report correctly, Wes Streeting was offering all the usual reforms for which he is now well-known. We will, apparently, all have a personal GP. We will get appointments within a week. There will be no scramble for appointments. Hospitals will be transformed. The demand for healthcare will be reduced through preventative medicine and the realities of addressing an ageing population, rising healthcare complexity, increased demand (most especially for mental health services) and the problems of staff retention because of low pay and poor working conditions will all simply disappear, for reasons that Wes Streeting never specifies.
And all this will be done, of course, without any additional spending, including on staff retention.
But let's suppose Streeting is right that a big focus in improved primary care and preventative medicine will, in the long-term, pay significant rewards in terms of reducing demand for hospital care. I have to accept the argument is plausible. The problem is one that Roy Lilley points out in his daily mail on the NHS this morning. As he notes, if you want to transform the system, the simple fact is that whilst the transformation is taking place, you have to run both the old and the new systems in parallel, and that is costly. Streeting makes absolutely no allowance for this.
Professor Sir Michael Marmot is as direct in the Guardian today, saying:
Labour's shadow health secretary, Wes Streeting, set out his vision for the NHS on Friday: the emphasis is not on more money, but reform. I'm sure about the need for reform – we must have a different approach to improving the nation's health and it must be more than organisational change within the NHS but include a focus on the causes of ill-health. But funding is important:the NHS has been starved of cash and it's difficult to see how it can be saved without restoring some of the losses. A reasonable approach would be to bring the spending up to the average of peer countries in Europe.
As he notes:
Health spending per person, adjusted for demographic change, grew at 2% a year under the Conservatives from 1979 to 1997; at 5.7% a year under Labour from 1997 to 2010; at -0.07% from 2010 to 2015; and at -0.03% from 2015 to 2021.
He adds:
If the UK had increased its healthcare expenditure from 2010 to 2019 as much as France did, we would have increased our current spend by 21%, and by 39% if we had matched Germany. The NHS needs more money. It would help in filling the 150,000 vacant full-time posts. Paying doctors and nurses appropriately would help.
Then he notes that even so, none of these will work unless there is spending to make good the impact of austerity in society, which has itself been catastrophic. The details are in the article.
My point is a simple one. Streeting has his head in the sand if he thinks he can deliver reform without more money. He cannot. It is impossible. A better NHS needs more money.
And I would add, this is possible. I set out how here:
I go where Roy Lilley and Michael Marmot do not, to answer the question 'How are we going to pay for this?'
It is possible to have a well-funded, functioning NHS. Streeting is wrong to deny it to us by refusing to discuss additional NHS funding. So, why won't he talk about it? If he does not he will fail to deliver, as Roy Lilley and Michel Marmot rightly point out.
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Streeting will probably say (if pressed), that the funding will come from ‘economic growth’ under Labour’s magic economic plan, the ‘green industrial revolution’, blah blah blah, and their golden prize the “Non-Dom” tax increase of £3 billion when at least £30 billion is needed.to save the NHS.
Fantasy and obscurantism seem to be the order of the day in Labour’s playbook.
Agreed
I’d like to see politicians who
– understand how governments fund themselves
– are not beholden to The City
– see their role as improving overall public quality of life, and not their own personal wealth
– say that the public purse will be used for the public good
– commit to publicly owned and operated services, natural monopolies, and strategic sectors
– have conviction to actually say these things and be prepared to stand or fall by them, not covet swing voters by wishy washy please everyone droning language
The only ones with conviction are the far right Tories, and I don’t support them at all. The majority of the left are depressingly boring, centrist, careerist, grifters.
I’m pissed off with the state of this country. It doesn’t have to be like it is.
He also overlooks that spending on NHS staff salaries inevitably improves local economic activity. Most NHS staff including consultants at the top of the pay scale spend most of the money they earn, in the localities they live and work in. This is especially so for primary care. Which needs massive investment, both in infrastructure and more importantly in staff take home pay. Most GPs work very long hours for very modest takings. They pay for the infrastructure from their income. Without a vibrant Primary care, the NHS is doomed.
But all the focus is on hospitals.
The only thing that really needs reform is this idea in many politicians’ heads that we cannot afford health care through the NHS.
I think that once that is done, then we can start to unpick the internal markets and all the other crap that has been brought in over the years.
My recent experience with the NHS has been mixed. The last time was a drop in to a surgical unit that incurred a 7 hour wait. I saw people still waiting for beds as we left, and still waiting to be seen. I’ve seen local outpatient clinics moved to central points that mean patients of all ages having to travel further. I’ve been to sites where the old hospital is being redeveloped into something usually smaller and the old site released for private development. There is all sorts of shit cracking off but none of it seems really helpful to patients.
But also I’ve seen lots of people ill for the wrong reasons – over weight, unable to breath because of smoking for example. Something needs to be done about how markets abuse people with sugar and tobacco. That’s what I’d call preventative medicine. If these aren’t dealt with, then all we’ll be doing is making sure that private health care gets to make money out of the results on the false flag of freedom known as ‘not telling people what is good for them or not’ and under regulated food and vaping products.
Permanent austerity, poor pay, lack of hope, debt, poor working conditions, exploitation by markets, polluted air, creating fear and division all make society very ill indeed.
Bleating’s (sic) ‘vision’ is just blurred and narrow. There has to be plan for a healthier society as well as a better NHS.
And I’m sick of this lie that some how unbeknown to government some tsunami of elderly has just crept up on us and can’t be coped with. It’s a disgusting idea – it makes government look stupid and it makes our senior citizens (senior human beings!) into a problem – we are all going get old and that is just not on.
Again, it’s disgusting notion that needs to be dealt with robustly. It’s a sign of a really sick society, a sickness that resides in politics in particular.
Hi Richard,
Perhaps not directly on this piece but relevant – have you had a chance to look at an unattributed piece on the BBC News web site today entitled “How much money is the UK Government borrowing and does it matter?” I would be interested in your view.Thanks.
I will post as soon as I can on this
Here is an example of health care in Tory Britain 2023.
“A woman who extracted her own teeth because she couldn’t find an NHS dentist says crowdfunding a new set of dentures has transformed her life. On Tuesday afternoon, MPs will question dental experts from NHS England as part of an official inquiry prompted by a BBC investigation into the dentistry crisis.”
https://www.bbc.co.uk/news/health-65336571
What a country we have become. Even worse, I suspect some Tories (and Streeting) will think “crowdfunding, now why didn’t I think of that….” Crowdfunding, the ultimate free market way of doing things. Hoping on the kindness of strangers.
What next, the return of the Poor Law?
The Tories are responsible for what dentistry has become in the UK. The rest of the NHS will follow if they have their way.
Labour, it is make your mind up time. Continue to play by the Tory blueprint playbook, or address the real issue. How bad does it have to get? How obvious does it have to be that the current way of doing thing has failed?
The BBC is pretending to be courageous with a Panorama programme on the monarchy – which dares to point out that young people are not that bothered.
But they will never mount a programme – from the perspective of serious political economists including Murphy, Mazzucato, Sikka, Blanchflower, Stiglitz etc, and challenge the main political parties to take part and address what’s required – and how to it can be funded.
As Michael Marmot points out the NHS can never deliver a healthy population if the society in which we live is profoundly sick, morally, politically and economically.
Not only have the Tories given up on trying to maintain any kind of a healthy society, they have now also reached the point where they view the dishonest exploitation of the causes of its ill health as their best of chance of staying in power.
If Labour think that they can produce an efficient Health Service without changing the fundamentals of how our society works and increasing NHS funding then they are deluding themselves.
Agreed
Thinking about this systemically, this would need massive reductions in pollution, and also, given the ACE’s research, immediate elimination of poverty, since most adversity is linked to aspects of poverty and the consequences are strongly correlated to adversity in childhood, including numerous highly prevalent physical health problems. Also, if people are engaged in prevention for themselves, this will not be possible with a 37 hour working week, since most work is harmfully sedentary, and meaningless, and allows insufficient time for self-care. Also, the tobacco industry will need to end, and much alcohol use curtailed. Many “food” items will no longer be sold that are linked to poor health. What this means is that a number of markets will collapse as health is focussed, and most of what is healthy doesn’t cost anything, do no replacement markets will appear, which means much more unemployment. My guess is that any government saying what Wes Streeting is saying is being obtuse at best. Physical health is a systemic problem not individual. Only a complete reorganization of society will achieve his aim. My guess is that he believes society will remain unchanged, and people will do even more in top of every other demand to get fit and healthy. This will ultimately be so that the government (if they’re in power at the time) can pass responsibility onto the individual. It really shows the paucity of anything remotely knowledgeable being suggested. The sheer absence of any structural thinking is staggering if not predictable. From economic thinking (i.e. saving money will always shrink the economy and destroy jobs – spending is always someone’s income!) to this tripe. I’m pretty certain it’s Disingenuous. Even if it isn’t, it’s plain dumb.
“My guess is that any government saying what Wes Streeting is saying is being obtuse at best.”
Agreed