Labour have just blown Britain's last chance to fix the NHS
This was Labour’s big shot. It’s unlikely another government will be gifted this golden chance to gut and rebuild Britain’s broken health system. But judging by the contents of Wes Streeting’s 10-year plan, Labour has lost its nerve.
The Government’s goal of shifting away from treating very ill and frail people in hospital to preventing their illness in the first place is a sound one. Streeting’s plans do include some interesting policy ideas, particularly around technology and neighbourhood health.
But too many concerns go ignored for these plans to be considered a serious blueprint for change. Not least the fundamental problem that the NHS is a nationalised service funded through general taxation, with no price mechanism. We continue to refuse to learn from the experience of other countries, from France and Germany to Switzerland and Singapore, which all operate mixed economy healthcare systems.
There is a real risk now that NHS reform may become Labour’s Brexit, a great opportunity with massive upside that ends up being squandered through timidity and incompetence, with a political fallout which could be just as fierce.
This is a moment of both unprecedented crisis and opportunity. Demand for healthcare in our ageing nation, with increasing numbers on sickness benefits, is set to explode by 40 per cent in the next 10 years.
The political climate for reform has never been more favourable, and Labour, as the “party of the NHS” is given latitude by the public when it comes to the health service. It also has 403 seats. The public no longer regards the NHS as a sacred cow: according to one poll just one in five are satisfied with the way it is run.
It is in the interests of the political Right to back a genuine bid by Labour to transform it. Streeting should be commended for an energetic attempt to lay out a new vision that threatens to ruffle feathers and challenge vested interests.
The PM’s press launch yesterday should have been a historic moment. But it was overshadowed by the fallout from Rachel Reeves’s tears in the chamber on Wednesday, which Keir Starmer yesterday appeared to try and laugh off. This is not a Government the public believes is serious about change, but rather one descending into chaos.
Many of Streeting’s policy proposals are welcome. Yet the plans are packed with oddities – such as a “patient power payments” trial whereby the public will be given a say on whether their healthcare provider should be paid in full for specific treatments. As one senior Tory quipped to me: “It’s like the TV show where people pay the amount they feel the hotel stay was worth”.
Doctors rightly fear that such provisions could lead to greater waste, with medics incentivised to offer unnecessary operations and drugs. Even more worrying is that the plan does not even engage with the social care timebomb. Nor does it offer any meaningful solutions to the NHS’s manpower crunch, even though its labour shortfall is set to quadruple in the next decade.
Arguably the biggest disappointment is that Labour’s 10-year plan fails to confront the reality that, at a time when Britain is cash-strapped, shifting the healthcare model from late treatment towards prevention would require that we defund the hospitals which currently consume 70 per cent of the health budget.
Put simply, the country needs to stop chucking money at bringing down waiting lists.
Instead it needs to bet the farm on preventative healthcare, putting money into everything from lung trucks and genomic sequencing to diet management courses for those at risk of diabetes. The UK could learn from Finland, which legislated in the 1970s to move funds from hospitals into community health.
Or from the prairies of the remote American Midwest, which have boosted the prestige and quality of neighbourhood health by setting up medical schools that only produce GPs. But the Health Secretary, perhaps wary after Liz Kendall’s disastrous attempts to reform welfare, seems reluctant to genuinely shake things up.
As the former North-West Regional Director for Public Health, John Ashton, told me: “An infatuation with hospitals has dominated the British psyche since 1948, when we dismantled a public health system that had prevention elements. Since then, the lion’s share of funding has been sucked into hospitals. And we have had this collusion between politicians and the medical profession, which is dominated by hospital medicine and hospital consultants.”
Those who back Labour’s vision are worried about its ability to see things through. If Streeting’s weaker policy ideas border on the bizarre, his stronger ones, such as enhancing the NHS app, seem incomplete.
Just as banking apps only became powerful when they could do more than display customers’ balances and were wired into underlying financial transaction systems, a healthcare app will only be of use if it can be connected to appointments and referrals networks.
It is not clear that Labour fully understands this, or is willing to put up the investment. They risk presiding over Britain’s biggest computer flop since the New Labour NHS IT upgrade fiasco.
Yet the most immediate problem with Labour’s plans is that they are simply financially implausible. This week, amid the Prime Minister’s Personal Independence Payment climbdown, a benefits cuts package that was supposed to bring in £5 billion of savings will probably end up costing the taxpayer tens of millions. Britain does not have the money to bankroll a NHS reform package which refuses to accept the need for trade-offs, or to end its most wasteful elements.
We saw with the Tories how the failure to rise to the historic occasion of Brexit can condemn an almost hegemonic party to irrelevance.
If the Labour Government, mired in division and bogged in ensuring its day-to-day survival, has just allowed an unparalleled opportunity to slip through the country’s fingers, then that is a national tragedy for which Labour may never be forgiven.
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