It’s odd. I mean it really does stand out. On the one hand, we have a Labour Government that seems to understand – in broad terms – the major issues at the heart of the NHS crisis. Indeed, its own commissioned report highlighted quite clearly that the NHS is too small and is grossly under-resourced. Despite this, Labour continues to focus on “reform” and on pushing more NHS resources into the private sector.
Labour has taken some positive steps toward improving the UK public’s access to healthcare. Beginning to address the dramatic real-world pay cuts that staff have endured over the last 14 years shows insight into the fundamental tenet of healthcare: without staff, there is no service provision! Labour’s identification of the need to invest in both midwives, mental health and primary care is again on point and critical to restoring access to healthcare in the UK.
But, Labour’s seeming preoccupation with ensuring the private sector benefits in some way from any investment in the NHS, is incongruent with both the healthcare crisis and any sense of economic prudence.
A unique emphasis on private healthcare
The issue is that the private sector exists in the UK simultaneously in two forms. One form is what you would expect: a private enterprise trying to build a customer base by offering a quicker and better service than the public service. Fine. The other is more peculiar: funding directly from the public purse. Not fine. I have some questions and comments.
The vast majority of private healthcare profit comes directly from the NHS budget. That is, we are paying private healthcare services directly from the public services budget. This is not the same as a private company securing government contracts to provide a public good. No, these are private companies generating profit from the budget assigned for our public national health service. Odder still, the NHS is paying private companies to undertake procedures and services the NHS itself provides. The obvious question remains unanswered: why not just use that money to expand the capacity of the NHS?
The only reason that this illogical use of public finances has been possible, is because waiting lists have grown to their highest-ever levels. So the prevailing political logic is – and stay with me here – because the NHS doesn’t have the resources to stay on top of demands; NHS resources are being taken to provide these services privately, leaving the NHS with even fewer resources to get on top of the waiting lists. The way to get on top of a lack of NHS resources is to give more of those resources to the private sector? Am I following your logic, Mr Streeting?
Is there a coherent argument behind the policies?
There was hope, that when Labour got into power, it would identify this bizarre set-up and reverse it immediately. Indeed, as the election loomed, Labour made a lot of the right noises about saving the NHS and “the NHS would be privatised over my dead body”. Yet, now that Labour is in power, they seem to be committing even more to this bizarre, economically incontinent set-up.
I have searched for the rationale for this policy – any rationale. A glimmer of a coherent argument in regards to a public good – and I’m stumped. I understand the rationale from the previous Tory Government’s perspective: they don’t believe in the NHS and want to extract as much profit as possible from our healthcare needs. Labour, the founders of the NHS, were supposed to be different, and at the very least have a more public-focused argument for maintaining, and indeed growing this strange dysfunctional relationship between private care and the NHS. I haven’t heard one. Are we then to assume the motivations for deepening this parasitic relationship haven’t changed?
Politically, the NHS crisis would seem like an open goal for Labour. To put another nail in the Tory coffin, Labour would simply need to place a large spotlight on the Tory record of neglecting the healthcare needs of ordinary people, highlighting the massive negative impact on economic growth of failing to invest in the country’s healthcare, and then tying it all into the utterly broken and self-serving Tory-model for governance. A very clear, ‘the NHS has been neglected on purpose’ line of attack would be like the ever-lasting gobstopper of political tropes – eventually choking the Tory Party all the way to the next election.
Labour’s rhetoric: temporary fixes versus strenghtening the NHS system
Instead, Labour seem to be taking the position that yes the NHS has been under-resourced by the Tories, but all we need is a small investment, and, actually, the model was a bit broken anyway and is in desperate need of reform. So, are we to take from this position, Mr Streeting and PM Starmer, that the Tories were right not to fund it properly? And actually, reappropriating NHS resources for dodgy back-of-the-fag-packet contracts wasn’t such a heinous crime that led to thousands of deaths and millions suffering – the NHS was broken anyway? If I’m following their logic correctly, we don’t need to urgently correct the massive underfunding of the last 14 years, even though it has very clearly occurred. Suddenly, the Tory’s abhorrent and willful destruction of a public service millions depend on, doesn’t sound so abhorrent.
Within this schism of reasoning and logic that seems to typify the current Labour government at the moment, the budget will be telling. Going by the current rhetoric, I would expect a bit of cash for primary care (maybe £1-3 billion), and then about the same level of public money to be redirected to private care. Bear in mind, that the private sector will deal with about 1% of patient contacts, while primary care deals with about 90%. If Labour continues to stick to its current rhetoric, then hospital funding will go up, almost certainly more than the 1% provided by the Tories, perhaps to 2 or 3%. Expect most of that money not to go to expanding NHS capacity or urgent care, but to staff overtime to get down the routine waiting lists – political versus clinical priorities; temporary fixes versus strengthening the system.
Labour’s priorities: public versus profit
Were Labour serious – in public-good terms, economic terms, and political terms – it would instigate a considerable recovery and expansion of the NHS. GPs’ budget would go up by about 30-50%, NHS inpatient funding by 5-10% per year for at least the next three years, and they would either freeze or reverse private sector contracts. There isn’t a sane health economist on the planet who would argue that such an investment isn’t pro-growth or a sound investment in the future of the UK economy. “We can’t afford to fund the NHS” isn’t a good enough excuse anymore. We are all fully aware that without investment in healthcare, there is no economic growth, at least not for ordinary people. However, we are fully aware that many Labour lobbyists stand to achieve significant personal economic growth from the continued redirecting of NHS resources to the private sector. The budget will spell out clearly where Labour’s priorities are – people or profit.
The clearest way I can summarise where Labour is in relation to the NHS, is that the Tories tried to bolster the private sector by slyly undercutting the NHS, whereas Labour is simply and openly giving the private sector more direct access to more of the NHS budget. No wonder the Tories are praising Labour’s ‘bold vision’. They are likely dumbfounded by Labour’s brass neck in, without any viable argument – public-good wise – for doing so, simply turning on the tap from the public purse directly to the private healthcare sector.
Labour trying to reinvent the wheel with rectangles
In essence, Labour is creating a new model of healthcare.; not a tax-based public healthcare model and not an insurance-based private healthcare model either. It seems Labour has pioneered the all-new ‘tax-based private healthcare model’. A model whereby the taxpayer pays ever-increasing taxes so the private sector can cream off profits by doing the simple and straightforward procedures, while leaving the public healthcare provider, the NHS, with fewer and fewer resources to manage the ever-increasing demands of the more complex care. As I say, it is odd.
Labour seems to have tied themselves in knots trying to maintain their pledge to the NHS while also ensuring those who have the ear of key ministers – private sector lobbyists – have their interests served as well. We end up with convoluted and contrary policies. For the Tories, it was much easier. They only cared about their own interests and those of their wealthy donors. Ignoring the patients dying in the back of ambulances or in corridors was easy with such a single-minded pursuit. I think it is fair to say that Labour does care – perhaps not as much as we would like but certainly more than the last government – but this complicates things. It’s why we now hear the post-hoc justification that “everyone should have access to private care”. It sounds almost socialist. It is of course the exact opposite.
As it stands, Labour’s split priorities between public and private will yield little public benefit and massive profits for the private sector, while unquestionably increasing the costs to the taxpayer. As it was with the Tories, we are being forced into the position of working harder so that more of our tax money can be gifted to the private sector. The only difference with Labour leadership is that they are seemingly being a bit more upfront about it.
More in health.
