Persistent underfunding by consecutive Tory governments has left the NHS on the brink of collapse. If Labour wins the next election, which seems likely, Wes Streeting will be responsible for rebuilding its shattered infrastructure and for getting desperate patients off waiting lists. His main task will be to increase capacity.
NHS at full capacity
Unquestionably, this will cost money, at least in the short term. To shorten the queue of nearly 8M people – in England alone – more of them must be squeezed through the system. Each one will carry a price tag. However, there is a limit to what money can do. Once every bed is filled and every staff member is at 100% workload, the system will choke. The NHS reached that limit long ago and is struggling with an exhausted and depleted workforce. Money alone will not get waiting lists down.
Streeting vows to solve the problem by spending public money into the private sector, where he hopes to find spare capacity. A seductive idea, but with an instant downside that a substantial chunk will drop into the pockets of shareholders. He also assumes that the private sector is a miniature version of the NHS that you can turn on and off. In fact, the private sector depends heavily on the NHS for its existence. Most private healthcare workers were trained by the NHS, and many split their employment between the two sectors.
The envy of the world
To properly understand the value of the NHS, the 99% Organisation commissioned The Rational Policy-Maker’s Guide to the NHS, which was presented to the Scottish Parliament in February and the Welsh Parliament in April. The report clearly demonstrates that the NHS is on its knees thanks to “chronic and severe underfunding”. Until recently it was regarded as the gold standard of health services. Using a fact-based approach the report shows how – on measures of effectiveness, equity, and efficiency – it reached its peak in 2014 and was the envy of the world. And how it could be so again.
But a thriving success was not something the Tories wanted to shout about. For them and private investors, system failure was much the more lucrative story. Labour has seamlessly picked up the baton.
Ironclad fiscal rules
In its dance with the Tories, Labour’s rhetoric has shifted to the right and has assumed the language of austerity and fiscal responsibility. The mantra of ‘ironclad fiscal rules’ seems to have become a mark of virility and Streeting has adopted a bullish persona to dish out a tough-love message. His public statements bear little relation to the lived experience of underpaid staff on long hours.
Streeting writes for The Sun
Take for example an article published in The Sun with the headline, “THE Shadow Health Secretary warns the NHS today that there will be no additional funding without the ‘major surgery’ of reform under Labour.”
To begin with the obvious, The Sun is a Murdoch-owned paper, and Murdoch is famously right-wing and despises the public sector. The article was clearly pitched to readers fed on a diet of woke-bashing. For their delight was the wasteful NHS squandering their hard-earned taxes – a trope, years in the making – and with the help of an unsubtle play on medical jargon they could visualise it being carved up on its deathbed.
The politics of the article should be grimly familiar. He is playing on a grudge. Some people will always resent paying for what others receive. The politics of division. Perhaps more egregiously, he set out to undermine the longstanding status of the NHS. “The NHS is a service, not a shrine” was one grenade he rolled under the esteemed institution. The days of joining in with the banging of saucepans are clearly over.
Deliberate obfuscation
Along with the grindingly familiar culture war tactics, Streeting also sought to confuse. Take this sentence:
“Middle-class lefties cry ‘betrayal’. The real betrayal is the two-tier system that sees people like them treated faster – while working families like mine are left waiting for longer.”
The sentence overloads the reader with meanings.
Streeting has become adept at this sort of trickery. He uses it to throw interviewers and critics off balance. The “middle-class lefties” phrase got all the usual suspects talking, as he knew they would. Free publicity for his underlying intention of boosting private health care.
Workable solutions for the NHS
Streeting is much stronger on rhetoric and wordplay than he is on workable solutions. The extra £1.1bn he promises in the article is minuscule compared with the total budget of £181.7bn (2022/23). Even this was conditional on staff working evenings and weekends. Most of them are burned out.
The only possible justification for privatisation is that we face an emergency, and a short-term intervention is warranted. There are several problems with this argument.
Most glaring is the fact that most private sector staff come from the same pool as the public sector. Diverting funds to private companies will help them poach talent from the NHS, but not necessarily increase capacity. What one gains, the other will lose.
Then we have the problem of evidence. Streeting is opaque on this. Despite improvements in gathering data encouraged by the Competition and Markets Authority in 2014, the British Medical Journal reported that “we still do not have the information on workforce, hospital capacity, outpatient services, and prices required”. These are shaky grounds on which to base such disruptive reform. Streeting has received over £193k from donors linked to private healthcare. Hopefully, he is not listening to their advice.
NHS needs long term commitment for the sake of the UK
What the NHS really needs is a commitment to long-term funding. Without this, as The Rational Policy-Maker’s Guide to the NHS makes clear, the UK will become sicker, less productive, and less able to afford the healthcare the nation needs. The resulting downward spiral is likely to do major damage to the UK economy. The knock-on effects of a failing healthcare system are often underappreciated. They feed into negatively reinforcing loops that undermine the morale, productivity, and mental health of the nation. Only the political commitment to proper funding can remedy these ills.
Private healthcare is not a panacea. It is less efficient than a well-funded NHS, more expensive, and driven by profit-seeking to cherry-pick the simpler treatments. Nor does it answer the capacity question. Giving it public money is a betrayal of the public interest. Streeting has set his stall out. The result will be yet more crippling damage to the NHS while private companies profit at our expense.
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