Wes Streeting is right. If Labour is going to save the NHS there needs to be a serious debate about its future

by David Talbot

The NHS is so central to British politics that a vague promise to provide it with more funding, festooned across the side of a bus, helped to sway a referendum of vital national importance. Such was the potency of the claim, which spoke to voters’ deepest passions, and indeed fears, about the NHS, that whilst voters believed Brexit would be bad for the economy, they had believed the Leave campaign’s claim of more funds for the health system in a post-Brexit Britain.

The pledge was indisputably incorrect, and horrid – but ultimately effective – politics. Little or no precious national debate was directed towards just what the funding ought to be directed towards, nor whether more long-lasting reform was required beyond the perennial resources argument.

That may be, of course, because ‘the NHS’ and ‘crisis’ has become the white noise of British politics. As an editorial in the BMJ pointedly stated: “The current media frenzy over the latest NHS crisis prompts speculation on how the NHS might end.” The caveat, however, is the editorial was written in 1999.

The Shadow Health Secretary, Wes Streeting, has lamented that the NHS is not “the envy of the world” and that “it is a service, not a shrine”. He has been lambasted from the predictable bastions of conservatism, the far left and the BMA. It did, though, signal a welcome, and long overdue, injection of realism from the Labour Party into the NHS debate.

The coalition years saw Labour figures, including Westminster outsider Andy Burnham, organise candle-lit vigils and people’s marches for the NHS. The Corbyn years were a confused cascade of sloganeering and comfort, culminating in the ideological pure – but unworkable – Medicines for the Many which terrified both industry and the health service alike.

Streeting’s diagnosis, that a future Labour government cannot continue “pouring money into a 20th-century model of care that delivers late diagnosis and more expensive treatment” is the correct one. Unless the debate over the NHS focuses on what it actually does, improving patient outcomes, than a myopic, nostalgia-fuelled focus on the organisation itself, than we stand little chance of improving our health.

Equally, those who ‘play the privitisation card’ each and every time reform of the health service is discussed are as guilty of stalling the health service as those who have starved it of resources.

The pandemic demonstrated that the health service can innovate and reform. Whilst vaccines will always receive the limelight, consider also that the health system gathered, processed and published – in an app built by NHSX – nationwide COVID-19 data available to the postcode. Not only did it inform national policymaking, but it empowered and educated the very people it was designed to protect – the public – to take care of themselves.

One in three people never need to be in a hospital and the NHS is buckling from the ill health its population bequeaths it. A stronger focus on prevention and reducing health inequalities will help draw down the eye-watering waiting lists but, over the longer term, also embed a culture of self-care.

The centricity of the NHS during the toxic Brexit referendum, and the convulsions it sent through the British body politic ever since, focused on one aspect only – its funding. As Doctor Streeting rightly notes, the real subject of debate and focus ought to have been on how to spend that funding wisely. Too much of the discussion about the health service currently does it a disservice.

The NHS has long occupied an untouchable status in British political life. The failure to engage in proper debate in its future is, unfortunately, an unwanted by-product of the reverence in which it is held. It is clear that the scale of vision and reform required for the health service will not fit onto the side of a bus at the next election. With some simple, but painful, admissions, Streeting has shown the courage to move the NHS off life support.

David Talbot is a political consultant

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