The headlines over Christmas were dominated by the NHS. The most intriguing story in the new year so far, though, hasn’t been Rishi Sunak’s refusal to confirm he uses private healthcare (let’s face it, there’s probably an unsurprising reason for that) but Wes Streeting’s radical plans for reform.
In an interview with the Times the shadow health secretary said he wanted to phase out GP practices and allow people to self-refer for some specialist services. He wants to end the sale of cigarettes and to clamp down on vaping. All of this is on top of previously announcing that Labour would use private healthcare to clear the NHS backlog (currently 7.2 million). Streeting clearly has no intention of tinkering around the edges.
Keir Starmer is ordinarily a risk-averse politician. His slow evolution on Brexit, his readiness to slash policies that carry a big price tag, and his enforcement of strict rules for parliamentary candidates show he prefers bomb disposal over firefighting. So what is Streeting up to, picking fights with the British Medical Association by threatening to rip up the GP contract?
We have become acclimatised to the NHS being in crisis every winter, but the pressure on healthcare post-Covid really is extraordinary. There is a fast-emerging two-tier system where those who can afford private healthcare pay and those who can’t are left languishing on waiting lists. And due to austerity between 2010 and 2019, the UK’s ageing population, and a social care system not fit for purpose, the NHS is increasingly dysfunctional.
But Britain is spending a lot of money on the NHS. The health budget is £170bn for 2022-23 (and was £192bn during the pandemic). According to the King’s Fund, Britain is spending 10.2 per cent of GDP on health; about the average for a developed country, but lower than Germany (11.7 per cent) and France (11.1 per cent). A recent report by the think tank Civitas, however, warned that despite that relatively high spend the UK has some of the worst health outcomes in the Western world.
On 5 January Starmer pledged “national renewal” but stressed he won’t get out the “big government chequebook”, meaning Labour won’t go into the next election promising more cash for a health service, which many will feel has failed them, unless it is teamed with reform.
Setting out big changes close to an election could provoke an allergic reaction, so it makes some sense for Streeting to act as disrupter now to try to build consensus. He believes the wait for GP appointments is putting pressure on hospitals and a shake-up of primary care will save money. His proposals also demonstrate that Labour is brave enough to take on what he calls “vested interests”. Streeting underlined in interviews yesterday, however, that Labour will consult on the plans, not bring them in wholesale.
Not everyone within Labour is happy. Some are aghast that Streeting’s opening salvo of 2023 was fired at GPs rather than, say, the parlous state of NHS dentistry. And some frontbenchers are resentful of Streeting’s “star status” and the freedom they feel he’s been given by Starmer to bend the rules. The plan was not raised at shadow cabinet meetings and some sources suggest the potentially huge costs of scrapping the GP contract were not even run past Rachel Reeves, the shadow chancellor.
The struggling health service is the biggest political hazard the Tories currently face, and Labour may need to tread carefully to ensure it does not become a danger for its politicians too. But throwing out a big idea early shows the party is growing in confidence and willing to take risks.
This piece first appeared in the Morning Call newsletter; subscribe here.
[See also: The politics forecast for 2023: A crisis in the Tory party and a Labour reshuffle]