Were the Advertising Standards Authority to adjudicate on the National Health Service it would swiftly rule that its brand is a quite spectacular misrepresentation. Despite health spending having risen 42 per cent since 2010, Britain’s strike-prone hospitals exist in a permacrisis. Timely GP appointments elude a majority of patients, and in large parts of the country NHS dentistry no longer exists as a service at all. It is a fundamental breach of the contract into which this country’s taxpayers have no choice but to enter. “We’re paying more but getting less,” Wes Streeting, the shadow health secretary, said this week. “This can’t go on.”
Mr Streeting is right. That much is reassuring. If the opinion polls are correct, he will be responsible for imposing order on the unholy mess that is British healthcare and he is at least candid about the scale of the challenge awaiting him. Not for the shadow health secretary the tired old homilies about the NHS being the envy of the world. That he chose to challenge this limping sacred cow in the pages of The Sun yesterday is an encouraging sign. Mr Streeting is to be commended for saying the right things. Doing the right things, however, will be much harder — and altogether more expensive — than he is yet prepared to admit.
Much of the shadow health secretary’s prescription for the NHS is sensible. Mr Streeting is right to defy the “middle-class lefties” who abhor any private involvement in state healthcare. Clearing the vast backlog of hospital appointments will, inevitably, require the use of spare capacity in private sector — just as New Labour did in its first years in power. As Sir Tony Blair said, what matters is what works. Deadly delays to treatment, however, are not a temporary phenomenon but a symptom of structural failure. Too often, the interests of patients are sacrificed on the altar of appeasing the lifestyle demands of well-remunerated, and lavishly pensioned, consultants.
It is inexcusable, as Mr Streeting says, that hundreds of NHS operating theatres lie empty on weekday evenings and at weekends. He promises to put them to good use via two million additional appointments. An NHS that is truly uniform in its provision across the country and truly full-time is long overdue.
How, though, does Labour propose to foot the bill? Rachel Reeves, the shadow chancellor, suggests that the answer is a renewed crackdown on tax avoidance. Welcome though that commitment is, it is not nearly enough to turn rhetoric on the NHS into a fully costed plan.
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The real test of his appetite for radical reform will be the extent to which Labour is prepared to face down the medical unions and especially the junior doctors’ absurd pay demands. Nor can solutions to previously insoluble problems reside purely in artificial intelligence.
On general practice, Labour needs to go further. Mr Streeting has travelled widely in his search for inspiration. But his next trip should be a short hop across the Channel. France’s government announced that, in future, the 27 million patients who miss their doctors’ appointments each year will be forced to pay a fine of €5. With more than 6 per cent of GP appointments in this country — each costing the NHS £40 a time — missed annually, serious consideration should be given to such a charge. Numerous exemptions to the penalty will inevitably reduce receipts but the prospect of a fine for no-shows should go some way to reducing unnecessary appointments. Rishi Sunak proposed as much during his campaign for the Conservative leadership in 2022.
Solving the NHS’s problems should be about practicality, not ideology. Mr Streeting gets this. He is prepared to say the unsayable. But his words will prove empty without the courage to go where no previous health secretary has gone before. His will be a long and difficult road.
