Wes Streeting: We must think radically — I want to phase out the existing GP system

With ambulances backed up outside hospitals and patients lined up on trolleys, the NHS is “buckling at the seams” this winter, Streeting says. “I had one elderly relative who had a fall and seriously injured their hip and shoulder. They were told it would be six to eight hours for an ambulance to come so the neighbours put them in the back of their estate car on boards and took them to hospital. Another relative had to go to A&E in severe pain and waited well over 12 hours, until past midnight. She just went home. I think there is a genuine fear in the country at the moment about what will happen if you need the NHS. For the first time in the history of the NHS, people no longer feel confident that emergency care will be there for them.”

Simply throwing more money at the problem is not, in his view, the answer. “We have to be certain that we’re spending the money the NHS already has to maximum impact, and the fact is that when people can’t get a GP appointment they go to an accident and emergency department which, on average, costs the taxpayer £359 per appointment, where if they could see the GP that would cost about £39. That’s bad for patients, challenging for hospitals and more expensive for the taxpayer.”

Streeting, 39, a former leader of the National Union of Students who grew up on an east London council estate, is a politician in a hurry. The health service, he says, needs “fundamental change”, although there are some immediate things the government could do to arrest the present crisis. It is “absurd that we are losing precious time to industrial action when patients desperately need access to care,” he says. If he were health secretary, he would “absolutely be willing to sit down and negotiate with Pat Cullen [general secretary of the Royal College of Nursing] and other health union leaders to see off this dispute”. The idea of a 10 per cent rise, now being floated by the nurses, “certainly looks like a more reasonable figure than where the RCN started”, Streeting says. “We are currently pouring £3 billion down the drain in agency costs, at the same time as saying we can’t afford to pay staff more. This is a ludicrous position.”

A notice on a café in Rotorua, New Zealand, which has introduced a law which means that nobody under the age of 14 will ever be legally permitted to buy cigarettes

ALAMY

The shadow health secretary has infuriated some Labour MPs by saying he wants to use spare capacity in the private sector to bring waiting lists down, but he insists he won’t be ideological about healthcare. “Where we’ve got to as a country is a two-tier healthcare system where those who can afford to pay to go private, and those who can’t afford to wait longer. I find that unconscionable. I know that there are sections of the left who find this deeply uncomfortable, and I can’t say that I’m over the moon about spending taxpayers’ money on more expensive private-sector treatment, but I would find it hard to look someone on a low income in the eye and say, ‘I’m sorry, but I’m going to make you wait longer because my principles are more important than faster access to care’. ”

Streeting wants two more big reforms, to GP services and to public health. With a record two million people waiting more than a month to see a GP, the shadow health secretary says: “I think we need to completely rethink what primary care looks like.” GPs should no longer be “the sole gatekeeper” to the NHS, he says. “I’m convinced that pharmacy has a big role to play. This is where competing interests among providers might not always work in the interests of patients. I can well understand why there are GPs who look with anxiety at pronouncements from politicians that community pharmacies should be doing more vaccination or more prescribing, but that’s because they’re thinking about their own income and their own activity. Vaccinations are money for old rope, and a good money spinner, and not unreasonably GP partners are thinking about the finances of their own practice. That’s totally reasonable but what matters to the patient is fast, accessible care, wherever that is.”

He also wants people to be able to refer themselves directly to specialists, rather than having to go through their GPs. “Sometimes it’s pretty obvious that you don’t need to see the [family] doctor. I had a lump on the back of my head, during the pandemic. I needed to see a dermatologist but in order to get an appointment with a dermatologist, I had to go through the GP. What a waste of my GP’s time. I think there are some services where you ought to be able to self refer.”

Instead of GP surgeries he wants modern health centres with a wider range of facilities “where you will have your family doctor, but you’ll also see nurses, you’ll see physiotherapists, you might go for a minor injury or a scan . . . Unless we shift activity and spending out of hospitals into the community we are going to continue to just spend more and more on a system that delivers poorer outcomes.” If Labour wins power, he wants to tear up the GP contract. “The truth is that the way that GP practices operate financially is a murky, opaque business. I’m not sure that people can honestly say exactly how the money is spent or where it goes. And from my point of view, as someone who wants to be a custodian of the public finances as health secretary, that would not be a tolerable situation,” he says. “I’m minded to phase out the whole system of GP partners altogether and to look at salaried GPs working in modern practices alongside a range of other professionals.”

This would put Streeting on collision course with the British Medical Association, but he is ready to take on the “vested interest” of the doctors’ union. “Nye Bevan famously said he had to stuff their mouths with gold because the BMA opposed the foundation of the NHS. There have always been people within the system who oppose fundamental change which, decades later, is widely accepted. I’m always prepared to work with people. We’re going to be actively consulting on this. I recognise it will be a big change. I want to listen to the profession and take people with us but, most importantly, I want to get this right for patients. The NHS is so broken, we do have to think radically.”

As well as facing down the doctors’ union, Streeting is ready to take on the libertarian right over smoking. New Zealand has introduced a law which means that nobody now under the age of 14 will ever be legally permitted to buy cigarettes, and he is interested in doing something similar here. “As the son of smokers I hated the smell of cigarette smoke growing up,” he says. “I’d like to see it phased out altogether . . . it would make such a transformational impact on the health of individuals and on the health of the nation as a whole and therefore, on the public finances in terms of the cost that we incur as a result of smoking.”

He thinks the public would be broadly supportive. “Every single anti-smoking initiative that has been introduced in this country has been fiercely opposed at the time by all sorts of vested interests, and has both had a transformational impact in terms of health and enjoyed real public support. How many of us remember the days of awful smoky nightclubs, train carriages full of smoke? Who’s calling for the return of smoking in cars with children in the back seat?” He also wants to clamp down on vaping. “I’m deeply anxious about the fact that having reduced smoking, particularly among young people, we’ve sleepwalked into the growth of a new industry in vaping, which has seen enormous take-up among children and young people who otherwise would not smoke,” he says. “My instinct is to take the same approach with vaping as we did with smoking in terms of packaging and marketing, because I’m concerned that the vaping industry is now growing exponentially and there may well be risks associated with it that are not yet clear. I’m sick and tired of seeing young people congregating outside vaping shops on high streets.”

Streeting is ready to take on the forces of conservatism on left and right. “I want to be a champion for patients,” he says. “We love the fact the NHS is free at the point of use, we love and appreciate the people who work in it, but we are deeply unhappy with the quality and speed of the service it’s providing. I don’t think that by being honest and hard-headed about the scale of the crisis I’m doing a disservice to the founding principles of the NHS. Quite the opposite. It’s having heard the cries for help from staff working the NHS that we want to grip the issue of reform.”

Curriculum vitae
Born January 21, 1983
Educated Westminster City School, Cambridge University
Career Elected president of the National Union of Students in 2008. Worked at the Blairite think tank Progress then became head of education at Stonewall. Elected MP for Ilford North in 2015 and became shadow schools minister in 2020. Joined shadow cabinet with the child poverty portfolio in 2021 and was appointed shadow health secretary in 2022.
Family Lives with his partner, Joe Dancey, a public affairs consultant. His grandfather was a bank robber and his grandmother shared a prison cell with Christine Keeler.

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