Change. That’s Labour’s big idea. Plastered across placards, podiums, and battlebuses, it unimaginatively captures their central selling point: not being the Tories. This election is a referendum #FourteenWastedYears. Keir Starmer doesn’t have to do much to win it except point to stagnant living standards, absurd immigration, and record dissatisfaction with the NHS. Candy from a baby.
But how superficial is the change that Labour offers? Will putting Starmer in Number 10 make much of a qualitative difference to Britain? Does switching the blue team for the red mean little more than a new regular cast of ministers to embarrass and underwhelm in the papers? What does the winner get, except five years squatting on top of the crumbling post-Blair perma-state?
Regardless of the election result, my bleak assumption that things can only get worse won’t butter many parsnips for any voters hoping for improvement. They might be optimistic that Labour could have realistic, well-thought-through plans for delivering qualitative change to Britain. Step forward Wes Streeting – avowed slayer of sacred cows and scourge of “middle-class lefties”.
My embittered eye has fallen on the Shadow Health Secretary’s plans to hit the 18-week NHS waiting list target within five years of entering office. Since the current target of 92 per cent of patients being treated within that timescale hasn’t been met for almost ten years, this is rather ambitious from Streeting. More than 3 million people have already waited over 18 weeks.
Labour has established several routes to reach this objective. Streeting has suggested the NHS will provide more treatment out of hours, enabling 40,000 more weekly appointments via weekend and evening slots. In the spirit of Anthony Blair, he has been bullish about using private sector providers to boost capacity. The NHS is a “service, not a shrine”, he informs his party. Look to Qatar!
Streeting’s tough talk seems attractive. Conservatives have been known to dabble in affection for self-styled heirs to Blair, to the chagrin of Peter Hitchens. We know that the Emperor has no clothes. The NHS is an appalling socialist behemoth, beloved only because of ignorance of alternatives, and superior to other available systems only in its great record in failing to keep patients alive.
Knowing that we blew Vote Leave’s post-Brexit opportunity to turn public trust towards fundamental NHS reform, we might hope that Streeting can live the cliché that only Labour can do so. He called the contaminated blood scandal indicative of a “cultural rot that places protecting the…NHS above protecting the public” and vows to put patients first and the organisation second.
All the right noises. The last Labour government saw big waiting list reductions. Can the next do the same? Alas, that seems unlikely. As the Institute for Fiscal Studies highlights, those falls came alongside a whopping great increase in health spending – over 7 per cent yearly in real terms. Rachel Reeves cannot provide that. She is still babbling on about ‘tax avoidance’ crackdowns.
Warm words about the potential efficiencies provided by AI cannot compensate for lockdown’s longtail or the demographic disaster of our aging population. As Neil O’Brien has laid out, despite NHS spending having risen by 42 per cent since 2010, the number of people in England aged over 70 is up around a third. This group has five times more GP appointments than the young.
Despite the Government reaching its target of 50 million more GP appointments a year, it hasn’t touched the sides. Demand has surged past supply. This long-term trend is towards a cavernous imbalance between the needs of an elderly and unfit population and an ever-shrinking tax base. Writing stern words in The Sun is much easier than being honest about the system’s plight.
But before Streeting can consider taking the questionable Canadian approach of bumping off the aging, infirm, and poor until the sums add up, he will have the immediate problem of striking junior doctors. Staging their 11th walkout in a little over a year in the run-up to the election, the BMA is using upwards pressure on waiting lists to demand a hearty – and costly – 35 per cent pay rise.
Lacking the money with which to stuff their mouths, Streeting must fear that continued union intransigence would scupper even the slight fall in waiting lists already predicted. Every day of the strike, all those big plans for NHS improvements become further away. But every settling on BMA terms for a quieter life would make it obvious that Labour’s fiscal pledges are fictitious.
Perhaps Streeting might surprise. Maybe Labour will achieve 2.5 per cent growth on the back of New Towns and good vibes. Maybe the new Health Secretary will immediately act to establish a cross-partisan Royal Commission, designed to produce a functioning healthcare system that lives up to Sir Henry Willink’s original vision. Maybe England will win the Euros, and so on.
The more likely outcome is that Streeting enters office, and finds himself overwhelmed by fiscal realities, producer interests, hostile backbenchers, and crisis management. The NHS will continue its inexorable slide into decrepitude, the omnicrisis entirely unavoidable. Unless Reeves finds a spare £100 billion down the back of the Treasury sofa, waiting times will soon get worse.
This sums up what we can expect from Britain under Labour: similar to how it is now, but worse. In the spirit of Jacob Rees-Mogg, I repeat some historical words of wisdom, often erroneously attributed to Lord Salisbury. Change? Why do we need change? Aren’t things bad enough as they are?
