Wes Streeting has sparked a fascinating debate on the NHS
It was an extraordinary headline. “Labour vows war on health unions”: surely not? But the headline writer had done justice to Wes Streeting’s remarks. I cannot recall a more intellectually honest declaration by a senior minister or shadow minister – on any topic – and it will receive its inevitable reward: barely concealed dismay in Labour circles, hearty applause from all wise Tories.
“If anyone in the NHS thinks that they can demand more investment without demonstrating better standards for patients, they’ve got another thing coming. We are not going to have a ‘something for nothing’ culture in the NHS with Labour. The NHS… is a service, not a shrine.”
No Tory minister would have dared to say such things, but they will all be able to quote them, often and loudly. This could be of considerable electoral value.
Some unwise Tories are drawing the wrong conclusion. Here is a Labour spokesman talking about reforming the NHS. Surely this is stealing what ought to be Conservative clothes. Not so. The NHS has always been a locked-up Labour issue. At election after election, Labourites have attacked the Tories for heartlessness on health, accusing them of secret plans to privatise it and slash spending in order to finance tax cuts. In response, the best the Tories could hope for was that health would only be of limited electoral salience. The voters might tell pollsters that they would prefer higher health spending to tax cuts. Voters do not always tell the truth.
Back in the 1990s, when Robin Cook was Labour’s shadow health secretary, some New Statesman journalists complained to him that Labour had no policies on health. To their surprise, Cook agreed. They asked him what he was going to do about it and were equally surprised by his answer: “Nothing.” Robin Cook went on to cite a recent opinion poll. When asked which party had the better policies on health, 70 per cent of those polled said Labour. If that ever looked like falling, he might do something. Otherwise, why bother?
Supplemented by claims that the Tories wanted to sell the NHS to the US private sector, such cynicism served Labour well. Post-Streeting, this will be harder. I have sometimes argued that there was a case for a Royal Commission on the NHS. It would have two advantages. It would be a forum for proper thinking, and it would kick Health into the long grass as an election issue. Some Tories disagreed, because the “long grass” aspect would be too apparent. But now Wes Streeting, effectively becoming a one-man Royal Commission, has made the Tories a present of all the long grass that they need. There is a lot to be said for congratulating him and building on the consensus which he has created.
Could there be a downside? Might some middle-ground voters be persuaded by Streeting that Labour was becoming trustworthy? Labour frontbencher criticises trade unions – in the Sunday Telegraph. What is going on? At the margin, this might be true. They would be the same voters who are hoping that Keir Starmer is a closet remainer. But in the broad sweep of electoral politics, we can be certain that very few people could be drawn to Labour because a Labour Government would be tougher than the Tories on the NHS. Many more voters are inclined to believe that a Tory government would be by the rich, of the rich, for the rich – especially on health. Correctly exploited, Streeting’s views could help to counter that. A lot of his colleagues will be saying “what is going on?” and not in friendly tones. The Sunday Telegraph is not popular in the Labour party.
Streeting did of course criticise the government for not doing enough to negotiate. On the back of his acknowledgements that the nurses’ demands cannot be met and his sceptical remarks about the British Medical Association, he might have made it easier for ministers to intervene. It is normally the case that when Labour urges intervention in an industrial dispute, they are thinking of turning another nine-letter word into a synonym for negotiate: surrender. But this time, Streeting is almost urging the government to stand firm.
Apropos the BMA, Tories have always found it a frustrating organisation. With the encouragement of the BBC, it gives itself the airs and graces of a learned body while behaving like the medical branch of the National Union of Mineworkers in the days of Arthur Scargill. Streeting will not buy their act. That should make it easier for Tories to do likewise.
We still need a Royal Commission, to work out, inter alia, how the NHS can turn its best practices into routine delivery. Do we need more doctors? Or is it better deployment of high-tech diagnostic techniques? Can we establish whatever works better in other countries, and why? Is “free at the point of use” sustainable, or could Wes Streeting be persuaded to announce that this is now out of date? No doubt there would be conclusions leading towards higher costs, but at least we should know that we will be spending for success.
We have moved on from the days when the streets were full of less than thoughtful-looking people, banging pots and pans. Streeting has started a fascinating debate, which will range more widely than the NHS. He should also have influenced the public mood against strikes, and thus made it easier for Sunak and his colleagues to face down industrial militancy.