Not even Labour can rescue the NHS from imminent disaster
It has been the consensus for some time that only Labour can save the NHS from oblivion. The story goes that Conservatives possess neither the confidence nor the credibility to push through reform. Which is hardly surprising, given they have been relentlessly criticised for “selling off the NHS” or allowing people to languish on waiting lists through “underinvestment”.
By contrast, conventional wisdom states that Labour – the guardian angel of Britain’s national religion – has both the public support and moral gravitas to guide the NHS into a new era.
Labour’s punchy rhetoric in Opposition, warning that the NHS must “reform or die” has set the scene for a dramatic reckoning.
Yet, 100 days into a Labour government, this neat little theory has unravelled. Keir Starmer’s great early mistake has not been his bungs to the public sector or even his cuts to the winter fuel allowance. It is his failure to put the NHS at the forefront of his agenda.
Labour doesn’t appear to have even a short-term war-room plan to get through the winter crisis, even though A&E is busier than ever and waiting lists continue to grow. True, Wes Streeting is touting his £1 billion rescue plan to clear backlogs by enlisting private hospitals. But he is rearranging deck chairs on the Titanic; every day, hip replacements are being delayed due to absurdities like lost paperwork and broken lifts.
Wes Streeting’s 10-year plan to reform the NHS is nowhere to be seen as yet. Had Labour been serious about getting on the front foot, it would by now be implementing an “oven-ready” reform plan. Instead it has kicked the can down the road. All it has done so far is order Lord Darzi to launch an independent investigation. But this largely told us what we already knew, whilst tangible recommendations were thin on the ground.
The Government’s decision to delay unveiling its 10-year plan until after the Budget is a mistake. NHS bosses already have a clear idea of where cash must be spent, from fixing leaking hospital ceilings to upgrading Windows XP computer systems.
Had it had the gumption, No 10 could have pushed back with an alternative “split screen” plan in which bold emergency measures are aligned with longer term goals.
For example, it could have insisted that NHS bosses agree that a big chunk of winter funding go into an emergency project to insulate the homes of poorer people who often end up in A&E and GP surgeries owing to avoidable conditions.
After all its fighting talk, it appears that, in government, Labour has lost its nerve. This may well be because it is dawning on Labour that its best-laid plans are doomed.
For one, the attempt to lock down the shift of resources from hospitals to community health is proving problematic. Tension has been mounting for some time between the NHS and local government.
Health bosses determined not to give up their budgets to councillors are seeking to control how healthcare is provided. Democratically elected local politicians have accused the NHS of trying to restrict them, allowing the NHS to avoid public scrutiny of how it spends taxpayers’ money. Labour is hoping to put greater emphasis on “prevention”, but will struggle if public health programmes suffer the same problems – a lack of accountability and inefficiencies – as its core operations.
The other major plank of Labour’s NHS vision – a health revolution powered by AI and medical innovation – is also losing some of its lustre.
The Westminster echo chamber is babbling about new anti-obesity cures and the infinite potential of AI-powered predictive medicine. But right now the scientific world is soberly discussing their limitations.
Evidence is building that many patients struggle to sustain weight loss after coming off the drugs.
Alarm is also growing that the rate of new medical discoveries is slowing down, as big pharma eschews in-house innovation and researchers (who are judged by the metric of citations) abandon pioneering research in favour of established fields.
It is not unthinkable that reliance on AI may exacerbate this trend because its method of reasoning – which boils down to extrapolating general rules from large data sets – can actually be much less efficient than the old-fashioned tradition of human beings, exploring hypotheses and following hunches.
In the end it is only by taking more responsibility for our bodies and minds that we can avoid a healthcare catastrophe.
But Labour is loath to concede this. The Left recoil at phrases like “individual responsibility”. But it is unlikely to accept the state’s limitations when it comes to changing our behaviours.
This leaves Labour trapped in an insane paradox, arguing that the way to alleviate pressure on the NHS is to make it do more.
The Left is pretending that the crumbling NHS can hold the front line as backlogs lengthen and staff leave in droves. But they also want it to flourish as a “back-to-work service” for those on long-term disability benefits and become a world leader in prevention. They seemingly believe that the NHS, rather than welfare reform, or better education around healthy diet in schools, can turn us from sloths into vegan gym bunnies.
With the Left unable to articulate a realistic vision for change, NHS actors are filling the vacuum with the familiar tale that the simplest way to fix the mess is to give it more funds. Predictably, pressure is building on Rachel Reeves to once more demonstrate her “commitment” to the NHS.
It feels like it’s already over. Plus ça change.