Tell the truth, Wes: it’s the NHS first, country second
In his speech to the Labour Party Conference today, Wes Streeting described the National Health Service as “unique in the world”.
It’s a step up from “the best in the world”, for it is at least true. But you’d think that at the point where even Labour politicians have shifted to this new, more honest form of words, they might have stopped to wonder why that is. Alas, no.
Streeting seems to be one of this Government’s stronger ministers, and he’s certainly talked a big game on reform – in the abstract. He might even privately wish to embrace substantive change.
However, nothing like that was in the Labour manifesto and there’s zero chance its restive backbenchers would wear it. Instead, we get more tinkering.
The Health Secretary promised new technology, so the NHS would no longer run on fax machines and decades-old versions of Microsoft Windows. That’s a fine idea, and has occurred to ministers before.
But part of the reason our hospitals have barely left the dial-up era is that IT contracts for something as vast and complex as the Health Service are extremely hard to deliver; there seem scant grounds for expecting this government to break new ground there.
He also touted Labour’s cunning strategy of settling the doctors’ strike by folding to the unions’ pay demands. The timing was a bit unfortunate, with the nurses having rejected a 5.5 per cent offer just the day before.
More importantly, such concessions solve a short-term political headache but permanently increase the day-to-day running costs of the vast NHS workforce. The forward projections for public spending on healthcare over the next few decades are already frightening, and Labour shows no sign of knowing how to reconcile an ageing population with the state’s increasingly straightened fiscal circumstances.
Well, not quite no ideas. There’s always that perennial favourite: trying to make the NHS a great system by preventing people from needing it.
Streeting cited the new ban on junk food advertising, but some of the public health interventions being debated inside Labour, such as restrictions on pub opening times, show the direction of travel when the open priority of advisers such as Chris Whitty is cracking down as much as possible on anything which might lead to NHS costs.
Reforming public services? Never. Reforming the public? That’s fine.
But people can take different views on these practical policies. Where the speech truly strayed into the realm of fantasy was here:
“But Conference, to seize that potential we have to reform the NHS to make it fairer... When the wealthy receive a diagnosis, they already know the best surgeons and can push to get the best care. But working people can’t. If the wealthy are told to wait months for treatment, they can shop around. But working people can’t. And if they pay top dollar, the wealthy can be treated with cutting-edge equipment and technology. But working people can’t.”
“Our ten-year plan will give all patients – rich and poor alike – the same information, the same choice, the same control.”
This section is bizarre – not least because Streeting is all but publicly conceding that the private sector is a vital part of our actual healthcare system. Again, something that ought to make him think a bit harder about why our model is “unique in the world”.
Yet the elision is also misleading. The wealthy having access to the best surgeons, technology and care, or the ability to shop around, is not a question of the NHS being unfair – it’s about people who’ve paid all the taxes that prop up the Health Service paying twice to receive treatment from completely different providers.
It therefore risks setting a completely impossible standard. Giving patients more choice within the NHS is one thing. But people do not enjoy differential treatment within the NHS because they’re wealthy. Is Streeting seriously suggesting that his goal is to deliver private-sector levels of quality and choice, to everyone, “free at the point of need”?
That’s impossible. Mixed-payment systems of the sort employed by all our European neighbours (which deliver better healthcare outcomes for similar spending levels) can even out the stark divide created by our binary state/private setup, but they don’t eliminate completely. Healthcare uses scarce resources like anything else – access to it needs to be rationed one way or another.
In the private sector, it’s rationed by price (and the high prices are why it can afford to be so good). In the state system, it’s rationed by queueing, and enforcement of NICE guidelines around how much money saving a ‘quality-adjusted life year’ is worth.
A system with all the quality and freedom of a price-mediated system (if you can afford it) and the universal access of a state-provided system is a financial apocalypse, a system for which there would be almost unlimited demand with no rationing mechanism at all.
Perhaps it was just clumsy wording. If Streeting was simply trying to create cover for more choice within the NHS, that’s all to the good. Labour tends to recognise that monopolies are bad for the user in the private sector, and it’s past time that it recognised that the same is very often true of the public.
But inviting a direct comparison with the actual private sector is a losing game. Given the NHS’ dominant role in our healthcare economy, private care is a luxury product. This Government dare not even scrap the two-child benefit cap; it should not pretend that it’s going to deliver a universal, luxury medical service.