It may be that the NHS will escape being overwhelmed, again, in that it will pass the test set by Sajid Javid, the health secretary, of being able to treat children injured in car crashes. But that is a low bar, and no one can doubt that the health service remains in a parlous state.
Even in the optimistic scenario in which further waves of coronavirus are manageable, the more serious problem over the next two years could be that the NHS simply fails to provide the basic level of care that people expect. Waiting lists are longer than ever, people are waiting longer for ambulances, and they are waiting longer in A&E.
Paradoxically, the less that coronavirus is a threat, the more voters will expect the government to solve the problem of the NHS. Before the pandemic, the NHS was central to the restoration of the Conservative Party’s fortunes. After six years of low annual increases in NHS funding, barely keeping ahead of inflation, let alone the pressures of an ageing population, the turning point came in the 2016 EU referendum. The real significance of the £350m-a-week figure on the side of the bus was not that it was untrue that we sent that much to Brussels, but that the Leave campaign said it was the amount that should be spent on the NHS.
By the time that Theresa May had caught up with the need to make that pledge a reality, it was too late to save her career, and the six years of funding famine stretched to a decade. Boris Johnson repeated her promise to increase spending sharply, and put targets for more nurses, doctors and GP consultations in his manifesto, but the new money had barely started to flow when the virus struck.
Now the NHS has to be rebuilt again, starting from further back, and with the political imperative to show clear results before the next election as pressing as ever. Keir Starmer recognises that this will be one of the central battles of what Trotskyists used to call “the coming period”, hence the promotion of Wes Streeting, probably Labour’s best shadow cabinet communicator, to the health brief. Streeting is one of those rare politicians admired by MPs of the opposing party. Tory MPs don’t yet say they are afraid of him, but they are keeping a wary eye on him.
It was notable that Streeting in an interview this week crushed his own party’s sensitivities on the crucial question of how to increase NHS capacity quickly. He said: “No doubt the government will turn to the private sector, no doubt the next Labour government may have to use private sector capacity to bring down NHS waiting lists, and I won’t shirk that for a minute to get people better health outcomes.”
He said that New Labour had done it: “It’s effective, it’s popular with patients, but it comes at a cost.” This last point was an ingenious twist, designed to sell the policy to those in his party who are ideologically opposed to the profit principle in the NHS in any form (people who, incidentally, do not understand that many GPs are private contractors providing NHS services free at the point of need). Streeting posed as the responsible guardian of the public finances, blaming the Tories for the higher costs: “It shouldn’t be the case that because Tory governments run down the NHS, we have to spend more taxpayers’ money than would be necessary in the private sector because we haven’t sorted out the public sector.”
This defence of pragmatic “what matters is what works” principle is essential, in my opinion, to give Labour the credible claim that it could do better than the Conservatives, who will come to the voters at the next election pleading for more time to finish the job.
Labour needs to understand that – assuming there are no catastrophic new variants – the NHS is likely to look as if it is moving quickly in the right direction by May 2024. One little-noticed feature of the NHS workforce is that, despite the short-term crisis of staff absences for the virus, nurses are being recruited from abroad at a rate not seen since the last Labour government. James Buchan of Edinburgh University wrote last month in Nursing Times that this year was heading for a record high of 20,000 new registrations, mostly from non-EU countries: “The international quick fix will enable the UK government’s 50,000 target to be met.”
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That was a target set before the pandemic for the number of additional nurses to be recruited by the next election, and meeting it despite the pandemic and the associated burnout would be a striking achievement. That, and the extra money pumped into the NHS this year, next year and the year after, has a chance of making the kind of difference that might be felt by the median voter by May 2024. Even the Institute for Fiscal Studies has given its seal of approval, saying that the new money “could be enough to meet the pressures on the NHS over the next two years”.
Which means there is one last test of the parties’ credibility on the NHS: how to pay for it. Johnson has taken the tough decision, defying the instincts of his party, to put up taxes. Labour and Jacob Rees-Mogg are locked in an unholy alliance of pretending that this is a choice that can be avoided. Rees-Mogg, who suggested at cabinet on Wednesday that the national insurance increase should be scrapped, proposed unspecified spending cuts and questioned the productivity of civil servants working from home. Labour, which voted against the health and social care levy, proposes different, unspecified tax rises, while also proposing tax cuts on energy bills.
Wes Streeting and Rachel Reeves, the shadow chancellor, need to do some serious work on how a growing NHS can continue to be funded after 2024, or the Conservative Party – assuming Rees-Mogg isn’t leading it – could be the more credible party on the NHS at the next election.