Wes Streeting wants to turn healthcare on its head.
To that end, the shadow health secretary has flown more than 10,000 miles, embarking on a whirlwind tour of Australian healthcare to see what lessons the UK can learn.
The case couldn’t be more urgent. For one thing – as Mr Streeting jocularly points out, to his Australian health officials – “you keep nicking all our doctors”.
It’s not a claim they can deny. The brain drain of UK medics to Australia has only intensified in recent years.
As Mr Streeting visits health facilities and meets officials across Canberra, Melbourne and Sydney, British accents ring out at every turn, with tales of deserting Northamptonshire, Yorkshire and west London for a better life Down Under.
There has long been a pattern of young British medics seeking to spend a few years in Australia, with some putting down roots.
But it is absolutely clear that the exodus has increased in recent years.
At every visit, medics tell how they are increasingly being lured not just by a lifestyle of sea, surf and sand, but by the promise of lucrative work, under less punishing working conditions in a health system which is not buckling under the strain.
Mr Streeting is in Sydney, on a visit to Maroubra Medicare Urgent Care Clinic.
The unassuming health centre, in a suburb of the city, is one of 38 which the Labor government has opened since being elected to office in May last year, with plans for 20 more by the end of this year.
Last month, Mark Butler, the health minister, told the Australian parliament that so far the sites – which are open 8am to 8pm – have significantly reduced pressures on emergency departments.
Around half of presentations to A&E are classed as “semi or non-urgent” he told MPs – and areas with the new units have seen the number of such cases turning up in emergency departments fall by one fifth.
One third of cases are dealt with at weekends, one fifth in the evenings, and one in three patients are children under the age of 15, he told MPs.
In introducing the policy across Australia – a country which develops many of its health policies on a state rather than federal basis – Mr Butler had a fight on his hands.
Mr Streeting met Mr Butler on Tuesday in Canberra in a series of meetings to help UK Labour develop its health policies, and learn from the Australian party’s electoral success.
The Australian Medical Association, the country’s equivalent of the British Medical Association (BMA), has bitterly opposed the drive, seeing it as a threat to the current system of GPs.
“It was really striking talking to Mark Butler at this stage in the life of the Labor government in Australia,” Mr Streeting reflected after touching down in Sydney.
“He’s got the scars on the back from taking on vested interests and taking on opponents of reform.”
In the UK, the BMA has a long history of rejecting such changes.
Back in 2008, the union led a campaign against Labour’s plans for a network of polyclinics, leading the normally mild-mannered Alan Johnson to accuse it of a “ludicrous misrepresentation” of the then government’s proposals.
With the union still more militant today, Labour is braced for pushback to its latest policies – but Mr Streeting expresses a determination to “be the patient’s champion” in changing the fundamental shape of health services.
“What I want to do is turn the NHS on its head,” he tells senior officials and GPs at the urgent care clinic.
“To move it from a system that is overly focused on hospital care, with so much late-stage diagnosis, basically a sickness service, to a neighbourhood health service, that gets to people faster, diagnosing and treating faster, and crucially joins up care, so patients no longer feel like they are being pushed from pillar to post.”
Doing this isn’t just about major reform – but also about getting some basics right: like helping the NHS hang on to its workforce, he suggests.
In the UK, patient satisfaction with GPs is at a record low.
But so too is GP morale, as measured by a number of surveys, while the numbers cutting their hours, or opting for early retirement keep rising.
Mr Streeting believes that tackling this also means reforming the GP contract to reduce bureaucracy – instead of a system where family doctors are measured and paid against compliance with hundreds of targets.
Speaking to senior managers and GPs at the Maroubra clinic, he says: “The extent to which they are tied up in red tape is just absurd. With the [GPs] Quality and Outcomes Framework we are so centrally prescriptive about what GPs’ activity and focus should be.
“That becomes the driver for everything, so GPs spend so much time ticking boxes and filling out forms, and drawing down funds, rather than being able to focus on the needs of the patient in front of them, and their community.”
Mr Streeting has already promised to increase pay for GPs who ensure patients can see the doctor of their choice, insisting the move would be cost neutral, with less funding for those who retain a “like it or lump it” approach.
“We need to bring back the family doctor,” he says.
If this brings to mind a rose-tinted vision of days of yore, the shadow health secretary says his case is also rooted in rather more hardheaded economic grounds.
“At the moment the situation is the worst of all worlds,” he says, highlighting research by the King’s Fund comparing the relative costs of GP and A&E usage.
“We are talking £40 for a GP appointment versus more than £400 for an A&E attendance” he adds, saying the NHS is too often throwing “good money after bad service”.
International league tables show that Australia’s health services outperform those of the UK on a wealth of measures: life expectancy, mortality from cancer, heart attacks and strokes among them.
Much of this comes down to diagnostics: Australia has four times as many CT, MRI and PET scanners relative to its population, along with more doctors, nurses and hospital beds.
Interestingly, it achieves this while spending significantly less on health, at 9.6 per cent of GDP compared with the UK’s 11.3 per cent, according to latest comparative data from the Organisation for Economic Co-operation and Development (OECD).
Getting better outcomes
Mr Streeting says: “In terms of OECD countries, we are lagging behind. And in fact, one of the reasons I’m here in Australia this week is because they are spending less on health care and getting better outcomes.”
Asked about the risks Labour faces in getting its electoral strategy right on health, he has no doubt – and also says such an approach would put the future of the health service in peril.
“The biggest risk to the NHS now is that we retreat to our ‘comfort zone’ and tell ourselves this is just about investment, and isn’t about reform,” he says.
“If we just pour ever-increasing amounts of taxpayer money into a broken system, we will continue to get worse health outcomes than other leading economies. And I genuinely fear for the future sustainability of the NHS in that situation.”
The politician points out that the NHS is already soaking up 44 per cent of government spending.
“I don’t think we can afford to go higher than that as a percentage,” he says, firmly.
“It weighs heavily on my conscience that every extra penny that goes into the NHS is a penny that could have been spent on child poverty reduction, or school standards or crime and policing. It’s also money that could go back into taxpayers’ pockets.”