Wes Streeting is right to want to reform the NHS – but how far would he go?

Wes Streeting, the shadow health secretary, has a good line in Blairite home truths: “I am not going to pretend the NHS is the envy of the world,” he said in a speech today to Policy Exchange, the Cameronian think tank set up by Michael Gove.

That is a good start, when going into the lion’s den of Conservatives, who often ask why, if the NHS is so good, no other country has copied it. Streeting had a good time, and obviously enjoyed taking the fight to the other side. He reminded his hosts that the NHS had the shortest waiting times and highest patient satisfaction after 13 years of Labour government. He didn’t quite put it like this, but he made it obvious that he was pleased that the government’s most loyal think tank was looking to him for the solutions to the NHS’s current problems.

Indeed, it was interesting that he had been approached by Policy Exchange after his speech to Labour’s annual conference, when he outlined his plans for a workforce policy to recruit, train and retain more NHS staff. The think tank offered to write a report on how that policy could be delivered – a report that Streeting will now draw on in his preparations for a Labour government.

In his speech, Streeting revelled in the cross-party competition for the best ideas, boasting that when he announced his policy at Labour conference, Jeremy Hunt – the Tory former health secretary who was at the time on the backbenches – called on Liz Truss to steal it, saying that “the smartest governments always nick the best ideas of their opponents”.

Streeting was also a true Blairite in taking the fight to those who regard themselves as to the left of him. “It’s great to be here at Policy Exchange, the perfect venue to rebuild my street cred with comrades on the left,” he said. “But I’m not just talking to them, I’m talking to the country.”

He was fresh from his dust-up with the British Medical Association, the doctors’ trade union which had objected to his saying that the recruitment of more doctors in the NHS must lead to improved service for patients. He said that he didn’t want to reopen that argument, but he added: “In my interview with The Sunday Telegraph, I was quoted saying the NHS must ‘reform or die’. A few extremely online bad-faith actors have taken those words to suggest I am ambivalent about which my preferred option would be.”

On the other hand, the New Labour government reformed the NHS and now it is dying again, so it may be that Streeting faces a bigger challenge than simply re-running the Blair programme. The NHS has never been the envy of the world, not even when it was working about as well as it can, in 2010, and even if it had been, briefly, world-class then, it quickly slipped back again.

If Tony Blair regarded the NHS as “basically fixed” by the time he left office, it didn’t stay fixed, and that poses a fundamental problem for those who want to defend and reform it now.

Streeting showed that he begins to understand this, telling Policy Exchange: “But I know we have to go further. This week’s report from the Institute for Fiscal Studies couldn’t have made the case for reform clearer. The NHS has more money, but we’re seeing fewer emergency admissions, fewer outpatient appointments and fewer elective and maternity admissions than in 2019. We’re paying more but getting less.”

He even said: “We cannot continue pouring money into a 20th-century model of care that delivers late diagnosis and more expensive treatment.”

Unfortunately, when he came to set out “the beginnings of our plan” it sounded very much like pouring more money into hiring more staff to work in essentially the same 20th-century model.

That may be a good idea, but it is not fundamental change. It may get waiting lists down and patient satisfaction up – after many years of sustained effort by a committed government. But then public spending may be squeezed by the next government, and the service will slip back into crisis again – and remember, the NHS was already in a perilous state when coronavirus arrived.

Can Streeting take Labour’s thinking about the NHS to the next level of heresy, and start to consider ideas such as those floated by Mary Dejevsky in The Independent yesterday, of moving to a continental European model of social insurance? Then the word “reform” might really mean something.