Wes Streeting’s spat with Nigel Farage on the NHS gives us a glimpse into the future
Reform UK’s leader is not used to having his breezy assertions challenged, and the health secretary proves a worthy attack dog, writes Sean O’Grady
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
What used to be called a Twitter spat has broken out between the health secretary, Wes Streeting, and the self-styled disrupter Nigel Farage. The Reform UK leader says that “the NHS needs Reform” while Streeting thinks it needs (lower-case) reform. They differ on the funding model, Streeting preferring to fix the current system, Farage advocating a French-style insurance system; but there are underlying questions of principle and an emerging willingness on the part of Labour to take Farage on. Streeting is a willing and effective attack dog, worthy of his populist opponent…
What’s the row?
Streeting made a speech attacking what is seen as Reform’s soft underbelly: its policy to introduce private sector insurance companies into the National Health Service. The health secretary turned Farage’s usual schtick against him, accusing Reform of offering only a “miserablist, declinist” vision of the UK, and peddling a false choice: “The crux of Farage’s argument is this: what was possible in the 20th Century isn’t possible in the 21st … People shouldn’t have to choose between a health service that treats them on time and an NHS free at the point of use.”
Farage, thin-skinned as ever, took to X to tease his opponent back: “Wes Streeting is so scared of Reform that he has now resorted to lying about our plans for the NHS. Let me be clear, the NHS will always be free at the point of delivery under a Reform government.” Unfortunately, Farage then gave an interview during which he said: “The funding of the NHS, for example, “is a total failure. The French do it much better with less funding. There is a lesson there. If you can afford it, you pay; if you can’t, you don’t. It works incredibly well.”
His unfortunate turn of phrase was seized on by Streeting: “‘If you can afford it, you pay’ is not free at the point of delivery. They’re your words, not mine. And I thought you were straight talking…”
What does it show?
For a change, it’s not a classic “culture war” issue confected to exploit grievances. As such, the NHS is an interesting test case as to whether Farage’s Reform UK can be more than a one-issue party – moving from an obsession with Brexit and then immigration to more mainstream, traditional voter concerns. Farage is an obvious repository for a protest vote in parts of the country that the Lib Dems, the Greens, SNP and Plaid cannot reach, but if his ambitions go higher, he’ll need more. Without some sort of credible offering on economics and public services, Reform’s prospects as a serious party are limited. For Labour, it’s about defending the gains they made at the expense of the Conservatives on the red wall, winning back their voters who’d been seduced and then disappointed by a previous populist, Boris Johnson. So Britain seems to be moving into one of its periodic flirtations with three-party politics.
Who’s right?
Both, maybe? It’s fair to say that the French, and others, can receive good health care but that’s not necessarily what would happen in practice, especially with uninsurable health insurance risks (long-term cancer care, dementia, mental health), and for people who cannot afford to pay the premiums or lack employers who will do so for them. Thus it could be, to borrow a phrase, a two-tier service, with only a tattered safety net at best for the most vulnerable, as Streeting predicts. The NHS is also a relatively efficient low-cost operation, standardising treatment and prioritising clinical need; the downside is less “consumer choice”.
Where will this go?
As one of the few members of the cabinet who’s actually good at politics and taking the fight to the enemy, Streeting will be a formidable foe to Farage, who’s used to not having his breezy assertions properly challenged. It will also do Streeting’s leadership ambitions no harm. For Farage, it means, as he has conceded, that his party will need to do much more work on policy, as well as organisation, as it moves out of its difficult adolescent years. For Kemi Badenoch and the Conservatives, there’s the obvious danger that they get squeezed, overlooked and seem irrelevant in the national debate (also a bit of an issue for the Liberal Democrats and Ed Davey, despite their impressive number of parliamentary seats). What, in other words, is the Tory plan for the NHS? Badenoch says wait… but in the meantime, Farage is eating her lunch.
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