Will Labour’s plans revive the ailing NHS – or kill it off?

Wes Streeting, Labour’s energetic shadow health secretary, has been discussing what he plans to do to fix the NHS if the electorate gives him the chance to play mechanic.

He promises to be “ruthlessly pragmatic” when it comes to the problems bedevilling the NHS – which he described as a “20th-century service that hasn’t changed with the times and isn’t fit for the modern era” – while floating the sort of ideas calculated to have his critics running to A&E with aneurysms. He intends to “[cut] the red tape that ties up GPs’ time” and bring an “analogue service into the digital age”.

Promising to call upon “spare capacity” in the private sector to reduce waiting lists, he said: “Middle-class lefties will cry ‘betrayal’. The real betrayal is the two-tier system that sees people like them treated faster while working families like mine are left waiting for longer.”

His critics, addicted as some of them are to student-union politics, will inevitably fall back on their go-to slur lobbed at anyone to the right of the Socialist Workers Party: “That Streeting bloke… he’s just a Tory!”

This is patently ridiculous. In contrast to many (most) of his critics, Streeting both comes from a working-class background and has a genuine commitment to the NHS. I’ve talked to him about it. Its failures infuriate him in no small part because he wants it to work for people but he has seen up close what users like me keep banging on about: the sheer hell that dealing with the service can turn into, the bureaucratic stodginess, the mistakes and, yes, the poor attitude of some staff.

Just as it did with me (twice), the NHS saved Streeting’s life – in his case, with treatment for kidney cancer. Relying on it for your continued existence is a sobering experience. You see it at its best – and the NHS can still be absolutely brilliant despite the criticisms I have levelled – but also at its worst.

Partly, I think, as a result of his own experience at the hands of the NHS, Streeting is willing to contemplate initiatives that, were they floated by a Tory, would be dismissed as them trying to enrich their City mates.

This is not Streeting’s goal, and it is frankly juvenile of his critics to suggest that it is. But he refuses to view the NHS through rose-tinted spectacles, nor should he. Our health service, free at the point of use, may once have been “the envy of the world” but it is not today. If getting it back to something like that means calling upon the for-profit sector, so be it. Take it from me, from the patient’s perspective, it doesn’t really matter who does the job. What matters is that the job gets done.

Streeting’s political creed is often described as Blairite. But Blairism often gave the impression that it had bought into the mantra of “private sector good, public sector bad”. It also provides a case study – and a cautionary tale – of how private involvement in the NHS can go horribly wrong. I am talking here about the private finance initiative (PFI), which was used to fund new hospitals but saddled them with huge mortgages in the process. I will never forget a doctor telling me that their hospital couldn’t afford to buy sutures for wounds because of a PFI contract which sucked its resources into a black hole.

That is not where Streeting is. He subscribes to the idea that what works is good, what doesn’t is bad. We haven’t seen enough of that in British politics of late.

Don’t let’s pretend there aren’t risks in his enthusiasm for the private sector. This is a project that will need to be carefully managed. But his proposals are more practical than ideological, which is just as important as his obvious willingness to crack heads to get his vision realised.

Streeting has also made it clear that the NHS must reform if it wants yet more government money; without structural changes, it “would be like pouring water into a leaky bucket”. He is well aware that an incoming Labour government will face severe fiscal challenges. More money does need to be found, and the recent British Social Attitudes survey indicates that the public wants this. That said, it is also true that the frustrations and difficulties patients can face aren’t always the result of poor finances. They are just as often the result of a stifling bureaucracy that spends too much time indulging in performative virtue-signalling, claiming to celebrate diversity while stamping on those of us with diverse disabilities and health conditions.

The service needs to address this and also prove that it is capable of using money effectively. I believe this is the right approach. We simply can’t as a nation afford to see scarce resources wasted.

I would still like to see Streeting doing more to ensure that the patient’s voice is better heard within the service. The way this has been stifled is, frankly, shameful. The NHS constitution, which I have read, says that the patient is supposed to be at the centre of everything it does. It too often fails to live up to that.

Streeting’s proposals will ultimately be judged on whether this changes. But if anyone can pull it off, he can.