If Wes Streeting pulls off a successful reform of the NHS, he’ll be a hero but…

When Labour has so few distinct policies, Wes Streeting’s plan to use private companies to provide NHS care stands out. It is a classic Blairite policy: a radical market-based model of reform of a public service in its own right, but also designed to attract attention by offending Labour traditionalists.

Just as Tony Blair was often accused of using conflict with his own party to dramatise his pitch to Conservative-minded voters, so Streeting deliberately provoked “middle-class lefties” as a way of gaining headlines.

I once asked him if he was being needlessly confrontational – on that occasion with the health service unions – and he replied disarmingly that “no one would report it, otherwise”. Just as yesterday, when asked why he set out his ideas in The Sun, a newspaper hated by many party members, he said he made “no apology whatsoever for making sure that the widest possible audience is hearing Labour’s alternative”.

It helps, of course, that Streeting is, like Blair, an outstanding communicator. He can make the “left-wing” case for private providers in the NHS as well as any of his New Labour predecessors as health secretary: Alan Milburn, John Reid or Alan Johnson.

Streeting told the Today programme yesterday: “There’s a principled argument here, which is that those who can afford it are paying to go private, are being seen faster, and their outcomes and their life chances and their quality of life will be better. Those who can’t afford it are being left behind. And those tend to be people from working-class backgrounds like mine, and I think that’s a disgrace.”

It is an attractive argument, but it depends on delivering results. The problem with a confrontationally Blairite approach to NHS reform is that NHS staff don’t like it, and even Tory-minded voters are suspicious of anything that can be labelled “privatisation” – even if the principle of “free at the point of use” is religiously preserved.

It is striking that Blair and his health secretaries were in practice cautious about the use of the private sector to deliver NHS care. One of the flagship New Labour reforms was the use of private diagnostic and treatment centres to clear backlogs of routine procedures such as cataract operations, but ministers found that the mere prospect of such centres was often enough to galvanise NHS trusts into doing the work themselves.

But if Streeting can deliver, he will be a hero. If he can dramatically cut waiting lists in the four or five years of a Labour government, his much-vaunted leadership prospects will be enhanced. He has often been dismissed as “too Blairite” ever to be a serious contender, but if he can overcome opposition from “middle-class lefties” to deliver change, it is worth noting that Labour Party members are increasingly what might be called pragmatic idealists as ideological Corbynites leave.

The crucial question is money. Last night, Rachel Reeves, the shadow chancellor, announced her replacement scheme to pay for Streeting’s NHS election promises, now that the Tories have stolen her policy of abolishing non-dom status. She is going to “crack down on tax dodgers”.

Never mind the obvious jokes about Angela Rayner having to stump up for the NHS, this is thin stuff. But it may be enough to get Labour through an election campaign. She quotes Gareth Davies, the boss of the National Audit Office, who said that £6bn a year could be raised by a concerted effort to tackle tax evasion and avoidance – although the same imaginary savings are also available to the drafters of the Tory manifesto.

The stiffer test for Streeting, and for Reeves, will be in government. The New Labour magic formula, which produced record patient satisfaction with the NHS by 2010, was reform plus substantial extra real funding. Streeting talks a good, if controversial, game now. No doubt Keir Starmer is happy to let him take the lead and act as his fire shield on the NHS.

But getting the policy right in government is harder. It took Alan Milburn several false starts before he finally started to turn the NHS round, with the help of Michael Barber’s Prime Minister’s Delivery Unit, in Blair’s second term.

It was the same in other public services. In education, New Labour did well on primary schools from day one, but it wasn’t until nearly the end of Blair’s premiership that academies started to transform secondary schools. Frank Field, who was sent to the Department of Work and Pensions with orders to think the unthinkable, managed only to deliver the unworkable and New Labour in effect gave up on welfare reform.

The Blair government, moreover, benefited from a strongly growing economy, which is not something on which Reeves and Streeting can rely. If Streeting cannot obtain a lot of extra money from the Treasury, those “middle-class lefties” he was so rude about yesterday are unlikely to forgive him.