Labour for the last few years has been too busy facing inwards. It has become obsessed in fighting deeply unpleasant ideological battles, but the people doing so claim that they had no choice. Labour is at danger of continuing to carry on with this protracted fracture rather than embracing the pragmatic issues of government. Labour does however emphasise the need to make practical pledges. The latest onslaught by Starmer and Streeting, however, could prove to be deeply damaging for their reputation as ‘guardians of the NHS’. It seems to want to turn the NHS into another ‘culture war’. If it does, I think it will fail.

I remember when I went to a seminar at the Academy of Ideas earlier this year in Church House. As ever, it was brilliant. We spoke our minds and listened respectfully to the views of others. The discussion was supposed to be on the decline on the NHS. Nobody mentioned the crisis in social care or austerity as factors, which surprised me. I pointed this out to the panel, and I remember being aghast when the director of a right-wing think tank told me that austerity had “nothing to do with it”. This is simply not backed up by the evidence. Even this week, a published report, commissioned by the Conservative Party, drew attention to it.

In recent times, the Conservatives have had a formidable reputation for economic competence. This has been enduring a previous Chancellor, Kwasi Kwarteng, causing a crash in the pound through a mini-budget. The Labour Party has always been seen as the “party of the NHS”. In December 2019, under previous management, Labour under Jeremy Corbyn had again warned about further privatisation of the NHS. Is it possible that Labour is finally going to lose its crown as ‘champion of the NHS’?

Heading into a news break this lunchtime, LBC presenter Shelagh Fogarty had to explain to a caller that a ‘zero immigration’ target was unreasonable, and that the country was not falling apart due to cross channel migrants. Brexit has overwhelmingly been found out to be a disaster, and was meant to solve the problem of ‘taking back control. There is unease about Starmer being unwilling to tackle it. Boris Johnson, meanwhile, the former MP who “got Brexit done”, is said to have pocketed more than £1 million in speaking engagements including in India and Portugal following Brexit. In the last week, Wes Streeting has given three interviews with LBC, and they do repeat the same views. Suella Braverman gave by all accounts this morning a pretty disgusting account of the deaths which had occurred on the English Channel this morning. Labour only a few years ago was pimping out its famous immigration mugs. Starmer, who has distanced himself from all policy from 2019 Labour manifesto, including – presumably – the attack on austerity, does not want to appear too ‘woke’ in case he goes ‘broke’ at the next general election in 2024.

The British Medical Association (BMA have apparently criticised Mr Streeting for what it called “disappointing” comments after he used an interview with the Sunday Telegraph to accuse the union of being hostile towards vitally needed NHS reform efforts. Wes Streeting is proud for not being on the side of the doctors but being firmly on the side of the patient, and this position certainly is more convenient also for attracting the ‘anti woke’ or Red Wall vote. Although it is time and time again said that such voters are not racist, there is a rarely a phone-in on LBC without the caller who blames an increased demand on NHS services by ‘immigrants’. Both Streeting and Starmer do not want to appear ‘close to the Unions’, which is a pathetic thing to pander to as neither the RMT or RCN are affiliated to Labour for example.

A symbol of the decline in the NHS has been the “mad scramble” for the GP appointment at 8 am. Most of us have had experience of ringing up punctually at 8 am to make an appointment only to be “number 42 in the queue” if delayed by a few minutes. GPs have been accused of offering fewer face to face appointments. The BMA have repeatedly pointed out that the promised recruitment drive in general practice never materialised, they have a retention problem with the GP workforce, and there has been a vast increase in the number of appointments overall. In July 2020, the then Secretary of State for health and social care, Matt Hancock, now more associated with ‘jungle washing’, had argued that GP apppintments “should be virtual by default“. GPs have a right to argue, therefore, that they have been delivering a system mandated to them, whilst overstretched and doctored. Streeting made no reference to the crisis in general practise in any of the interviews, presumably because he is trying to present himself as the ‘patient advocate’.

In a new policy paper from earlier this year, the Royal College of Physicians repeated the case for long-term workforce planning and sets out a range of short- to medium-term solutions the government must implement now to keep the NHS running. Wes Streeting has repeated many times his aspiration to grow the workforce of the NHS. To avoid the accusation of ‘overpromising and underdelivering’, Streeting made clear in all his recent interviews that the pledge would be paid for from the money accrued rom the ‘non dom status‘. Discussing the “back and forth”, Wes Streeting told presenter Shelagh Fogarty: “We announced the biggest expansion of NHS staff in history — so we would double the number of medical school places, increase nursing and midwifery clinical training places by 10,000, 5000 more health visitors, doubling the number of district nurses.”

But this in itself is a hopeless solution to the NHS workforce crisis in itself. It took a caller to Shelagh Fogarty’s show, “Felicity from Greenwich”, a doctor, to point out that there is a bottleneck for places at every stage of training. With doctors being unable to find jobs, therefore, it is not surprising they are leaving the profession. There is no structured return to work scheme including extended induction or reasonable adjustments (phased return) for disabled doctors for people who have taken unanticipated leave for years off the register; such a scheme is necessary for re-skilling and building up the confidence of such doctors. There is a pensions crisis in the NHS which means that long-established doctors are having to leave the profession rather than to be clobbered by huge tax bills. Wes Streeting acknowledges the campaign on pensions by the BMA. Ask any trainee how they feel about the increase in medical school places, and you’ll soon have your answers.

A report from the right wing think-tank Policy Exchange earlier this year provided details a ‘rescue package’ for general practice.  The report from Policy Exchange recommended specifically:

• The overhaul of the current core GP contract to redefine incentives, reduce bureaucracy and free-up GPs to help the patients with the most complex needs;
• A £6 billion ‘rescue package’ to enable improvements to general practice premises, data collection and to enable an orderly transition to new contractual models;
• The ‘levelling-up’ of general practice with a massive boost in high-quality video consultations in areas where there are not enough doctors;
• The introduction of ‘NHS Gateway’, a more coherent entry point to primary care and to reduce dependency upon the 8am call to the GP surgery for appointments;

The Daily Mail were so enthused it even ran an article promoting this report to its readers, including a section on how the BMA were unable to support the proposal.

“Family doctors wanted extra funding to cover the rising national insurance costs and inflation.  But the final contract, given to the BMA just hours before being made public, made no mention of the additional cash it had demanded.“

I don’t deny the attraction the Daily Mail must have for Streeting or Starmer, being avid consumers of the Sun and Telegraph. Streeting at no point in his LBC interviews made any mention of why the BMA had been critical of recent proposals, rather leaving the average voter with the impression that the BMA was just a militant union opposed to change. All registered doctors have a regulatory obligation under ‘domain 2’ to commit to improvement of the quality of the service with the General Medical Council, and this inevitably has involved change initiatives.

The Conservatives chose not to implement the Policy Exchange proposal, but were too busy with their own leadership election and the coronation of Liz Truss – who blew a sum vastly larger than this on crashing the UK economy as a sign of ‘taking back control’ (a Brexit dividend) from a ‘Singapore on Thames‘ economy forewarned by her Britannia Unchained movement.

Implementation of technology here might have really helped, however.

I have for nearly a decade commented on how the increasing use of technology is a ‘Trojan horse’ for further marketisation of the NHS. For example, in an article for Open Democracy back in 2015, I commented on a recent speech by Jeremy Hunt, the then Secretary of State for Health. Whatever happened to him?

I wrote,

“This month Jeremy Hunt MP gave what he told us was his “most important speech as health secretary”. The speech – delivered at the Kings Fund, and entitled “”Making healthcare more human-centred not system-centred” – fulfilled its function of generating blockbuster headlines, mostly focused on the ‘7 day NHS’ and consultant pay. But there’s been relatively little comment on his new ‘big idea’ – a patient-centric transformation in a post-bureaucratic age, which he calls “intelligent transparency”.“

Embracing technology within a nationalised service is sensible. Using technology to privatise a service and to demolish the workforce is a different motive, and one which is bound to cause a problem with core Labour voters. It has been a consistent tactic of the right wing opposition and Wes Streeting to frame anyone who won’t embrace technology as being opponents of change. To give just one example, in August 2022, the RMT reported that a funding deal struck by Transport for London and ministers would attack tube workers’ pay and pensions and would lead to further strike action, RMT have warned. The proposals seemed conditional on attacks on workers’ pensions, potential job losses and a push for pay restraint in the future despite the astronomical rise in inflation and an escalating cost of living crisis. Driverless trains are also part of the reforms insisted on by a previous Secretary of State for transport, despite the huge costs involved and safety concerns. Driverless trains are a massive safety concern for disabled passengers, and are not a trivial matter. To frame protection of the workforce as ‘looking after vested interest’ is a political choice which Starmer and Streeting have decided to take. Technology can be used alongside the workforce to improve their working conditions, and not just as a replacement for the workforce to maximise profit margins. Technology besides is not a universal panacea. The report of the AI chat bot which ‘turned racist’ is notorious. Tay was an chatbot that was originally released in March 2016 which caused subsequent controversy when the bot began to post inflammatory and offensive tweets through its Twitter account, causing Microsoft to shut down the service only 16 hours after its launch.

All people, including clinicians, are the lifeblood of the NHS, and Labour talking over them is poor mood music.

Here, for example, is Labour taking credit for ‘training doctors’. It is the existing workforce who is expected to train others.

At this very second, the likelihood is that Labour might become the largest party in the 2024 general election, but unlikely to win an overall majority. Streeting says that he and Starmer have been working on a plan for the NHS and social care. Many of us remember how traumatic the last NHS reform was in 2012, a ‘top down reorganisation’ which David Cameron had said would never happen (see for example an open letter some of us sent in 2016). The mood music from Streeting was bad, and has opened up much mistrust amongst hardworking professionals within the NHS. Lifelong Labour voters are telling me now that they might never vote for Labour again, given how bad the coverage was. But there are many patients in the voting public, just as there are many NHS staff who want to vote Labour ideally.