“Call this a cure for NHS, Sir Keir?” splashes the Daily Mail, its opening paragraph claiming: “Doctors and experts last night rounded on Keir Starmer’s plans for NHS reform.” It’s no surprise the Mail wants to divert attention away from the cataclysmic collapse of the NHS, which Rishi Sunak still refuses to call a “crisis”.
The very word “reform” risks sending shudders through the NHS. How much more can it take after countless disruptive upheavals throughout its history, including two major ones since 2010? How many more here-today-gone-tomorrow politicians will seize the levers to shake up the working environment of the professionals keeping the NHS alive?
When uttered by Tories and their press, “reform” is always code for dismantling the “socialist” NHS to bring in insurance, co-payments or something even worse, which is too unpalatable to spell out. Ken Clarke now wants “some means of better-off patients making some modest contribution to their treatment”, though 80% of Tory voters oppose that. Distrust lurks when private health firms have donated £800,000 to the Tory party over the past 10 years.
So when Labour purloins the code word “reform”, many instinctively bristle in alarm. Why announce it in the Telegraph, if it’s not a Tory plan? But like Starmer’s theft of “take back control” to define Labour’s devolution to localities, stealing NHS “reform” for a Labour plan has ambushed the Tories. Indeed, it has flustered them so much that Sunak tried to use NHS reform against Starmer in prime minister’s questions, in the process landing the Tories uncomfortably on the side of the broken status quo.
Labour is always accused of “throwing money” at everything, especially the NHS “black hole”. Already committed to the biggest-ever expansion of training for doctors and nurses, to be paid for by abolishing non-dom tax relief, Starmer says that “investment alone won’t be enough” to rescue the NHS. Of course all public services always need improvement. “The NHS is a service not a shrine”, and “if we don’t get real about reform, the NHS will die,” he warns.
This is political positioning, with maybe a touch of Blairite triangulation, which could be infuriating. But when Starmer and Wes Streeting, the shadow health secretary, talk, for instance, of using contracts with the private sector, that’s an idea that poses no threat to the NHS. Tony Blair brought in treatment centres to crash through waiting lists for simple procedures. Back then, I met furious NHS eye surgeons who had seen their private practices for cataract removals vanish overnight, as new treatment centres opened for NHS patients at NHS tariffs. The private sector is tiny – just 8,000 beds (the NHS has 150,000) doing profitable high-volume procedures on hips and hernias, leaving more complex stuff to the NHS. Rapid throughput private ops can cut waiting lists at NHS tariffs, but that’s a marginal part of Labour’s plan.
Its true focus is on primary, community and social care: treat people early and hospital corridors will unblock. A GP appointment costs £39, an A&E visit £359, so investing in primary care is a money-saver (though the Treasury hates those arguments). The plan brings back Labour’s scheme for polyclinics in every area, as set out by Lord Darzi. GPs would work in groups with community and social care, with diagnostic scans, minor treatments and specialist clinics run on-site by visiting consultants for anything from gynaecology to mental health. These hubs will have spokes retaining local GP community contact: some of this exists already, such as at the renowned Kentish Town health centre in north London.
What drew most fire within medicine was Starmer’s remarks about letting patients self-refer, avoiding wasteful visits to GPs. That conjured nightmare images of precious specialists inundated by the worried well. But in the context of polyclinics, Starmer gave examples for bypassing delays: “Why can’t people with persistent back problems self-refer to physio? Why if you notice bleeding do you have to get a GP appointment, simply to get the tests that you then do yourself at home?”
Labour is forever accused of representing public sector producers, not patients or consumers. So Streeting was sent out to make deliberately eye-catching remarks to show Labour was not captured by producer interests. However, roughing up desperately overworked doctors mid-crisis was needless provocation: he called their funding system “murky and opaque” and their £10 per vaccination “money for old rope”. That was not the most tactful start to announcing plans “to phase out the whole system of GP partners”, replacing them with salaried GPs in polyclinic hubs and spokes.
There was a more soothing meeting with the British Medical Association (BMA) last week, reassuring its members that no GP will be forced out of their partnership: how could they be, when they could quit? But GP members of the BMA and the Royal College of GPs are themselves deeply split, as young doctors increasingly reject running a business partnership. They trained to be doctors, not business managers: current trends will see most opting to be salaried by 2026. With more than 4,000 fewer GPs than in 2010, more burned-out GPs hand back contracts, surgeries are closing and a collapsing system needs urgent renewal. The private sector hasn’t found primary care lucrative. Oddly, the left was riled by a plan that fulfils Aneurin Bevan’s original intent for all doctors to be NHS employees. Famously, he had to stuff their mouths with gold to get them to join at all.
Politically, Labour owns the NHS, with Tory underfunding thoroughly blamed for making the service no longer “the envy of the world”. Robert Francis, who chaired the Mid Staffs inquiry, and Rachel Power, CEO of the Patients Association, have just written a letter to the health secretary, warning: “What we are witnessing across the NHS is the Mid Staffs scandal playing out on a national level, if not worse.” No need here to list each day’s new shocker in heart attack, stroke or cancer waits and needless deaths. Oxygen supplies are running out due to so much having been used in corridors and ambulances; corridor care is turning into a new medical specialism.
The spiralling demand for GP appointments had been underestimated by demographers, says the King’s Fund’s Beccy Baird. New needs spring from deprivation, and from greater longevity, leaving more old people with multiple conditions. The NHS blockage is a consequence of years of failures in early prevention, leaving GPs struggling to see patients queueing on hold at 8am. When I spoke to Dr Kieran Sharrock, a rural GP and the deputy chair of the BMA’s GP committee, he had just done a 7.30am-7.30pm day, without a break, during which he was in contact with 70 patients – and like all over-burdened GPs, he is terrified of making mistakes. That’s why Labour puts GPs and community care first, but when Labour talks “reform”, it has no resemblance to Tory “reform”.
Polly Toynbee is a Guardian columnist
