I was pleased to read that Michael Marmot agrees that reform of the health service is necessary (Labour’s Wes Streeting is half right about how to fix the NHS, 24 April). Progressives cannot surrender the reform agenda to the right. The Labour party was founded to reform Britain’s institutions and change the way our country is run, for the benefit of working people.
When it comes to the NHS, a system geared to providing late diagnosis, instead of early intervention, fails millions whose conditions are missed until it is too late. And as Michael rightly argues, prevention is better than cure.
The fundamental reform of the NHS that Keir Starmer and I set out last month would see far more services available on people’s doorsteps, allowing more patients to be treated in the comfort of their own homes. The NHS must once again be there for us when we need it, so patients can see a GP on time. And patients should have real choice over their own care, which studies show is better for them and NHS staff.
Michael was also right to argue that greater investment is needed. The last Labour government showed that it is the combination of investment and reform that delivers results. That is why it is so important that Keir and Rachel Reeves have made getting the economy growing a mission of the next Labour government. Had the economy grown as much under 13 years of the Conservatives as it did with the last Labour government, there would be £40bn extra each year to spend on public services like the NHS.
Labour has already announced a package of £1.6bn to train 7,500 more doctors and 10,000 extra nurses a year, paid for by abolishing the non-dom tax status. Put another way, public services for the many, paid for by ending tax breaks for the few.
Wes Streeting MP
Shadow secretary of state for health and social care
• Thank you to Michael Marmot for an enlightened contribution to the politicised debate about healthcare reform, in which the determinants of ill health are often conveniently ignored.
I am a GP working with a population in the highest 10% for deprivation in the UK – and in a network of practices with the same challenges. Watching gross health inequality play out in real time is our daily experience and has become frighteningly unshocking.
We expect to see patients in their 40s and 50s suffering with multimorbidity, not seen commonly in wealthier populations until their 60s and 70s. It is normal that our patients often have no way of receiving dental care. We don’t expect our patients who have experienced the most complex abuse and repeated violence to receive appropriate psychological support. We witness “public squalor” in our communities in the form of poor housing, rubbish, substance misuse and unwelcoming community spaces.
We continue to do what we can with dwindling resources. This is where the need is and our purpose is refreshingly clearsighted. Many of us are inspired and motivated by the patients and staff we work with. We could do a lot more with more resources, but the NHS cannot act as a panacea for the level of inequity in this country.
Dr Charlotte Bryson
Sheffield
• In his comments on a recent speech by Wes Streeting, Michael Marmot outlines very clearly how NHS spending has fallen dramatically in real terms under the Tories from the levels set by New Labour. Despite the flatlining of spending and against a backdrop of growing need, Streeting’s prescription is not more money, but reform.
The essence of Streeting’s reform is that prevention is better than cure. That sounds fine, but as Marmot makes clear, the key to prevention lies in many areas beyond the NHS remit: housing, education, lifestyle and the depredations of poverty. While the idea of prevention is worthy, it’s not going to have an early or dramatic impact on waiting lists.
Given the Tories’ appalling economic legacy, Labour may well have limited room for reviving the NHS. However, that does not excuse Labour’s omertà on the question of privatisation in the NHS. In the Labour leadership election, Keir Starmer told us “Public services should be in public hands” and pledged to “end outsourcing in our NHS”. Where, then, is a pledge to repeal the Tory Health and Care Act of 2022?
Analysis by Allyson Pollock and Peter Roderick in Sage Journals, titled Dismantling the National Health Service in England, paints a picture of increased private involvement in the NHS governing structure with concomitant increased outsourcing. They charge that the Tory act breaks “decisively with the Beveridge/Bevan model” and that the NHS is “no longer universal and comprehensive”.
Effectively, the Tories are paying private health companies to take the NHS off the government’s hands and dump it. Yet, given the opportunity of a major speech, Streeting is silent on the very future of the NHS as a national health service in public hands. Labour created the NHS, now it seems actively complicit in it’s demise.
Richard Rosser
Canterbury
