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Wes Streeting: “NHS privatisation could not be further from my aims”

The shadow health secretary on the Labour left, trans rights and the case against outsourcing health services.

By Rachel Wearmouth

Wes Streeting, Labour’s combative shadow health secretary, is disappointed. The left-wing activists that were protesting against his proposals for the NHS dispersed before he arrived. “I wanted to have the argument,” he tells me inside the social club near Blaydon, Tyne and Wear, where he is due to speak to party members.

As the foremost Blairite in Keir Starmer’s shadow cabinet, Streeting will always be a target for some on the left. But rarely does the 40-year-old cancer survivor dodge confrontation, and sidestepping difficult questions over the state of the NHS – record waiting lists, overwhelmed A&E departments, rising voter dissatisfaction – is not, in his eyes, a luxury Labour can afford.

[See also: Keir Starmer essay: This is what I believe]

“This is the year where we have to grab the microphone from the Conservatives and make sure people hear Labour’s positive message on our terms, not just as a reaction to the day’s news agenda,” he says at the meeting, in reference to how several of his earnest speeches about the NHS failed to achieve the all-important “cut-through” to the public. This is despite how well received most of Labour’s health proposals have been. The party would channel the £3.2bn it hopes to raise from scrapping the non-dom tax status towards recruiting NHS workers and doubling the number of medical school places.

But Streeting says the party must “rattle some cages on behalf of patients”, and his plans to rip up GPs’ contract have done just that. They would mean family doctors becoming salaried NHS employees, patients self-referring in certain instances and a structure more reliant on pharmacies, clinics and care in the community. The plan, unsurprisingly, attracted the ire of the British Medical Association.

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Streeting has also called for private-sector capacity to be used to help clear NHS backlogs. For his internal party critics this is a red flag, but he robustly defends his position when challenged during the members’ Q&A in Blaydon.

“It’s pragmatic and it’s definitely popular with those swing voters we need to win over,” he says. “I don’t think I would be able to look someone in the eye and say: ‘I’m sorry, I know your grandmother could get her hip or knee replacement up the road at a private hospital but my principles mean she can’t.’” Streeting’s declaration that GPs were claiming “money for old rope” during the Covid-19 vaccination programme antagonised the profession, but he makes no apology for “asking probing questions about the status quo”. 

He rejects claims he was “knocking” GPs’ work, adding: “Don’t try and kid me into thinking there aren’t regularly tensions about whether pharmacies should be doing vaccination or general practice, and that these arguments aren’t in part driven by the value of the GP contract and balancing the finances. I think people have got to, by all means, engage with me, tell me where they think I’m wrong, but also recognise that I’m motivated by what’s in the best interests of patients, and how we get [the] best value for money from the almost £200bn a year we’re pouring into the NHS.”

[See also: Keir Starmer interview: “Am I aiming to be just a one-term prime minister? No, of course not”]

Streeting fears the principle of a free-at-the-point-of-use health service is in peril, noting that Matt Hancock and Sajid Javid, two former Conservative health secretaries, have both proposed charging for health appointments. “I don’t know whether it’s bemusement or frustration, probably a combination of both, when I turn on social media and I still see people on the hard left saying ‘he [Streeting] wants to privatise the NHS’ and ‘he wants to sort of sell it out to US interests’,” the shadow minister says. “It could not be further from my politics, values or aims. I look at where the Conservative Party is positioning itself at the moment and [I] see a genuine threat there.

“As I regularly say to critics on the left, and as I said to Owen Jones at the Labour conference last year: surely you would prefer to write your columns challenging Labour governments to be better than pretending that the problem in our country is the opposition party.”

Streeting had spent the morning before I met him at Richardson Hospital in County Durham’s Barnard Castle, where he says that despite rising demand for care, wards are under-utilised due to chronic staff shortages. With more than 130,000 vacancies in the NHS at the last estimate, this is not an anomaly in what Streeting says is increasingly a “two-tier” system.

“If you look at what’s happened in dentistry, I think that is the ghost of Christmas future for the rest of the NHS if we’re not careful, because in some parts of the country, NHS dentistry simply doesn’t exist,” he warns to me. “Those who can afford to pay are seeing dentists. Those who can’t, are literally pulling their own teeth out. DIY dentistry is now a real problem in this country.” Decreased access to dentistry are now “one of the biggest causes for children visiting A&E”.

Streeting emphasises that he does not favour more outsourcing to the private sector, which he believes is “bad value” and likely to lead to pay and conditions being eroded. “It’s a way of basically cutting corners, cutting costs, and then at the end of it people are paid less for doing the same job.

“Actually, we’d like to bring more services back in-house. Rachel Reeves [the shadow chancellor] talks a lot about radical insourcing and I’d like to see some of that because I think we are paying over the odds for some services, including in the NHS.”

He adds: “And going back to the point about GPs, one of the groups that has written to me saying ‘actually I would like to see GPs run by the NHS and directly employed by the NHS’ are the nurses that work in GP practices and other health professionals, who are saying: ‘Does this mean we can come onto Agenda for Change, the nationally agreed pay and conditions structure?’ Because a lot of these staff are underpaid for what they do. I’d like to see that too, so watch this space.”

[See also: To succeed, Keir Starmer needs to be much more than “business friendly”]

Though Labour is around 20 points ahead in the polls, a Labour government still feels far from reality and members of Starmer’s shadow cabinet have mixed emotions. “There’s a sort of an irony in that, on the one hand, there’s still potentially quite a lot of time until the election,” Streeting says. “A lot can change in terms of events, in terms of opinion polls. I have to say, especially now I’m spending so much time thinking in a really deep and practical sense about what we will do in the first 100 days, the first year, the first term, it feels like we’ve got no time at all until the next general election. I feel simultaneously the pressure of a lack of time to prepare for government and also an abundance of time, which could scupper our chances of being in government.” 

Streeting was raised by a single mother in a council flat in Stepney, east London, and studied history at Cambridge University, before becoming president of the National Union of Students and later deputy leader of Redbridge Council. He was elected MP for Ilford North in 2015 and has since turned a majority of 589 votes into one of 5,198. 

He did not nominate Starmer for the leadership (preferring Jess Phillips) – “he’s never held it against me” – and says the opposition leader has been underestimated. “The thing that people used to say was a potential weakness or vulnerability for Keir – that he’s not been around very long, he’s not steeped in politics in the way Tony Blair or Gordon Brown were – has actually been an enormous asset. Because he just shuts out the noise and trivia of day-to-day politics and he’s just kept a steady course with a clear plan. And that’s a really interesting model of political leadership, and one that I think more of us should emulate.”

Starmer has been accused of abandoning most of the ten pledges he made to win party members’ support back in 2020. “Do I think that Keir believes in those things? Of course I do,” says the shadow health secretary. “But I think it would have been an act of supreme arrogance and folly to basically say: because I wanted to stand on those ten things in the Labour leadership contest, therefore they are non-negotiable [and because of them] I’m not going to listen to the country, I’m not going to listen to what my shadow cabinet are telling me about what we can practically deliver, I’m just going to go hell for leather because I’m an ideologue. Well, we’ve seen where that approach takes us. It takes us to defeat.”

Streeting also has little time for those who claim the party’s strict selection process for parliamentary candidates has ruthlessly marginalised the left. Labour HQ now has powers over shortlisting and many close to the former leadership have been barred. Two MPs selected during Jeremy Corbyn’s leadership have been jailed – Fiona Onasanya and Jared O’Mara – while others have had the whip removed for conduct matters, which Streeting says proves the previous system had been a “car crash”.

“The public deserve to know when they go to cast their vote and see a Labour rose that it’s not just a mark of our values, it’s a mark of quality candidates. There is no divine right to be a member of parliament. It is a hard job that carries big responsibility, and it demands high standards.” Streeting points to the selection of Faiza Shaheen, one of the few candidates from the party’s left to succeed, in the constituency of Chingford and Woodford Green: “No one blocked her from standing, because she didn’t have a back catalogue of behaviour that was concerning and she is objectively a smart, clever and local candidate.

“So I don’t think being from the left of the party is a bar to standing for elected office. We can’t have this attitude which I think epitomises why the Corbyn regime got themselves into trouble with candidates by saying, ‘It doesn’t matter if they’ve said this or that, they’re a good comrade.’ That’s not the right approach.”

Labour figures have become more optimistic about the party’s general election chances since Nicola Sturgeon’s resignation, which has raised hopes of a significant number of gains in Scotland. One of those vying to replace the First Minister is Kate Forbes, the Scottish Finance Secretary, a practising Christian who has been condemned for saying she would have voted against gay marriage. How does Streeting, who is himself gay and a Christian, balance faith with progressive politics? “It’s quite easy for me in the sense that I cast my vote in a secular way, recognising that we live in a diverse liberal democracy and it’s not for me to impose my faithful beliefs on others,” he says. 

He adds that he feels “a sense of empathy” towards Forbes: “I don’t want her to feel like she’s under attack because of what she believes in.”

He goes on: “I’m not interested in us being given a cross-examination about our religious beliefs, but people do have a right to know how we will vote. And if we are saying, as people of faith, that therefore we’re going to vote against same-sex marriage or a woman’s right to choose or other social issues, then I do think voters have a right to say ‘I can’t vote for you’. And I think that’s what’s been lost in some of the outcry from some parts of the Christian community, saying she’s been discriminated against.”

Streeting is much harsher on Forbes’s fellow SNP leadership candidate, the Scottish Health Secretary Humza Yousaf, who was absent for the final vote on equal marriage in the Scottish Parliament. “Yousaf joins a very long line of people who support equality after the battle was fought and won by others. And actually, I have less respect for someone who ducks and weaves on issues of equality than someone like Kate Forbes, who at least says what she thinks.”

[See also: Keir Starmer interview: Labour is “starting from scratch”]

This brings us to the latest battleground of equality: transgender rights. Streeting, a former director of education for the LGBT charity Stonewall, would make the case for reform of Britain’s gender recognition laws. As it stands, for a person to legally change gender they require a diagnosis of gender dysphoria from a doctor, and they must have have lived in their chosen gender for at least two years. Labour’s policy is under review.

“For me, it comes down to basic respect. I meet people all the time who introduce themselves by their name and use particular pronouns, and I respect them and accept that without asking to see their birth certificate, their passport, or asking them to pull their trousers down.”

But Streeting acknowledges the complexities. The Scottish government’s Gender Recognition Reform Bill, which Westminster prevented from coming into effect by invoking the section 35 order of the devolution agreement, was undermined by questions over transgender prisoners. The legislation would have cut the need for a medical diagnosis and reduced the required time for living in the preferred gender to at least three months.

Isla Bryson, a transgender woman who was convicted of raping two women as a man before transitioning while awaiting trial, was initially remanded in an all-female prison before Sturgeon reportedly intervened, and Bryson was removed to a male facility.

Scottish Labour had attempted to amend the legislation to protect single-sex spaces and bar anyone charged with a sex offence from obtaining a gender-recognition certificate, but they were struck down, and the party ultimately voted for the bill. Its policy on the issue is also under review.

“You can’t have a situation where a male rapist rapes a woman and then after the event defines as a woman,” Streeting says. “It is an insult to people who are trans who are seeing their identity used as a political football, and it is a danger to women as well.

“I think that the Scottish case provides an opportunity for us to all pause and take stock. I acknowledge that women who have been raising the alarm about this have done so in good faith. We need to stop gaslighting women, stop silencing women and stop pretending that there aren’t challenges, because this male rapist in Scotland has proved that there is a challenge.”

Negotiating a way forward with this issue is one of the many conflicts Labour will encounter in the months ahead. It is no bad thing that Streeting is always ready for confrontation.

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