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Keir Starmer knows his NHS plan will make life harder for a Labour government

The condition of the NHS is not like other political issues, so any politician who promises health reforms had better deliver.

By Andrew Marr

A fine political speech should raise the stakes. It should increase the sense of jeopardy and put the speaker in a harder position, not an easier one. Keir Starmer’s speech in Braintree in Essex on 22 May was a fine one. I hope he felt a quiver of hot joy giving it; a relieved exhalation of, “Yes, this is why I am in politics.” It certainly increased the stakes. If he makes it into government, it will make his life harder.

It was about – no surprise – the National Health Service. This is not ordinary politics. It is personal for most of us, and certainly for him. He talked about his mother, who was a nurse, who suffered most of her life from Still’s disease, a rare and dangerous arthritis. As a child she was told that she’d be in a wheelchair by her twenties and should forget about having children: “A doctor at Guy’s Hospital in London refused to give up. He found an experimental treatment for this 11-year-old girl and the rest, as they say, is history. Lots of people say they owe the NHS everything and I’m definitely one of them.”

We all have our own versions. He wouldn’t have been making that speech without Guy’s Hospital. I wouldn’t be writing this column without Charing Cross Hospital. After my major stroke a decade ago my family were told, first, that I would probably die and next, that I would be in a wheelchair for the rest of my life and unable to communicate. It was only the NHS that saved me, the NHS that got me walking again, the NHS that got me talking again (I can’t type but I am dictating this).

The NHS is not only in crisis, it has become the central symbol for what is wrong with Britain today. The pollsters tell us that it is still the prime reason for being proud to be British, and yet according to the British Social Attitudes Survey, overall satisfaction with the NHS fell in 2022 to 29 per cent (and no, that’s not a misprint) – the lowest level since the survey began in 1983.

Behind that apparent paradox are the headlines about strike ballots, missing ambulances, chaotic A&E departments and desperate struggles to get GP appointments. And behind those realities are the miserable life experiences of millions of people becoming more ill and not getting the help they need. As Starmer said, some people are even reduced to pulling out their own teeth.

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We may be talking ourselves into an almost terminal depression about health – as, of course, millions of excellent operations are still being carried out, and life-changing conversations are being held in local surgeries everywhere. But there is a sense not only that the NHS is falling apart, but that it cannot be rebuilt – not by us, not in our time.

It has taken so much money – will there ever be enough? – and yet, as the nation ages, everything seems to get worse. The nurses and the junior doctors are still not properly paid. The delays for important treatment are ridiculous. Covertly, shamefacedly, people who believe in free-at-the-point-of-need are going private. The British private healthcare market is forecast to be worth about £11bn by the end of 2023, with a 40 per cent increase in private hospital capacity in London since 2018.

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[See also: What does Keir Starmer stand for?]

The condition of the NHS is not like other political issues. It has become the touchstone of our faith in politics and the public realm in general. A weary nihilism about politics begins with a hopelessness about the NHS. Because of this any politician, and any Labour politician in particular, who makes big promises about it, had better deliver.

The NHS is the prime example of what we owe to one another in a modern society. Starmer included in his speech a wonderful quote from Nye Bevan: “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised.” A Starmer government that failed on this would be a Starmer government failing completely, and it would open the door to private US health companies across the country.

In this situation, the promises he made in his Braintree speech were remarkably bold. He’d get the waiting times and targets back to where they should be: “Ambulances – seven minutes for cardiac arrest; A&E – back to the four-hour target; GPs – the highest satisfaction levels on record; waiting lists – down; planned treatment within 18 weeks. No backsliding, no excuses – we will meet the standards again.”

Beyond that, Labour would improve healthy life expectancy for everyone and halve the inequality gap between the different parts of England. Michael Marmot, a professor of epidemiology at UCL and the UK’s leading health inequality specialist, would confirm: that is a really big promise. Three quarters of all cancers would be diagnosed at stage one or two; heart attacks and strokes would be reduced by a quarter; and suicide, an epidemic among the young, would be driven down with a major investment in mental-health care.

Most of this could be achieved within the first five years of a Labour government, and yet there are so far no plans to find extra funding beyond the £3.2bn the party estimates it would raise by abolishing the non-dom tax privileges. Wes Streeting, the shadow health secretary, is certain that the promises can be kept. He told me that he would resign if he failed – and indeed he’d expect to be sacked if the Braintree pledges were not achieved.

Illustration by Barry Falls

Streeting has great faith in the power of technology, particularly AI, in diagnostics to generate wider improvements in the NHS. He believes that a major reform programme can be pushed through without huge extra funding. The basics of that programme are centred around keeping people out of expensive hospitals by treating them in remodelled primary-care centres, giving patients the ability to choose the hospital in which they receive their treatment, and better pay for care workers.

These points have long been laid out by Phil Whitaker in the New Statesman and have since become almost consensual. But shifting resources is itself expensive, and nothing can happen without resolving the pay disputes for junior doctors and nurses.

Reforming the NHS is a titanic task. This will have to become the centre of everything a future Labour government does, dedicating all its best people, and using almost all of its concentration. As to the money, it was telling that Starmer was so explicit: “No backsliding, no excuses.”

On finances, Rachel Reeves has been steelier than the Thames Barrier. But what happens, a couple of years into a new Labour government, if the NHS is still flailing? If it ever came to a choice between those pledges and the need to find more money for a reformed health service, which would win out? Everyone shakes their head – but I still think it raises the likelihood of some kind of wealth tax in the middle-distance future.

All that, in turn, takes us to the meaning of Starmer himself. He gets a lot of grief for tearing up pledges he previously made to become Labour leader. This is turning into a narrative, shared between the Tories and the hard left, which insists the Labour leader has no real view – no core – and doesn’t stand for anything.

I disagree. To win from so far back, against such odds, you have to do what you have to do and be steely, tactical, guarded – yes, at times equivocal – but utterly focused. There’s no point whinging about how beastly the Tories are and then flinching at what’s needed to replace them.

So yes, this speech raised the stakes about the very purpose of a future Labour government, and hard choices ahead. It was a rallying cry for hope, entirely necessary in our politics which, for Keir Starmer, will make everything just that much harder, and more exciting.

[See also: Keir Starmer’s manifesto: Labour’s Five Missions]

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This article appears in the 24 May 2023 issue of the New Statesman, The Tory Crack-Up