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The Conservatives are bringing the culture war to the NHS

The Health Secretary’s conference speech focused on trans issues and union relations rather than waiting lists and staff shortages.

By Zoë Grünewald

It is the last days of Rome in Manchester.

The Conservative Party conference, which began on Sunday, has been distinctly dour. The government is running low on energy and ideas. The crowd are collectively murmuring about the dearth of clever ideas needed to solve the country’s problems and reanimate the electorate.

The Health Secretary Steve Barclay had a difficult job giving his conference speech to the main hall today. Health and social-care provision are collapsing, and record numbers of staff are leaving the NHS in search of better pay and treatment. More than seven million Britons are now on the waiting list for NHS treatment, with an increasing number seeking private healthcare. Ambulance and emergency waiting times hit new highs in January. Doctors, led by the British Medical Association (BMA), are at loggerheads with the government over pay, resulting in a strike in July that was the longest-single period of industrial action by medical staff in the NHS’s history. The dispute is still not solved.

The scope of the challenge for the NHS can seem almost too big and too bleak for discussion. Many of the fringe events focusing on health policy at the conference have felt despondent, with policymakers questioning whether anyone understands the scale of the challenge ahead. The consensus remains that the health and social-care sector is totally ill-equipped to deal with the winter storm, and the NHS desperately needs drastic changes.

Barclay could have used his speech to announce something compelling. Wide-reaching NHS reform, ambitious plans for the recruitment and training of staff, or a substantial, cross-departmental vision for preventative healthcare would have excited policymakers and offered vision to the electorate.

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Instead, he flew through minor announcements, many of which had already been made. There are to be three new medical schools (the University of Worcester, the University of Chester and Brunel University), which will provide an additional 205 undergraduate places from September 2024, but failed to mention staff retention. He reiterated commitments made in January for new hospital beds and ambulances, and promises made in the 2022 Autumn Statement for social care funding, but failed to give details on reducing the patient backlog and waiting lists. He offered no explanation for the adoption of new technologies to improve patient care, talking in vague terms about the role of artificial intelligence (AI) in the NHS.

Barclay’s focus wasn’t structural reform or ambitious retention plans, it was culture wars. He dismissed the need for diversity consultants in the NHS and vowed to update the NHS constitution to account for “what a woman is”. He announced plans to change the NHS constitution so that transgender hospital patients in England would no longer be able to be treated in female- and male-only wards, and said that patient requests to have intimate care provided by someone of the same biological sex would be honoured.

He implored the need for “simple common sense” and attacked the BMA, which he dubbed as “militant” and a “serious threat” to the recovery of the health service. He paid no mind to the reasons for their strikes and offered no solutions to ending the industrial dispute.

Barclay then launched his attack on the Labour Party, claiming that it was joining the BMA on the picket lines and criticised the opposition’s NHS plan. He pointed to Wales and “Labour-run London”, saying “their record on health makes for grim reading”.

“Let’s stand up to militant BMA leadership that does not accept the need for reform, let’s challenge the ideologues who silence the voice of women, and let’s be very clear that we won’t take lectures from a Labour Party that has utterly failed patients in Wales,” the Barclay concluded, before exiting the stage, content with the reception to his lukewarm offering.

Barclay’s speech was much like those of his cabinet colleagues. The party has felt particularly untethered at this year’s conference; little substantial policy has been unveiled. The NHS, an issue that consistently tops the list of public priorities along with the cost of living, could have been the Tories’ rallying cry. But like the rest of Conservative Party policy, it has fallen victim to the culture wars. Reform will have to wait.

[See also: The BMI scale is a cheap and accessible starting point to prevent disease]

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