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Editorial: Starmer's NHS ‘vision’ dodges the three big issues: investment, pay, and privatisation

EVERYONE who works in or depends on the NHS should be deeply concerned at Keir Starmer’s vision for the service.

Like so many cheerleaders for public-sector “reform” — which has invariably meant fragmentation and privatisation over the last 40 years — he accuses those calling for higher investment of avoiding the big issues. Yet that is what he is doing.

Starmer dodges questions on NHS pay, despite ongoing disputes involving doctors, nurses, paramedics, porters and domestics. 

These disputes have prompted the biggest strikes in NHS history this year — but Labour is “not focused” on pay rises, he says.

That’s not good enough from the leader of a party founded to represent organised labour. Especially since we know from his previous comments that they regard inflation-proofed pay demands as “unaffordable.”

His excuse for vagueness on pay is that he wants to “set out… what we need to do to make sure the NHS is fit for the future.” But chronic understaffing cannot be separated from 15 years of declining wages.

He is similarly vague about investment, refusing to confirm that Labour would raise spending. Those who think the NHS’s problems can be solved with more money are refusing to face changes in the real world such as longer life expectancy, he argues. 

It’s a familiar argument, but disingenuous.

The mantra that we need an NHS that costs less reinforces Rishi Sunak’s “something has to change” speech back in January — based on the fiction that the NHS is failing patients despite record levels of investment. 

But real-terms NHS spending is a fifth less per head than health spending in France and two-fifths lower than Germany. Labour and the Tories conspire to exaggerate the cost of the NHS in order to promote their favoured “reforms.”

Nor is either party interested in scrutinising the financial burden these “reforms” have placed on the NHS since a Labour government began introducing private-sector provision in the early 2000s. 

New Labour’s private finance initiative deals still saddle the health service with around £50 billion in debt, with some hospitals spending more on debt repayment than on drugs

Combined with low pay, this leads trusts to struggle filling staffing vacancies. Remaining staff are overworked to the point they too are desperate to leave. Hospitals then pay more for private-sector agencies to fill their staffing gaps, exacerbating the problem.

Labour in 2019 had solutions. Cancel the PFI debt. End the expensive and inefficient use of private-sector provision right across the NHS.

Starmer does not. He doesn’t mention the private sector, but shadow health secretary Wes Streeting has already told us Labour intends to expand its use.

His cost-cutting concept of a “preventative” model of care is not novel, but even here his concern over junk food advertising seems quaint when reports show record levels of malnutrition and a resurgence of Victorian diseases from rickets to polio. Nor does he grasp the link between poor health and poverty, driven above all by falling pay.

His insistence that technology will give “patients more responsibility and professionals more time” is at best a recommendation for further reliance on the digital platforms already heavily used by the NHS, at worst a means of intensifying the trend of online self-diagnosis and referral used to mask the real problem of staff shortages. 

How it dovetails with a country where millions are cancelling broadband contracts they can no longer afford, when many of those most dependent on the health service were already struggling with online services because they were elderly or disabled, we are not told.

Starmer says the NHS cannot cope with more years of Tory government, and he is right. But on a prospectus like this — no promises on investment, no promises on pay, blind faith in “technology” and continued exploitation by the private sector — its agony would continue on his watch, too.


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