Everything Has A Limit

 Considering the fact that six months ago I agreed with hardly a word Streeting said, it might appear somewhat baffling that his political position appears to have shifted dramatically. But the explanation is not that complex. Streeting has been tasked with saying what Starmer would like to say, but which for political reasons he cannot.

The current Streeting/Starmer position on the NHS is, I think, part of an attempt to reposition the Labour Party away from the perception that it consists of an alliance of special interest groups rather than (key phrase coming up here) "the ordinary working person in the street".

The changes to the NHS that Streeting has posited are important in that Labour has finally accepted that the organization is not staffed solely by saints and that it is not perhaps the perfect system.

In fact he went further, he said that the NHS was in an "existential" crisis.

Now, obviously I've been saying stuff like this for a long time, so confirmation bias will mean that I am happy to hear someone in the Labour Party saying it. For a start it makes me more likely to vote for them.

But the more interesting parts for me were two other points that Streeting raised. He said that there was a perception that the Labour Party represented the interests of NHS workers rather than the interests of people who used the NHS. That for me was a key point and represented a fundamental attempt to shift the power base of activist Labour away from those who are effectively public sector employees (among others, academics, teachers, NHS staff, lower-grade civil servants, social workers, and the part of the charity sector dependent on public funding, and a mélange of what we might politely term "the metropolitan elite") and back towards the raft of voters who moved en masse to Boris Johnson at the last election.

Starmer has realized that, as a coalition, this only worked for Labour when there was a residual "old Labour" vote – working-class white people whose parents had always voted Labour (and who had probably been in a union) but who no longer felt that those in charge of Labour represented them in any way. The Islington Corbynites attracted many of the young left (often at university), yes, but this was not enough to put together a winning coalition.

Streeting went further in stating, almost explicitly, that this was a new Labour (or, perhaps, a new "New Labour") when he called  the "left-wing" critics of his proposals "the true Conservatives". That is another argument that I have been making for several years – that Labour activism today is basically conservatism. It harks back to 1945 to 1951 as a mythical golden age, and it wants to return to a time of class division and strong unionism. It consists of people mainly looking back rather than looking forward. And it is, I posit, a group of people who fail to realize that the "wealth" of the ordinary working person in those days was mainly based on poverty in what was then called the third world. Much of the UK's wealth that was built up from the 16th century onwards has been based more on the taking of raw goods from other countries and then turning it into something else, which we then sold back to them.
Controversial line from me, there's nothing wrong with that, just as there was nothing wrong with those countries eventually getting pissed off with the deal and doing the "conversion" themselves (this, after all, was exactly what England did around the late 15th century when it stopped exporting its wool to Flanders and letting Flanders make all the profit from turning that raw product into a consumer good, and started producing stuff from the raw material  itself).

But there is no going back to what was really a non-existent golden age. Once again, things are not black and white. Globally since the 1970s there has been a stagnation in the wealth of "the ordinary working person", while entrepreneurs and rentiers have got better off. As will often be stated, everyone (well, not actually everyone, but that's the basis of another article) benefits in absolute terms from these entrepreneurs creating higher overall GDP, it's just that the *share* allocated to the employee that falls. As such (this argument goes) the ordinary working person should be grateful. Meanwhile the opposite argument is that a small elite hoovers up the majority of the gains, leaving "scraps" of improvement for the ordinary working person.

But, back to Streeting and the NHS. He said when speaking at a seminar of the  Policy Exchange think tank, that the NHS was not "delivering a standard of care that patients should be satisfied with".

Hard to disagree with that. The important point here is though, that he did not provide the standard Corbyn and NHS solution – that more money would solve it. As I have observed, not only has the NHS received more and more money over the years since 1947, but it has also received a higher proportion of GDP. And this has been at the expense of a more holistic strategy to the health of the nation. While cutting-edge advances have been made (from which I, personally, have benefited), the balance between non-medical care and medical intervention has shifted towards medical intervention. Put simply, the structure of the NHS is not built to deal with those who need looking after and who have no-one to look after them, but who are not acutely or even chronically unwell.

Labour, said Streeting, would " give the NHS the investment and staff it needs, but that has to result in better standards for patients".

Streeting said in a speech only 15 minutes long but which I think will be seen as a pivotal shift in how Labour hopes to put together a "new" Labour-backing coalition that the NHS's problems were about far more than pay levels for nurses.

Streeting said it was clear that NHS staff were "working as hard as they can" (a point I would not concur with. Some do, but some don't). But he also said that  we cannot continue pouring money into a 20th-century model of care that delivers late diagnosis and more expensive treatment".

Let's face it. This is Starmer-speak, and it's something that I have been waiting to hear for a long time.

Streeting said that he endorsed a report by Policy Exchange, which lays out a roadmap for how Labour could achieve its target of training 15,000 medical students a year, if it wins the next general election.

Streeting said Labour's plan would involve:

Training 5,000 new community health workers a year

Using spare capacity in the private sector to bring down NHS waiting lists

Fair pay, terms, and conditions to stop the exodus of care workers (note that this indicates an intention to blur the lines between the NHS and social care – something that NHS are likely to resist vigorously because, well, they are conservative).

This will all be poison to the old Labour represented by the likes of Diane Abbott, Long-Bailey, etc. Academics too will hate it. This is a full-frontal attack on special interest groups who have wielded huge influence within Labour for the past 12 years. One of the big differences between Blair and Brown was that Brown was at heart a more conservative "old Labour" politician. His coalition was more Wilsonian. But he missed the fact that he was getting out of touch with the general population. His constituency was dying off. The new dichotomy was, as it were, between radicalism and conservatism, with radicalism (seen in UKIP, the Brexit wing of the Conservative Party) becoming more significant, and conservatism (things "as they were" losing touch).

Streeting said that it was" plain to see for anyone who uses the NHS that it is failing patients on a daily basis," Mr Streeting said. "So yes, we are going to reform it and make the NHS fit for the future. Ironically, it is those voices from the left who oppose reform, who prove themselves to be the true conservatives."

As the BBC's Iain Watson observed:

"All this was designed to make people who don't usually vote Labour sit up and listen. But there is little doubt that some who usually back his party won't entirely like what they are hearing."