As well as making noises about wealth taxes that sound suspiciously similar to the kind of thing Andy Burnham would normally say, Wes Streeting has also been opining this week about the lack of radical action from the government he’s just resigned from. When he quit as health secretary, he managed to overshadow the publication of his own legislation, leaving the task of getting yet another reorganisation of the NHS through parliament to his successor. Streeting told Nick Robinson that while the government had done ‘some important things’ on health and social care, it had fallen ‘well short of my ambition’, particularly on social care.
As it happens, that ambition is also something Streeting has long shared with Burnham: to legislate for a National Care Service. Instead, Keir Starmer kicked social care back into the long grass with another consultation and an ambition to make it a ‘second term issue’. The Prime Minister’s predicament now shows the hubris of talking about second term issues: even if he manages to limp on for months, there will be no second Starmer term. He should always have taken the big, initially unpopular decisions on open sores in British policymaking such as social care early in his premiership when he had the political capital. Now, even the most charismatic of his successors will struggle.
But it’s not just on social care where Starmer and Streeting have lacked ambition. The Health Bill does represent a big structural change in the NHS (again), but absent from it is yet another agenda that Streeting talked a lot about in opposition: prevention. It is arguably easier to fiddle about with the train set of the NHS than it is to change the direction of the trains themselves: at the moment the focus is on acute services, but Streeting and his predecessor Jon Ashworth had both expounded the virtues of moving to a preventive, community-based system which treats patients earlier on, and even prevents the onset of some of the most complex problems. Conservative politicians had promised similar, but the flow of money and resources had always continued towards acute, and hasn’t stopped with the change of administration. It doesn’t stop in the new Health Bill, either: the focus in this piece of legislation is largely on centralising control for the secretary of state, despite some rather postmodern protestations from ministers that they are in fact devolving it.
Streeting seemed to talk less about prevention the more his leadership prospects grew: while it sounds like a motherhood-and-apple-pie policy that no one could disagree with, its practical implication would mean switching the flow of money from acute – in other words, closing hospitals. As with levelling with the electorate about the costs of any meaningful social care reform, closing hospitals is not what you want to do if you want to win friends and influence people in politics, even when it’s the right thing to do. And so prevention has once again been prevented from becoming a serious and real policy other than in the speeches of opposition politicians. That won’t likely change with either a Burnham or Streeting premiership, either.
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