Labour created the cult of the NHS. Now it is desperate to tear it down

Amid more strikes, it is the Opposition’s responsibility to find a path for reform – otherwise disaster awaits

Looking forward into 2024, it is tempting to utterly despair at the country’s prospects. A failure to control the borders threatens to plunge British liberal democracy into a fresh existential crisis and cleave the country once more into warring tribes. The country is set to slide further into an economic ice age. Neglected elephants in the room are evolving into dangerous woolly mammoths, from the potentially underestimated costs of net zero to the ruling class’s colossal – perhaps irremediable – botching of Brexit. When Britons go to the polls this year, it risks replacing a government that is not fit to govern with one that is not ready to rule. Still, if politics has become a broken record, there is one area in which we could see a breakthrough: that is NHS reform.

As junior doctors prepare to strike over pay this week, it is quite something that the Labour party is likely to pass up the opportunity to bewail the “chronic underfunding” of the NHS. In fact, in recent weeks, the shadow health secretary Wes Streeting has insisted that Labour would not meet junior doctors’ wage increase demands. More broadly he has denounced the health service as “complacent”, wasteful, and even mendacious, using the so-called winter crisis as an excuse to demand more cash. Perhaps even more controversially, Labour has called for funding to be directed from hospitals to prevention programmes.

At a time when it is easy to be cynical about politics, it is genuinely encouraging that both major parties agree that the NHS is imploding – and merely throwing money at the behemoth isn’t going to solve it. This is something that the Tory Party has, for a long time, whispered, but been afraid to shout about, as it has scrabbled to fund anti-obesity campaigns alongside hospital building bonanzas and, in the back benches at least, called for a sober debate on the merits of a social insurance model. At last, Labour is willing to not only match but surpass the Tories in its calls for change.

For the best part of 40 years, such a consensus has proved elusive; with the rise of Thatcherism in the 1980s, Left-wing activists crafted a vision of the NHS as a sacred institution. Coinciding with a “Saatchi age” of slick political branding, this new NHS religion was reinforced in daily life by badges, and window posters. True, New Labour heretically pursued reforms to introduce “choice” into the system, but Ed Miliband wrenched Labour back to its comfort zone as the anointed protector of the untouchable NHS.

Yet, in a fascinating turn of events, the Left – having masterminded the cult of the NHS – is now desperate to tear it down. This is for the simple reason that it has no choice; the NHS has reached a crunch point. Recruitment from overseas is no longer plugging the gap, as burnt-out healthcare workers leave the NHS in droves. Hospitals are doing less with more: NHS funding has risen 20 per cent since 2019 and yet there has been a 5 per cent fall in treatments and operations undertaken. Just as developing countries are virtually forced into corruption when injected with more aid cash than they have the structures to put to good use, so the NHS is almost by design compelled to burn money on snake oil management consultants and HR gimmicks. With NHS spending now more than that for education, transport, the Home Office and defence put together, Britain is arguably now merely a health service with a state attached.

Still, if Labour is to make headway when it eventually takes office, it must show an even greater appetite for challenging NHS taboos. The stakes couldn’t be higher. Should Labour fail to bring about an axial shift in the public debate in the coming months, it will likely find itself bogged down in everyday fire-fighting from day one.

While Streeting’s bid to desacralise the NHS is welcome, what Labour has not been honest about is that taming the cult of the NHS will demand one final, colossal sacrifice by the people. Because the brutal truth is that reforming the NHS will either carry a death premium or a tax premium. If Britain is to put more resources into health prevention, as Labour has quite argued it should, it will either have to find additional funding for this on top of the cash that is being thrown at hospitals to prevent A&ES collapsing. This may demand the introduction of new NHS super tax. Alternatively, as the party has hinted, it could merely divert significant funds away from hospitals. This risks a further hemorrhaging of frontline hospital staff and a spike in excess deaths.

A further complication is that it will take time for the country to crack the secrets to successful preventative healthcare. The NHS’S track record in the arena is dire, with stop smoking schemes and cervical cancer screenings and weight management programmes yielding disappointing results. In truth, nobody yet knows how to best do preventative health in the free West, where the individual must ultimately retain responsibility and agency over their own body. In truth then, even once Britain has embarked on what is the right course, we face another generation of frustrating trial and error, and waste.

While this fleshing out of scenarios is not particularly palatable, politicians on both sides need to be frank that the alternative – which is to do nothing until the system finally collapses – is infinitely more dangerous.

Labour needs to be no less bold at confronting other major NHS taboos. The party remains worryingly ambiguous about the role of the private sector. True it has vowed to make more use of the commercial firms to whittle down waiting lists. But Streeting has also played to the Left-wing gallery, insisting that “privatisation could not be further from [his] aims”.

And while the shadow health secretary must be commended for insisting on the need to shift resources from prevention, he needs to stop pussyfooting around the fact that fat Britain needs to lose weight. With two thirds of adults overweight and obesity costing the country £100billion a year, the problem is becoming cataclysmic. Unlike the much maligned Tory “nasty party”, Labour has the power to alter the debate by making the moral case against the UK’S engagement in neocolonial practices of plundering the healthcare labour of developing countries to plug its own shortages.

In truth then though there is a rare window for a revolution in Britain after all the question, whether aptly or ironically, is whether politicians are brave enough to seize it.

If Labour is to make headway when it eventually takes office it must show an even greater appetite for challenging NHS taboos