If Streeting saves NHS he could easily be our next PM

Keir Starmer is following the Tony Blair model for fixing the NHS. He takes advice from Blair himself, and has brought back two of the people who were key to mending the health service in the New Labour years — Michael Barber, head of the Prime Minister’s Delivery Unit in Blair’s second term, and Alan Milburn, health secretary during the most innovative phase of NHS reform.

But the most important person in the NHS recovery plan is the current health secretary, which is why it matters that Wes Streeting is an arch-Blairite. The prime minister’s message this week — “no more money without reform” — was absolutely right.

More money is essential — especially capital investment, as Ara Darzi said in his instant review, published on Thursday. I noticed that Starmer said in answer to questions after his speech welcoming the report: “I was struck by what Lord Darzi said about capital funding; I thought it was really profound.”

But there is little point in pouring more cash into the health service without improving efficiency. This is why the NHS needs to be led by an unrepentant Blairite who will force the pace of change.

As I wrote on Thursday, the Darzi review is the first step in a familiar New Labour manoeuvre to prepare public opinion for a tax rise, just as the Wanless review in 2002 paved the way for the rise in national insurance contributions “to pay for the NHS” that came into effect in 2003.

Money is important, but it is not all that is needed to get the NHS back to where it was at the end of the last Labour government, with waiting lists cut right back and patient satisfaction at a record high. That also requires determined leadership and a willingness to challenge inertia and vested interests.

Barber, whose appointment as “adviser on effective delivery” to the prime minister was announced yesterday, played a vital role in chivvying the NHS to collect real-time measures of its performance, setting stretching targets and monitoring them in a constructive and supportive way.

Milburn, who has been advising Streeting informally, prompting an absurd fuss from the Conservatives about “cronyism”, provided vision and leadership. He argued that change was needed to give patients on low incomes the level of service they deserved — he said that it was unfair that the better-off could buy their way out of the health service’s problems. And he regarded his work, 20 years ago, as incomplete.

He was trying “to align the culture of the service with the culture of modern-day society”, he told me, but he did not fully succeed. “Outcomes got better; performance got better; but culturally, did I get where I wanted to in terms of being able to permanently change the system, so that it felt more owned by the patients and less by the doctor or by the politician? No. That’s the unfinished work in my view that has to be done.”

Streeting has the same jaw-jutting impatience with arguments against change. Defending his plan to expand the use of private contractors to supply NHS services before the election, Streeting wrote in The Sun: “Middle-class lefties cry ‘betrayal’. The real betrayal is the two-tier system that sees people like them treated faster — while working families like mine are left waiting for longer.”

If he can combine that combative approach with Barber’s tactful and collegiate way of working, he has a chance of turning the NHS around. He made a quiet start this week, talking in general terms about the “three big shifts” needed in the NHS, from analogue to digital, from hospital to community, and from sickness to prevention.

So far, so bland and consensual.

But if anybody can argue for and push through the more difficult policies needed, it is Streeting. He will need to take on the British Medical Association, one of the toughest trade unions in the public sector. He will need to shift incentives throughout the system in favour of patient service. He may even have to make the case for new funding models.