NHS Rhetoric or Reform?

Plus: The fiscal time bomb & the legalisation of cannabis

“You won’t hear me pretend that the NHS is great, that somehow the timeliness and quality of NHS care, which is currently appalling, is the envy of the world”.

These were the words of one Wes Streeting, then Shadow Health Secretary, in October 2022. It was not his only pronouncement of that kind. Streeting, perhaps sensing an Overton Window shift around the NHS, initially tried to market himself as a radical reformer who was not afraid to challenge entrenched orthodoxies. A year later, he would even go on a “fact-finding mission” to Australia and Singapore, in order “to learn from other countries’ health systems”.

I never fully bought the whole “Streeting the reformer” persona. I thought it was a bit like when somebody wants your feedback on something, and asks you to be “brutally honest”, assuring you that they “won’t be offended”: if you’re actually being brutally honest, chances are that that person very much will be offended. It’s a second-order preference. What they mean is “In the abstract, I like the idea of being able to handle brutally honest feedback without being offended.” It doesn’t mean that they really are.

But while I never thought Wes Streeting was going to be the reformer we need, I nonetheless thought he deserved credit for his rhetoric. I wouldn’t dismiss it as “talk is cheap”, because when it comes to the NHS, talk is not cheap. Talk can be quite expensive. Indeed, Streeting quickly became something of a hate figure for the Corbynite wing of Labour, who, while they have been demoted within the party, still dominate social media, and who can cause him trouble. I did not expect him to change anything structurally, but I did expect him to help change the tone of the conversation.

So it is a shame that this period of reform-minded rhetoric is now officially over. Labour have fully retreated into their NHS-adulation comfort zone. At the recent local elections, they were handing out leaflets which showed a mock hospital bill, complete with a photo of a doctor holding up a credit card reader. On Twitter, they are now frequently scaremongering about the supposed evils of insurance-based healthcare systems. This is exactly the old NHS cultishness which Streeting used to denounce until five minutes ago.

It shows that Streeting is no longer trying to convince anyone that he has some brilliant health reform plan. What he is trying to do instead is make you afraid of the alternatives. He is trying to appeal to the NHS’s sacred cow status, in order to derive some political capital from it.

Politicians used to do this in the past, because it was easy, and it worked. It will be interesting to see whether this is still the case today. Because the Overton Window shift which originally inspired Streeting to adopt that reformist persona is real. Droning out the usual pro-NHS clichés used to be good enough, as a political strategy. Let’s see whether it still is.

Kristian Niemietz
Editorial Director

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IEA Podcast: Executive Director Tom Clougherty, Director of Communications Callum Price, and Editorial Director Kristian Niemietz discuss winter fuel payments, Britain’s fiscal projections, and political speeches, IEA YouTube

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The Spending Review

Tom Clougherty, Executive Director of the Institute of Economic Affairs, said:

"Next week’s Spending Review is being billed as a root-and-branch reassessment of government priorities. It isn’t. What we will see is the same old tinkering around the edges that we’ve had for the last fifteen years.

“We’ve been stuck in a cycle of short-term fixes, while the state continues to expand in scope and cost. With record-high taxes and no budget surplus for a quarter of a century, we can’t afford to keep pretending the status quo is sustainable.

“Hard choices are unavoidable. We need to rethink what the state does and how it does it, and transition to a public sector that employs fewer people to do fewer things. A meaningful spending review would start by listing everything the government does, rank those activities by importance and effectiveness, and then fund down the list until the money runs out. Anything that doesn’t make the cut should be shut down, or left to the private sector.”

• Britain on 'road to bankruptcy', warn experts, Executive Director Tom Clougherty, The Express

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News and Views

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How to Save Western Civilisation | Johan Norberg | IEA Interviews, Executive Director Tom Clougherty interviews Johan Norberg, IEA YouTube

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Europe’s Nanny State Problem, Communications Manager Reem Ibrahim, FEE

If policymakers want to improve public health, they should not restrict liberty, but should follow the evidence and pursue policies which are conducive to economic growth.

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The public sector sicknote epidemic: They're 60% more likely to be off than staff who work for private firms, Daily Mail

Len Shackleton, of the Institute of Economic Affairs think-tank, said: ‘Private sector workers are more likely to be employed in small workplaces where absence is more noticeable and they may feel obliged not to let colleagues down.

‘Their jobs may also be less secure than those in the public sector, again a motive for “presenteeism” [where employees go to work despite being sick] which public sector workers don’t feel to the same extent.’

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Why Britain's Cannabis Laws Make No Sense | IEA Interview, Communications Manager Reem Ibrahim interviews Mike Morgan-Giles, IEA YouTube

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