The Critical List
Today, I’m here to speak about something that is fundamental to the Labour Party, fundamental to our purpose of working people. The NHS. Just look at it. The eight o’clock scramble, the appointments missed, opportunities missed, to spot the pain that turned out to be a tumour. Patients who want to go home, are well enough to go home but who have to stay in hospital for months, waiting for a care package. Day long waits in A&E, record numbers off work sick, people pulling their own teeth out, seven million on waiting, waiting, waiting lists… Nye Bevan – the Labour Health Secretary who created the NHS put it best. He said: “illness is neither an indulgence for which people have to pay; nor an offence for which they should be penalised” That’s what we believe. And it’s under threat. I mean it. I don’t think the NHS survives five more years of Tory government.
This is an unpromising beginning. The Labour party does, as Starmer acknowledges later, always say that the NHS is on the critical list. “No”, he seems to be saying, “this time it really is”. The strange football-speak tense of this sentence – “I don’t think the NHS survives” – is the only thing that marks this out from the commonplace. It’s a shame because this isn’t in fact a good introduction to what follows, either in content or in mood. There is more than a suggestion of writing by committee in this speech. A bad process is an enemy of clear writing, and it sounds as if there are competing voices in here. Indeed, later in the speech there is a much more sophisticated critique of the Tories which accuses them not of failing to care at all but just not caring enough. That one bites because it’s true. It’s unfortunate that it has been prefigured by an opening that is standard political abuse and doesn’t establish at all the rather interesting speech on the future of health care that, unbeknown, the audience is about to get.
More Than Money
Some people will tell you this is purely a question of money. And money is part of it… I’ve run a public service – I know that money makes a difference. But it only gets you so far. You can’t look at the problems now and tell me it’s just about money – that’s not serious. You can’t ignore the fact the world has changed – that’s denying the evidence before our eyes. The British people are living longer – life expectancy in 1948 was 68, today it’s over 81. That is a good thing, but it brings new challenges. The nature of disease is different – instead of urgent and acute hospital care, now it’s more about managing chronic, long-term conditions. The wonder of science has taught us, with ever increasing clarity that our health depends on how we live. Mental health has stepped out from the shadows – and thank goodness. And with artificial intelligence, with personalised medicine, with new vaccines, we stand on the cusp of a revolution that could transform healthcare for the better. My message today is this – science and technology are the game-changers. This is the prize – this is what it gives us. An NHS where prevention comes first, where care is closer to home, where patients have more control.
This is where the speech gets going. I once had a History Professor who gave me the great advice to cross out my first paragraph and do away with the throat-clearing. That was good advice then and it is good advice now. This is the paragraph-length summary of the speech that functions like the opening stills in a movie – it’s an establishing shot and also a concise account of what is to come. It is possible to withhold information in a speech, the better to do a big reveal near the end, but there is no need. It’s not a mystery thriller and this is compactly written and signals that this will be a speech that will do more than present the bleeding stumps of the NHS. You cannot say that of all Labour NHS speeches. It is possible that the opening paragraphs – the Tory knocking copy – were placed early in the script to win permission for some tougher thoughts later on. That rarely works, though. Labour audiences rapidly forget the Tory lines once they are confronted with reform messages.
A Flavour of Government
Shift one – we must move care away from hospitals and closer to the community, the NHS must become a Neighbourhood Health Service. I’ll put it bluntly – at the moment we aren’t good enough at treating people early in the community. We leave it to hospitals – and quite often that’s too late. And if we change this it will save lives and money… Shift two – we must move from a mind-set that views health as all about sickness. To one where we put prevention first – right across society. So we’ll take bold action where early intervention can make a huge difference…. Shift three – technology. A revolution that will accelerate the first two shifts and herald a different kind of healthcare… Britain leads the world in science and technology – we can make this happen. This is the game changer. The light at the end of the tunnel. This is what will make the NHS fit for the future.
The fuller version of these paragraphs (which I have pressed together here) give the lie to the notion that Labour has nothing to say or that the party has no policy. If anything, Labour has too many small policies but not enough big ones. The policies that oppositions need are flavours. We need to feel that Labour knows how to apply artificial intelligence to make us healthier, not what its view will be on car parking charges at hospitals. These paragraphs do that sort of work. They are an attempt to give the audience a flavour of what a Labour government would seek to do. Moving care out of hospitals, moving from remedy to prevention and applying the latest technology. These aspirations were accompanied by goals, with measurable outcomes. Not many people read speeches like this at all, let alone in their entirety, but it is impossible to do so and pretend that Labour has nothing to say. The novelty here, though, is the flavour. There is a political intelligence behind these paragraphs that is good news for anyone who wishes Starmer well.
The Unsparing Sentiment
The sum total of these three shifts, what you get is a plan…. In Place of Fear – that’s what Nye Bevan called his book. And if people want to call me dewy-eyed, want to say I’m a romantic about the values of the NHS – I plead guilty. The NHS has played an enormous role in my life. My Mum was a nurse, a proud nurse too. But she was also severely ill for most of her life with a rare condition called Still’s disease. At the age of 11 – she was told two things. One – she would be in a wheelchair by her twenties. Two – that she should forget about having kids. Now that diagnosis didn’t reckon with Mum’s determination and courage but it also didn’t reckon with the NHS. A doctor at Guy’s Hospital in London refused to give up. He found an experimental treatment for this 11 year old girl and the rest, as they say, is history. Honestly – lots of people say they owe the NHS everything and I’m definitely one of them. But that’s just the point. Mum’s story isn’t special. Behind every single door in this country, there is a family who will have their own version. This is who we are, the NHS belongs to everyone. The foundation for the comfort, security and health of working people. For 75 years: an ever-present in our story – family and nation.
This is a clever ending. The usual practice is to put the autobiographical references closer to the beginning but here they come at the end, as a validation of Starmer’s bona fides on the NHS. To the initiated the tale of his mothers’ Still’s disease is familiar but it bears repeating for those for whom politics takes longer to seep in. The reason this section is cleverly placed is that it allows Starmer to cop-opt Bevan – always the sentimental reference of choice -and confess to being dewy-eyed about the NHS in a speech which is otherwise decidedly unsentimental. Labour politicians give one of two speeches on the NHS. There is Gordon Brown at the Social Market Foundation in 2003 in which public provision is lauded over its private rival. And then there is Tony Blair, passim, in which the principle of the NHS is glancingly defended but the practice is found wanting. Starmer gives us content from Blair with a rhetorical covering from Brown. In part for that reason, and in part because he has an argument to make, it’s his best policy speech yet.