I have published this video this morning. In it I argue that it seems as if Wes Streeting's dream for the NHS is that it be a low-cost, semi-automated, significantly privatised provider of healthcare to consumers – which is what he thinks we all are. That dream is going to be shattered by a sugar and ultra-processed food healthcare crisis and the wave of litigation that is going to hit the NHS as a result of Streeting's plan to use under-trained staff.
The audio version of this video is here:
The transcript is:
Wes Streeting's dreams for the NHS are going to be shattered very soon after he arrives in office.
Wes Streeting has for some time been the shadow Secretary of State for Health on behalf of the Labour Party and I've little doubt that Keir Starmer will give him the real job the moment that he gets into office.
But Wes Streeting is a seriously misguided man. He believes that he's taking on this role for the purpose of delivering increased privatisation in the NHS. He's also taking it on, frankly, to take on the staff of the NHS who he thinks are pretty unproductive and who he believes should be working the way that happens in Singapore, which is a very different society indeed.
His dream is going to be shattered for a number of reasons.
One is because of the rise of demand for the NHS. We have a massive problem with ill-health in the UK, which is exploding, not in the way that it did under COVID, but nonetheless, absolutely extraordinarily.
Type 2 diabetes is the most obvious sign of this, and the cause is very simple. It's excess sugar. Sugar is the threat to the well-being of the NHS, and it is being supplied to people by the ultra-processed food industry, which is out of control, and creates foodstuffs which are intended to induce an addiction towards those foodstuffs.
They quite literally provide a stimulus to the parts of the brain that says just after you've eaten that you're hungry again and therefore can you have some more food and so you eat again, and the consequence is obesity and then type 2 diabetes.
So, his idea that he can contain the cost of the NHS within its existing budgets and supply the services that we want by greater involvement of the private sector on some of the routine activities that it undertakes is absurd and it's going to go wrong.
So, in that sense, Wes Streeting's belief that he's going to be delivering some ultra-smooth private sector NHS is going to be shattered by the reality of ill health in this country.
But there's another problem that he's going to have.
The current government has begun the process of employing non-fully trained staff to undertake roles in the NHS. We have nursing assistants who are doing the roles of nurses and we have physician assistants who are undertaking the roles of doctors.
But they're not the real thing. They are not trained in the tasks that doctors and nurses undertake. And in the case of doctors in particular, where some of these physician assistants are doing things like operations, the lack of knowledge is going to be absolutely threatening to the future of the NHS because of the litigation that is going to follow when things go wrong, as surely it will.
The job of a doctor is to manage complex risk. We are complex. We create risk every time we sit in front of a doctor and cannot adequately describe our symptoms of ill health. Which, of course, most of us can't. The doctor has to use their skill of us as a whole person to work out what might be going on.
Doing so, they are not looking at techniques that they can apply to deliver surgery or to prescribe a drug. What they're looking at is a complex system that has a fault in it, which they're trying to identify as the cause. Now that's a totally different task from learning about how to, for example, do an operation for a cataract.
That's a very specific skill. But you've got to, first of all, work out that that is the right thing to do. And these people are not being trained to do that.
Worse, If somebody does an operation for a cataract and doesn't realise that that is the operation that is not needed because there's something much more complex going on in the eye, they could cause harm, and I think they will cause harm, and I think most doctors realise that.
And this move towards untrained people, or only partly trained people, I should say, inside the NHS, who cannot do complex risk management because they're not trained in it, is deeply dangerous to Wes Streaking's image of what he wants to deliver in the NHS because we already have tens of billions of pounds sitting on the government's balance sheet in terms of provisions for litigation costs from people who are claiming from the government for damages caused by botched NHS procedures.
That sum will go out of control if Wes Streaking gets his way to substitute yet more doctors and nurses with these partly-trained people.
We know already there are lots of doctors who cannot find employment in the UK. There's no shortage of GPs. They're just unemployed right now.
And we know already that nurses finishing their periods of qualification training are not getting jobs in hospitals because nursing assistants are being employed.
Instead, we're getting a dumbed-down NHS, and Wes Streeting is dedicated to that.
His image of the NHS is deeply flawed.
His dream needs to be shattered as soon as possible, because we need a proper NHS, with properly trained people, who understand the complex beings that we are, and our needs, if we are all to get the health service that we need, which is nothing like the thing that Wes Streeting wants to deliver to us.
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Streeting is functionally incapable of asking the right question which is:
What is the link between austerity and health? (i.e. does making people poorer make them less healthy & thus increase NHS burdens).
I found 4 studies in peer reviewed journals (3 in BMJ) that linked austerity with rising deaths/declining health. Streeting (& by extension LINO) is thus fixing symptoms rather than causes. Fixing causes requires money and Reeves claims there is none. A cynic would think that the LINO approach is designed to fail – thus validating the claim that the NHS is not fit for purpose and needs more privatisation (more market – not less – yeah that’ll fix it).
Much to agree with
Is Wes Streaking because he’s wearing the emperor’s new clothes?
I’m sure that Streeting is not influenced by the £175,000 of donations he has received from private healthcare companies. Disgraceful.
https://www.thenational.scot/news/24250557.wes-streeting-takes-175k-donors-linked-private-health-firms/
I recently attended the outpatients clinic at a hospital some miles away from where I live. Several things struck me about it.
The first was how difficult it was to access for those like me who arrived by public transport. If I had been in wheelchair it would have been almost impossible.
The second relates to sugar. I arrived early and so had a green tea in the canteen. There were various sandwiches and wraps for sale. Without exception they all had sugar high on the ingredients list. It was breakfast time, and some hot food which was probably more nutritious but an awful lot of baked beans were being served. What was worse was what was available for when the canteen was closed: a coffee machine, a machine full of sugary drinks and a machine full of sugary bars and packets of crisps. One might have thought that, in view of the type 2 diabetes epidemic, a hospital would set a good example when it came to what food was served on its premises. However the canteen had been outsourced to a private catering company and the hospital may have had little control over what was served there.
The third was a feeling of inevitability. I picked this up mainly from a fund raising stool run by the friends of the hospital. There was a display showing what they had already funded and what they were intending to fund. Much of it was described as essential equipment. The man who was in charge of the stool seemed very proud of what he was doing and talked me through it. I put it to him that he should not have to fund raise for essential equipment but that it should be provided by the state. His reaction was that this was never going to happen and, besides that, when you are patient it doesn’t matter to you how it was funded.
This particular hospital is in the middle of a fairly affluent area. Possibly the friends of the hospital can raise the funds for many of its needs. But hospitals in deprived areas need essential equipment too and this can only come about through state funding and if it is accepted that this is never going to happen then these hospitals are condemned to go without forever.
Now I don’t say that people should not raise funds for their local hospital but it is a pity if it does not come with an awareness of the political context in which they doing so and without any hope of society changing for the better.
As I see it, the NHS is already in disarray. Wes Streeting’s plans for it can only make matters worse.
Much to agree with
I’m confident Streeting and maybe Reeves will take a leaf out of ex-Chancellor Hunt’s book and run some marathons to raise money for essential equipment while in their day jobs they will sit there wringing their hands while reciting their favourite mantra “there is no money”.
Bernard, here is a picture that I took from Salford Royal Hospital that illustrates your point. Its from 2018 but I am willing to bet its still there, along with thousands of others across the NHS.
https://imgur.com/a/mQBjfLY
Richard, my wife has just had eye laser surgery (peripheral iridotomy) to correct a supposed issue with her eyes. She had one eye done and something did seem weirdly wrong somehow with the way things were handled and when she attended to have the second eye done it was established she didn’t need the work done at all and that they have damaged her eye. It very much looks like she might need all sorts of remedial work as her lens has been damaged and will likely lead to a cataract. It looks very likely she will be going down the litigation route. If anyone whose reading this knows of the best route for this please let me know.
I should have added the laser eye surgery was of course done be an outsourced/privatised clinic.
I find it incredible that none of the parties are being honest about the most obvious impact of increased privatisation of the NHS, which is increased cost for poorer outcomes. A fully funded NHS with no element of private health care will dedicate every penny to health outcomes. Any level of private provision immediately siphons off part of that funding in order for the private provider to make profit.
Streeting is not misguided. Far from it.
He is doing the usual neoliberal trick of single entry book keeping. Only counting the immediate short term cost and, as you say, disregarding future costs as well as the obvious benefits of a properly funded NHS. He only looks at one side of balance sheet. Such is the weapon of those whose end is in privatisation and austerity.
Streeting is guided by neoliberal ideology for neoliberal ends in much the same way as a drone is used to kill innocent civilians
He is well guided to very singular ends.
We need to look at more democratic ends that at present are not counted
The Future of civilisation is Double Entry Bookkeeping
Thank you and well said, Richard.
I have not heard Streeting refer to Singapore, but can imagine that he has. Having worked there, I’m often amused by people who talk about Singapore on Thames, but have not been to the original apart from perhaps a transit to further afield.
Streeting has neither the educational nor professional background to opine on such matters. His professional background is a bit mysterious. His donors are doing his thinking. One notices how abusive he becomes when there’s push back. His physical demeanour is a sight to behold.
He went there to express his admiration….
Thank you, Richard.
Oh, dear.
I only know Singapore at second hand through various Chinese who were either born there or have lived there for a substantial amount of time. They seem to be equally divided among those who think it is a Heaven on Earth where all the streets are clean, everything is orderly and everyone is polite to each other and those who find the atmosphere of the place stifling and want to keep as much space between themselves and the place as possible.
I can see how demand for private healthcare will soar if that is where you can be sure of being seen and treated by a fully qualified doctor / nurse/ physio etc instead of a bunch of very inadequately trained people but with overinflated ideas of their abilities.
The new system for trying to make a GP appointment is so challenging I’m sure a simple phone call to a private GP will soon become very appealing.