Dodging the big issues of investment and pay

Keir Starmer's speech on the NHS

Yesterday’s speech by Keir Starmer on the future of the NHS dodged the need for increased investment in the NHS, including a specific requirement to resolve the staffing crisis through a sustained increase in wages. 

Keir Starmer’s message in his NHS speech yesterday was “you can’t look at the problems now and tell me it’s just about money – that’s not serious.” More important, he argued, is to show Labour’s “recipe for reform.”

However, investment and spending dominated a series of questions from the press following Keir Starmer’s speech. When asked by the BBC if more money would be going into the NHS under Labour, he did not answer; asked by the Telegraph if health spending as a proportion of the economy was too low, he did not answer. 

Although in the main body of the speech the Labour leader said he would set out more on plans for ‘money’ before the election, he went on to lower expectations: “like any incoming government, we will make decisions based on a full appreciation of reality – on the state of the NHS and our public finances.” 

But the NHS needs more investment. People know it, and want to know that the service is going to be protected.

Sir Michael Marmot is the author of major studies of health inequalities in Britain. As he has argued, problems in the NHS cannot be simply attributed to the pandemic, the war in Ukraine, or “greedy” staff: “the problems began in 2010.” In response to Wes Streeting’s emphasis on reform over more money, Marmot pointed to figures that show how health spending per person, adjusted for demographic change, grew at 5.7% a year under Labour from 1997 to 2010; at -0.07% from 2010 to 2015; and at -0.03% from 2015 to 2021. 

The need for more investment in the NHS applies in an acute way to the workforce. While Labour proposes an ambitious plan to recruit more essential NHS staff it proposes no plan to correct the wages crisis, which has led to the very severe problems of recruitment and retention.

Rather, the Labour leadership has set its face against the nurses’ pay request, calling it “more than can be afforded.” Yesterday’s speech went nowhere to address the question of pay in the NHS despite its centrality to the pent-up problems of staffing levels and service delivery.

Across the economy household incomes face their sharpest decline on record. Workers need a programme of measures to increase the share of the economy going into peoples’ pay packets. This need is particularly acute in a public services such as the NHS. 

There isn’t a single person who thinks that the NHS doesn’t need change but fundamentally Labour’s health mission contains a dodge on the very deep and serious problem of funding for the NHS. An incoming Labour government will face big policy pressures over spending including pay.

You can argue that NHS funding is not the only thing, but it is a very big thing indeed.