In an otherwise excellent column, Jonathan Freedland misses the point over NHS reform (If Keir Starmer is to win an election, he has to restore Britain’s faith in politics, 25 February). To assert that “reform is something a new government could actually do” is not a convincing argument for embarking on unnecessary and disruptive change. The NHS in England is in the midst of major reform following the introduction of integrated care systems arising from the Health and Care Act 2022. The last thing overburdened and demoralised staff need is more reform.
Keir Starmer should resist the temptation to uncritically re-enact the New Labour playbook. Where Tony Blair and Gordon Brown got it right was to inject new money into the NHS, resulting in falling waiting lists and high public satisfaction levels. Where Blair and his health secretary, Alan Milburn, got it wrong was in “redisorganising” the NHS, with their fixation on patient choice, foundation hospital trusts and public-private partnerships. These proved to be costly, disruptive and ineffective, resulting in reform fatigue. What the NHS needs after 13 years of austerity is a restoration of funding and a workforce strategy – no more, no less.
David Hunter
Emeritus professor of health policy and management, Newcastle University
• Jonathan Freedland correctly identifies the damage that 13 years of Tory rule has inflicted on this country. The disastrous impact of austerity, outsourcing and privatisation on public services, however, is only half the story. While millions suffer the grim consequences of services that no longer work and wages that don’t cover the cost of living, astronomical profits are being made by privatised energy and water companies, banks so recently resuscitated by the public purse, landlords, supermarkets and equity-firm owners of care homes. In other words, the very definition of private wealth and public squalor.
Conspicuously absent from Keir Starmer’s speech and his five missions, and Freedland’s piece, was any recognition of this reality. Despite Starmer’s silence, there is no shortage of proposals for raising significant sums – for example, Tax Justice UK lists five policies that could raise £37bn in tax.
In addition, as Boris Johnson’s government so ably demonstrated during the pandemic, when it spaffed £37bn on a test-and-trace system that didn’t work, the magic money tree is available to government – and Labour only needs to learn how to shake it.
Professor emeritus Nick Spencer
Leamington Spa, Warwickshire
• In 1945, Labour was faced with a dire scenario: an economy wrecked by war and so weak that import licences were required to ensure that “unaffordable” items not needed for repairing the economy were not bought. Yet, it introduced a far-reaching reform programme that transformed the country.
The broken economy and society that Labour is likely to inherit in 2024 is nothing like that of 1945, yet it feels constrained to nothing but a modest, incremental programme of reform, one that will be inadequate for the task ahead. It seems, for example, that it will continue the government’s programme of public sector austerity, which has been the cause of so many of today’s problems. Rather than Labour restoring people’s faith in democracy, it seems unable to grasp that radical reforms are necessary to mend our broken economy and society, so confirming people’s cynicism about the nature of Westminster politics.
Derrick Joad
Leeds
