On the first night of the Labour Party conference, Wes Streeting stood in front of a huge crowd and told them it was him, not the prime minister, who would prove pivotol in Labour's ability to secure re-election.
Addressing a room of delegates who had queued for an hour to watch his first appearance at event in Liverpool, he told them: “I’ve always known this, and this is the pressure I’ve felt since I walked into the DHSC on day one and why I have striven not to waste a single day of the massive privilege – I have of one of the best jobs in government."
“It is the recognition of knowing that, at the next election – if we have not delivered on the NHS – the public will not trust us to deliver on anything else. And we will not get a second term.”
It was somewhat surprising, then, that the conference was so lacking in focus on the health service, with the topics of migration and Reform instead dominating from start to finish – even in the health secretary's sessions. Streeting spent much of his time taking aim at Nigel Farage, particularly over his “racist” immigration policies.
Although Streeting was clearly following the PM's lead – who had ramped up his attacks on Farage in the days before the conference – not far away in another hall, polling expert John Curtice issued a word of caution to Labour. He told another fringe event that putting all your energy into solving the issue of migration is a dangerous political move because it is largely out of most politicians’ control. The reality is that voters also care deeply about the economy and the NHS – two areas which are much easier to influence.
For his part, Streeting did make two major health policy announcement: the first was “online” access to hospital, an announcement which garnered attention and was splashed across the front page of several newspapers. The second was a promise of a “fair pay agreement” in social care. But health experts at the conference reacted with the usual caution.
On the online hospitals, one Royal College official said with a shrug: “The devil will be in the detail.” This sentiment swept through to the fringe events, attended by the great and the good of the health arena.
Clearly, while Streeting's rousing address to the conference had demonstrated his impressive speaking skills and charisma, it had failed to convince some health experts so invested in the future of the NHS – many of whom have waited years for Labour to be back in charge of public services – that Sir Keir's party really had enough of a radical plan to overhaul the service.
Firstly, many were sceptical that Labour will be able to make its “three shifts” – from hospital to community, analogue to digital, and sickness to prevention – a reality and Streeting did little to talk them out of this. Think tanks, unions and the royal college leaders milling about the conference openly questioned the conflicting notions of saying there's no more money for the NHS, while having the ability to make a tangible difference in those three areas.
Elsewhere, there was uncertainty about making the life sciences the engine of the NHS’s reform. The long-awaited NHS 10-year plan, published earlier this year, posed making the NHS “open for business” to the life sciences and technology industry – making clear the government’s desire for the sector to play a part in improving access for patients and delivery of healthcare in the UK.
Sally Gainsbury, senior policy analyst for the Nuffield Trust, who sat on a panel with me, reflected the tone of many well. “I think there's a real problem with the 10 year plan – if it is completely out of kilter with the level of resources that's going into the NHS and what the NHS has been asked to do in terms of productivity."
She added: “The 10 year plan is presented as an investment brochure to the life science industry, and reframing the NHS as a sort of a consumer service.”
Sebastian Rees, head of health at the IPPR, also agreed Streeting was taking a “gamble” with his backing of life sciences. But he pointed out: “I think their evidence suggests that for a country like Britain, given our economic strengths and weaknesses, taking a bet on life sciences could be the economic stimulus that we need.”
He said there was a wider issue of two “rival visions” for the NHS – one of ensuring the health service meets patients’ demands in the future, and one about “health spending” and the value in where money is placed.
In another panel session on how the government can fulfil its promise to create a healthy generation and address its shift from “sickness to prevention”, Labour Stroud MP Simon Opher said “a really big clean up of politics” was needed to tackle obesity. He said he was "cross" with watered-down promises on junk food advertising.
Sarah Woolnah, chief executive of the King’s Fund, said it would require “brave politics” to shift the dial in this space - but Streeting didn’t address this issue.
Elsewhere, it was pointed out to me on a third panel, around Air Pollution, that the government had gone very quiet on the idea of a new Clean Air Act.
Meanwhile, mental health was barely mentioned by the health secretary. When challenged during Sunday’s session over the government's lack of waiting list targets for this sector by former Australian prime minister Julia Gillard, Streeting pointed instead to overdiagnosis and promises of how technology will improve access.
Despite the concerns and challenges playing out, most of those working in the health sector appeared more positive about the future of the NHS under Labour than its opponents.
Whether or not that feeling will remain is down to Wes and what he does with the NHS over the next few years.
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