Hostile response to Labour’s suggestion for GPs to be made salaried NHS employees is predictable - David Behrens

In the give and take that followed, he agreed to let GPs continue running their surgeries as private businesses that could be bought and sold, with contracts to dispense NHS healthcare. It was a fair compromise because practices then were benign institutions run like the one in Doctor Finlay’s Casebook. Three-quarters of a century later they are mere profit centres for faceless corporations like the American insurance firm that runs “health hubs” in Leeds and Doncaster.

Bevan was guided by the knowledge that without doctors there could be no health service. It is a lesson that seems to have been forgotten in today’s organisation – one in which four in 10 junior medics plan to leave as soon as they can find a job somewhere else.

In bringing the ownership argument full circle, Labour has put its finger on another fly in the ointment: a resistance to institute reform from within. Today’s NHS is too often run for the benefit of its staff. Layers of bureaucracy are harnessed to make face-to-face contact a last resort when it should be the first recourse. Bottomless pits of money are wasted on management consultants, corporate videos and websites that don’t work. And while nurses are reduced to going on strike, 2,000 trust managers are pocketing six-figure salaries.

Whistleblowers who try to speak out are often sacked unceremoniously to dissuade others, while their bosses complain about how hard it is to retain staff. Is it any wonder?

That’s why Starmer and his health spokesman, Wes Streeting, hit the nail on the head when they said that well-meaning reverence for the NHS had supplanted reality; that it must no longer be considered off-limits for criticism. “The idea that the service is still the envy of the world is plainly wrong,” said Starmer.

A year ago, the current Chancellor, Jeremy Hunt, made similar noises – admitting he had presided over a “rogue system” during his time as health secretary and criticising the “blame culture” within the NHS. His views were dismissed as sour grapes at the time, but Starmer, coming at the problem with less baggage, cannot be swept aside so easily. Next year he may be running the show.

Besides, politicians who want to be elected don’t say things they think will make them unpopular. Labour has calculated that the groundswell of emotion which saw millions of us banging saucepans on our doorsteps three years ago has now turned on its heel.

The reason is that the service is no longer there for us in the way it used to be. Doctors’ appointments are harder to get than Wimbledon tickets, and it takes less time to queue for centre court than it does at A&E. That’s not wholly a consequence of the pandemic nor of underfunding; it’s the result of staffing and organisational problems that managers could have addressed long ago.

At the core of Starmer and Streeting’s argument – and it’s the same drum Bevan was banging – is the need to alter work practices to suit the changing needs of the population; not vice versa. Investment alone would not rescue the NHS, they said; the “ingrained thinking” of hospital managers had to change.

Another Labour sage, Tony Benn, made much the same point in the Commons in 1995. “There is masses of bureaucracy in the health service and a denial of what people need,” he said.

Starmer went so far as to suggest that patients be allowed to refer themselves to a specialist without a note from their GP – a notion that drew derision from industry pressure groups. There would be chaos if everyone with a headache pitched up at A&E demanding to see a brain surgeon, they said.

But, honestly, if you can’t see your local GP in person, what’s the point of them being local? You might as well go over their heads and call the parent company in America.

Root and branch surgery is not quick or easy, as Starmer acknowledged. But it is potentially life saving. And without it, how long will it be before we start to think of our health service in the same disparaging terms as the train network, the Home Office and all the other broken public services that have failed to embrace change?