Whisper it, Labour may actually be serious about overhauling the NHS.
Paul Corrigan is the most influential adviser you’ve never heard of. And he has big plans for healthcare
FRASER NELSON11 July 2024 • 
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It won’t suit Wes Streeting to say very much about his plans to transform the NHS: not now, at least. “The reformer has enemies in all those who profit by the old order,” says Machiavelli, “and only lukewarm defenders in all those who would profit by the new.”
This makes NHS reform a thankless task, strewn with so much political danger that Tories never dared attempt it in 14 years – with calamitous results. But Streeting is reassembling the team that did it before, 20 years ago, and hopes to do it again.
Paul Corrigan is not known to many people outside the world of health, but he’s famous inside it. He was an architect of the Blair-era reforms enacted by Alan Milburn which brought new private clinics into the NHS system. This annoyed the Brownites who, eventually, thwarted them and mothballed the reform.
Milburn, now 66, is back as an adviser to Streeting. Others are coming back, too. And this time, there’s no Gordon Brown to stop them.
Corrigan’s agenda is no secret. He spent his working life in the field: not just in health but politics (his wife, Hilary Armstrong, was chief whip when Labour MPs were rebelling against his reforms last time). He has been a prolific commentator – churning out pamphlets, blogs and interviews with energy that has only intensified at the age of 76. “At this stage of my life,” he said recently, “I want to know how to make things happen – rather than writing statements of intent.” He now has the power to do just that.
Let’s start, for example, with Streeting saying that he’d end the “begging bowl” culture where the NHS and its lobbyists say hospitals will be in crisis unless HM Treasury stumps up more money. In his blog, Corrigan held these tactics up to ridicule. “Sometimes this is backed up by the sophistication of graphs and international comparisons,” he wrote. “Bids that are successful will usually involve quite a powerful political threat for HMT and its masters. But year on year, it’s not much more than: ‘Ah, gwan, gwan, gwan. We really really need it!’”
Quite so. The tragedy is that the Tories fell for these tactics every single time. Real terms health funding is up 37 per cent since 2010, and the UK now spends more on health than almost any other country in Europe but with some of the worst results.
Every time the Tories have ended up in a pickle – be it austerity, Brexit or Covid – they have thrown money at the NHS. “You’ve had no increase in demand in hospital care, but a 19 per cent increase in resources,” said Corrigan in a podcast last month ago. “Now, that’s weird.”
Just as Labour tested borrow-and-spend economic theories to destruction in the 1970s, the Tories have shown what disaster lies in thinking that cash helps an unreformed NHS.
“If the answer to cutting waiting lists was simply more staff, it has to be said that we have tried this recently,” Corrigan recently said. “It’s only reform, rather than more money, that solves the NHS crisis.” If Tory Cabinet members had spoken with such candour, we might have made some progress.
So what might be to come next? The NHS is split into trusts – 229 of them – and Corrigan has pointed out the scandalous regional variation. If good trusts can do five hip replacements for the price it takes badly run trusts to do one, Corrigan points out, the scandal is not just waste but that so so many are waiting needlessly. Streeting wants to incentivise the best ones to keep at it, with more freedom. The worst trusts can expect very tough love.
Intriguingly, Streeting talks about the NHS as a back-to-work service. Rather than demand money from the Treasury, he said, his NHS will “deliver billions of pounds in growth” by reducing the almost three-million-long queue of those off work because of long-term sickness.
This nods to another Corrigan idea: that the NHS could get paid when “the person gets the job”. For example, if the NHS treats a patient who has been off work with anxiety or depression, the payment would come once he’s safely back at work.
Corrigan is no closet Tory. He’s an ex-Communist, but they often make the best market radicals once they have been mugged by reality. He points out that high taxes deter surgeons from taking extra shifts. He even has a theory that throwing money at an unreformed NHS is a trait of Right-wing populists (he tends to see Tories through this prism) because they blindly seek voter applause.
You can see here the beginnings of a Left-wing argument for NHS reform: that the Brexit boys splurged. It takes Labour to care enough to restructure.
That narrative may come, but it isn’t ready yet. Streeting’s immediate problem is belonging to a party that shrieks “privatisation!” every time anyone wants to change anything. Keir Starmer is, unfortunately, a case in point: he likes to recall how his mother once made him promise that he’d never let his dad go private. But if the NHS pays for a Bupa operation, is it private? Would paying for that care be such a blow to the welfare of the working class?
All this may come to nothing. Starmer may panic. Tony Blair, let’s not forget, asked the late Frank Field to “think the unthinkable” on welfare – then fired him when he did it.
But Starmer has promised to stick by Streeting when (and it will be when) the BMA and other unions try to destroy him. There’s an obvious advantage in reforming early, while his political capital is too high. A party of 411 Labour MPs flush with the thrill of success is unlikely to turn mutinous within the first year.
Machiavelli’s Prince, Corrigan once wrote, is full of “ big themes for NHS reform” – mainly how mankind “does not truly believe in anything new until they actually have experience of it”.
So the thanks, if it comes, will only be when a new NHS system has been running for some time. If Streeting and Starmer want any chance of that happening before the next election, they have no time to waste now. DT.
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