Two rising Labour stars and the pursuit of dual goals of health and wealth

During the election campaign , a poll by More in Common found that the biggest issue for voters was the NHS . Luke Tryl of More in Common says: “I think the die was already cast but for a reason that has been too underplayed – the NHS. More than twice as many people select it as their number one concern as immigration .” That should not be a surprise. In UK political polls, two issues usually dominate: NHS and the economy . Of those two, the health service is way ahead. What happened this year is that the Tories took their eye off the ball and allowed themselves to be hijacked by the agenda of Nigel Farage and Reform, which put immigration at the top, Mr Tryl suggests. Isaac Levido, the Tories’ election strategist, warned as much. In the second week of December 2022, with Rishi Sunak’s reign just six weeks old, at a private session at Chequers, Mr Levido told senior Conservatives to focus on the economy and NHS waiting lists . Third was people crossing the Channel in small boats . That advice was forgotten as Mr Sunak made flights of illegal immigrants to Rwanda a personal issue, involving himself in rows with the likes of Suella Braverman and losing in the courts. NHS and the economy. It always is. Labour knows this. Keir Starmer and his colleagues are aware that while they have a huge majority, the electorate can easily turn. Unless Labour is seen to make good progress on the NHS and can show it knows how to manage and grow the economy, the pendulum could swing back. By definition, those who delivered Labour’s victory in places that have never seen a Labour MP do not hold any deep-seated loyalty to Mr Starmer and his party. Which is why the performances of two of Labour’s biggest hitters, Rachel Reeves as Chancellor and Wes Streeting as Health Secretary, are critical. They’re equally ambitious. There’s little doubt that if something befell Mr Starmer, they would be vying to succeed him. Yet they’ve also got to work together, to find a way of producing the reforms the NHS requires while not busting the public finances as a result. What this makes for is a tension at the heart of government. Within hours of taking office, Mr Streeting was moving to end the junior doctors’ pay dispute. With what, though? A mixture of ideology and lack of cash saw the Tories dig their heels in; along comes Mr Streeting and a long-running sore is seemingly set to end. But what then, what if making concessions to the junior doctors gives a cue to other sets of public and NHS workers to follow suit? Ms Reeves won’t thank him for that. He’s also promising billions to ease GP appointments’ lists. Apparently, Mr Streeting believes he can find the money from hospitals. Just like that. It’s hard to believe, given the state of them and the pressure on beds and length of the wait for consultations and surgery. By taking cash from one side and giving it to the other, Mr Streeting may be storing up problems. Covid has not gone away, once we’re through the summer, attention will turn to the coming winter and how that is likely to affect the NHS. And he’s also got social care and the management of the infirm and elderly to contend with. Welcome to the real world, Secretary of State. Days into his new job and Mr Streeting has called the NHS "broken". So, he is not shirking from the task, he’s not going to pretend it’s all rosy. The feeling is that he has a window in which to exact change. He will be able to use up Labour’s store of goodwill and drive through reform. Inevitably, however, making improvements, altering working patterns and targets, recasting the public-private model, will come at a financial cost. Requests for old, existing money are dealt with by the department; anything that requires ‘new’ money must be made to the Treasury. That is bound to put him on a collision course with Ms Reeves. A contrast is emerging. There is Mr Streeting promising to fix GPs; Ms Reeves, meanwhile, used her first speech since becoming Chancellor to warn that Labour was intent on reducing national debt, despite having been bequeathed “the worst of circumstances since the Second World War.” He’s merrily pledging to spend, spend, spend; she is downbeat. One of her first acts has been to order an emergency assessment of the government’s spending inheritance, for delivery before MPs break up for the summer break time. It’s expected to pave the way for likely tax increases in the autumn. It will also herald tough choices on spending. Ms Reeves is blaming the Tories for what lies ahead. “Our economy has been held back by decisions deferred and decisions ducked,” she said. “Political self-interest put ahead of the national interest. A government that put party first and country second. “We face the legacy of 14 years of chaos and economic irresponsibility. I am under no illusions about the scale of our inheritance. I will need to take difficult decisions as a result of the mess left by our predecessors.” Labour was not elected, however, to constantly poke the Tories. The country, as evidenced by the scale of the victory, is desperate for change – that’s real, tangible change, not a mere shift in manner and attitude. Expressing concern and saying all the right things will only get you so far; people want a government that delivers. If you’re Mr Streeting and you’re being denied funding, hearing it’s the fault of the Tories will only cut so much ice. He still wants the cash. That is down to Ms Reeves, not the previous regime. Ms Reeves v Mr Streeting promises to be fascinating. It’s a relationship that will determine the shape of Mr Starmer’s administration and ultimately, the outcome of the next election.