It’s risky territory to march into, given the sensitivities, but he is doing so because the scale, reach and popularity of the NHS is so great that failure to shepherd it successfully would threaten his entire Government.
It was striking that the Labour Party itself went so far as to describe the NHS as “broken” in 2024, on the campaign trail and after the general election.
But it was also about laying a rhetorical case for reform. Mending something necessarily requires an acknowledgment that it is in some way malfunctioning.
Speaking to an audience of NHS staff, he warned that “productivity can’t bump along 11 per cent lower than it was before the pandemic. Working people can’t be expected to subsidise the current level of care with ever rising taxes”, and even raised the fear that without “top to bottom” reform, the health service would “become the national money pit”.
With a budget approaching £200bn, getting less for each pound you spend causes problems on multiple fronts. Though he didn’t say it in so many words, by implication, failure to address this would not only let down patients, but it would also threaten other public services by consuming an ever larger share of spending.
They would be accused of insulting NHS staff, of talking down the health service, and of doing so in order to pursue some nefarious, albeit incoherent, plot to sell the NHS to Donald Trump, Vladimir Putin or maybe Elon Musk, the bogeyman of the hour.
Starmer is powerful enough to reform social care - he's choosing not to
Read MoreBut it’s more than that: while Conservatives accurately argue that they have safely overseen the health service for the majority of its history, the fact remains that it is still a weak spot for them reputationally. Meanwhile, Labour can – and regularly does – lay claim to founding it in the first place.
But that head start does not make him immune from opposition. The fear-mongering which has tarred “reform” itself as a dirty word was built up over many years, and will not vanish overnight just because the speaker stands in front of a red backdrop instead of a blue one.
The Prime Minister evidently knows there will be battles ahead: “I know some people won’t like this, but I make no apologies. Change is urgent. I’m not interested in putting ideology before patients and I’m not interested in moving at the pace of excuses.”
It is revealing that his goal now is to “unite the NHS behind a plan for reform”. It will not always be possible to serve patients and satisfy unions – and the government and health service exist for the former, not the latter.
Mark Wallace is Chief Executive of Total Politics Group
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