Streeting’s election encapsulates Labour MPs’ dilemma

Pulse editor Jaimie Kaffash’s take on Labour’s victory and the consequences for general practice

This was one of the most underwhelming election campaigns I can remember, but it has left us with a fascinating result that has several policy implications – no more so than in general practice.

Of course, all the headlines are about Labour’s success, and the size of the majority. But what makes this result so interesting is that this a majority unlike any other I can remember. Because while the new Government has the seats in Parliament to do what it likes, the shallowness of the victory severely hampers them.

If you indulge me putting my Politics degree to use (which I obtained a mere 23 years ago), this is very unlike 1997, where we last saw such a big Labour majority. Back then, Tony Blair’s new government not only had a huge majority in Parliament, but most of their MPs were pretty safe within their seats because they were able to retain their traditional support and also attract swing voters. The majority in Parliament, but also the nature of MPs’ constituency support, gave the Blair government the chance to do more or less what it liked.

That is not what happened yesterday. Labour’s vote share barely increased on 2019. Its biggest wins were in Scotland – where, of course, it doesn’t set health policy. The Labour majority was almost solely due to the decimation of the Conservatives vote, with Reform helping to split the vote. Meanwhile, Labour lost a lot of its core support to the LibDems, Greens, independents and in some cases Reform – indeed its vote share went down in its traditional strongholds of London and the North West of England. It replaced these voters with other disillusioned Conservative voters.

So what does this mean? If you’re still reading, it means you did indeed indulge me, so thank you for that. But it also means that for many individual Labour MPs, their majorities are precarious, and they can’t rely on their core support to fall back on. So they may have a dilemma – do they try and appeal to traditional Labour supporters (which may be at odds with the new Government) or do they consolidate the support from these floating voters – which will rely on things actually getting better in the next five years?    

I hear you asking what all this has to do with GPs and health policy. Well, what makes this so fascinating, is that no MP in the country encapsulates this dilemma as much as the new health secretary. Wes Streeting won his constituency by the barest of margins – just 500 votes. Quite clearly, this was mainly due to Gaza, and a popular opponent who ran on this ticket.

But Mr Streeting’s willingness to embrace private sector support throughout the campaign, and to write in The Sun about the ‘middle class lefties’ who opposed its use, probably didn’t help much in his London constituency that traditionally has a lot of ‘lefties’ (from not only the middle, but also the working classes). He may be celebrating today, but he will have an eye on 2029.

In this case, what can we expect from Mr Streeting? In my opinion, he has two choices. First, he can tow the party line, and look to consolidate his new support. Labour’s pitch was that the Tories were incompetent, and this was their main problem – there was nothing majorly wrong with their approach to taxation and spending. There is no evidence we will see an injection of spending into the NHS and general practice from the new Government. Improvements will come about through smarter use of the private sector, and reforming the GP contract with more or less the same levels of funding.

But his new constituency support – which is dependent on showing competence – will stick with him only if this approach does bring about noticeable improvement. Personally, I think improvement without more funding is impossible, and will therefore guarantee Mr Streeting will lose his seat at the next election.  

So his other option is to push for more funding for the NHS – even if it goes against the ‘sensible’ approach to public spending seemingly favoured by the Prime Minister and the Chancellor. This way, there are two ways for him to keep his seat in five years. First, by this funding bringing about an actual noticeable improvement in the NHS, with more GPs resulting in easier access for patients, shorter waiting times for secondary care services and better outcomes (all of which will still be hard with more funding, but impossible without it). This would also give him national appeal, and help him in his quest to one day be Prime Minister.

But the second way this approach could help him keep his seat is that by pushing for more NHS spending – and vocally doing so – he is far more likely to win back core Labour support within his own constituency. By displaying traditional Labour principles to adequately fund the NHS, his constituents will more likely give him time to show noticeable improvement.

This is a dilemma that will affect a number of Labour MPs who want to retain their seat post-2029. In my opinion, it is a positive thing that the health secretary is one of them. 

Jaimie Kaffash is editor of Pulse. Follow him on X (formerly Twitter) @jkaffash or email him at editor@pulsetoday.co.uk