To galvanize the nation, Labour’s posable action figure Al Carns has made a video urging us all to “be ready for an emergency”, but he, too, is eerily silent on what exactly that means. The bathetic chasm between jumpy headlines and strangely repressed instructions — buy in a bit of bottled water and tinned food, write down a few phone numbers, order medication in good time — is also jarring. Should the National Grid fail, then so will every refrigeration unit, food production line, and water treatment plant in the country. The difference between dying of thirst immediately and doing so three days later seems somewhat academic; and the same goes for eking out small amounts of food and meds. Are we really supposed to be facing down the apocalypse with half a big shop each?

Some might prefer to take a leaf out of the grizzled North American handbook and get serious about survival. The internet is full of information for disaster preppers, as they are known, and bits of it already seem pertinent to British life. Start small by assembling what is known as a Get Home Bag, designed to help you bypass paralyzed transport systems during blackouts, and also for when you are stuck on Avanti. Next, graduate to a Bug Out Bag, useful for fleeing your house for 72 hours at short notice in order to go to a music festival. After that, though, it all gets complicated and expensive. The basic kit for civilizational collapse includes a renewable-powered generator, water filtration system, and waste disposal system; none of which is really practicable when you live in a small terraced house or flat. It is all slightly easier when you live on the prairie or in the desert, able to whip up a solar gravity shower or compostable toilet without needing planning permission first. 

Browsing websites for useful tips, it appears there are psychological pitfalls to avoid here as well as practical ones. A big one is not letting the whole prepping project take over your life; hard to do when the main motivator is cold sweat in the middle of night, and there is no upper limit to what counts as being adequately prepared. A different problem is when your partner is not quite as fixated on doomsday scenarios as you are. Some men online seem to long for global breakdown, just so they can justify all the money they have spent on methane-harvesting septic systems to their wives. 

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Resentment arrives from another direction in discussions about what the best attitude is to take to blindsided normies. Some imagine themselves as generously sharing their knowledge and resources during future disasters, but these tend to be in the minority. Having invested so much time and money in securing their own family’s future, most preppers insist no mercy will be shown to clueless panickers begging for shelter and spare tins of spam. They had so many chances to ready themselves for Armageddon, yet chose to go to Disneyland instead.

Take this line of thought only a little further, and you start picturing aggressive attempts by others to steal whatever it is you own. Indeed, the presumed covetousness of others puts a prepper of average sociability in a strange position: tempted to brag about the sheer scale of his root cellar on Facebook, while also being aware he might just as well be making an advert saying “free food here!”. The truly sagacious doomer would surely not bother to build or buy much himself, but simply keep a map of the most productive and least ferocious-looking local preppers handy for a rainy day.

For this sort of reason, most of what is loosely called “the prepper community” seems to spend a lot of time and money securing their set-ups from the predatory designs of fellow members. Alongside husbandry tips, their websites are also full of information about the best motion sensors and automatic weaponry to buy. The track from hobbyist to Hobbesian looks fairly short. One minute you are buying zucchini seeds, the next you are contemplating the ferocity of human nature and investing in camo and a crossbow.

When imported into Britain, such visions of rugged self-sufficiency look immediately comic: less John Rambo and more The Good Life. Faced with the prospect of intense competition for resources, plus the collapse of established order, there is not enough land here to avoid encountering hostile others altogether; and nor (thankfully) are we allowed to stockpile weaponry in preparation. If there had been a supply emergency in Surbiton, Margot and Jerry would presumably have cheerfully waltzed straight off with Tom and Barbara’s marrows.

Whatever the Government pretends, transplanted into our relatively small-scale, close-knit setting, the notion that a household could be “emergency ready” on its own is obviously fantastical. When it comes to national disasters, there can be no substitute for a shock-proofed state to manage the response. Slowly, the authorities do seem to be realizing this. Under Keir Starmer, Labour instigated a lot of programs in the name of increasing national “resilience”, though whether they work in practice remains to be seen. My own impression of key organizations such as the UK Resilience Academy and the Centre for Long-term Resilience suggests that far too many bureaucrats and effective altruists are leading the conversation, and not enough ex-military.

As the 2025 UK Government Resilience Action Plan correctly puts it, “building a truly resilient society requires a fundamental cultural shift”. The point applies as much to professional organizations as it does to individuals: lanyards and nice-sounding platitudes are not going to cut it in a genuinely dramatic crisis. But equally, we will need citizens with a strong sense of agency, who possess the skills and aptitudes helpful for negotiating energy- and screen-free zones. 

It is a shame, then, that so many of us are avoidant about leaving the house now, and horribly dependent on technology for things that we used to do ourselves; and that successive authorities have cheered this trend on. To take just one example: a society that prefers to deal with the obesity crisis by introducing highly complex international supply chains, rather than simply telling people to run about a bit, does not exactly inspire confidence that it will cope WTSHTF. 

There are accelerationist figures, both on Right and Left, who desire a world where our heads are always in clouds and vice versa. Goodbye, physical objects; hello, total tech dependence. The more we blindly go along with their superficially appealing program, the worse the shock of systemic failure is likely to be. As Thomas Hobbes once wrote, with his pen, human beings are “made fit for Society not by Nature, but by Education”. But do we want to educate people for the society where they have hoverboards and Meta glasses, or for the one where they contemplate eating their pets?

Until our politicians decide to prioritize a modicum of self-reliance, talk of emergency prep will continue to ring hollow. Even tinned goods are no use when nobody remembers how a can opener works. And if there really is limited time left before some amorphous entity attacks civilisation as we know it, we should probably use our remaining internet hours wisely, skip the Al Carns videos, and learn a few basic knots and self-defense moves instead.

Labour and the Conservatives have always taken very different approaches to the business of changes of leadership. Tories care mainly about electability. Margaret Thatcher’s ideological legacy was adored by many Tories — and indeed still is. When they knifed her in 1990, her Cabinet were more concerned that the electorate had fallen out of love with her. Tellingly, John Major’s turn at the helm didn’t herald a decisive shift in ideology; he was simply a more acceptable face of Thatcherism for the Nineties.

When Labour looks for a new leader, though, it inevitably becomes an internal referendum on the political direction of the party. That helps explain the violent swing, say, from the Bennite Jeremy Corbyn to the centrist Keir Starmer that left the Labour faithful gasping for breath. But despite the bloodshed, modern political parties are not versions of Terry Pratchett’s Assassins’ Guild, where advancement comes through the elimination of rivals. Michael Heseltine’s proclamation that “he who wields the knife never wears the crown” has proven to be remarkably reliable. Either way, Starmer’s position is not new — but you don’t get the impression he’s relying much on the lessons of history.

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Two years on from its famous landslide victory of 1945, Clement Attlee’s Labour government was already in bad shape. Chancellor Hugh Dalton was reportedly taking Benzedrine to keep going. Herbert Morrison, leader of the House of Commons, was recovering from a serious illness. Foreign Secretary Ernest Bevin was drifting between office and hospital. Churchill had described Attlee as “a modest man with much to be modest about” — but he was clearly easy to underestimate. When Attlee’s internal enemies decided to oust him in 1947, their leader Stafford Cripps left his fateful meeting with the PM having accepted a new position as the Minister for Economic Affairs — a position created especially for him. In keeping his enemy close, Attlee took a somewhat different approach to Starmer, who first refused to meet with Wes Streeting, only to frostily dispatch him after 17 minutes of conversation the next day.

Hugh Gaitskell succeeded Attlee as Labour leader in 1955 but never became prime minister, dying suddenly in 1963. Harold Wilson took over and won the general election the following year, but before long the rumblings in his party about his leadership became too loud to ignore. By the late-Sixties, the Home Secretary Roy Jenkins seemed the most obvious choice to replace him.

Starmer claims his political hero is Wilson; Streeting has declared himself a Labour revisionist in the ideological mode of Jenkins and Anthony Crosland, who argued for reducing inequality, improving opportunities and dispensing with socialist dogma. Jenkins was admired by almost everyone who mattered in late-Sixties Britain, intelligent journalists, broadcasters, civil servants, captains of industry, and had a coterie of well-heeled and glamorous mistresses. He looked and sounded like the future. Wilson looked like the present, stretching out to infinity.

All Jenkins had to do was pick his moment — and the aftermath of the disastrous local elections of 1968 would have been ideal. He was egged on by his enthusiastic supporters, the Friends of Roy, whom Gerald Kaufman compared to a group of schoolchildren with a crush on the hockey mistress. But to his eternal regret, Jenkins failed to act. He later admitted that successful prime ministers generally possess “a seam of utter ruthlessness”, and wondered if perhaps he lacked it. Elsewhere, he observed that if you fired a shot at your enemy, you had better make sure they ended up dead. This is a conundrum that Streeting must have grappled with himself in recent days. As for Wilson, still the greatest Houdini figure in modern British politics, he governed on and off until 1976, by which time he had moved from a modernist belief in the “white heat of technology” to being more of a national headmaster figure, permanently disappointed with everyone.

Still, worse than failing to act is sending your foot-soldiers over the top and then failing to follow them yourself, creating only bitterness and resentment. A prime example was James Purnell resigning from the Cabinet to trigger a coup against Gordon Brown, only to find that his ally David Miliband had bottled it and failed to follow through with his own resignation. Purnell left British politics soon after: the Labour Party is not kind to failed assassins.

And there is another danger that Jenkins, who was at Bletchley Park during the war, would have appreciated more than most. This is the concept of political game theory — specifically, the tragedy of the first mover whose act will always benefit the second mover. The first mover bears all the costs while exposing themselves to a counter-strike, neatly explaining Heseltine’s famous quip, which he learned the hard way in his own doomed attempt to replace Magaret Thatcher. So while Jenkins could have mortally wounded Wilson with a challenge, in doing so, he may have allowed one of his rivals — whether Denis Healey, Jim Callaghan or Michael Foot — to take the prize and unite the party behind them. This was something the wily Wilson also knew, which was why he surrounded himself with a collection of powerful lieutenants, each the commandant of a different Labour faction. If one faction thought the other faction might triumph, that persuaded them to back the status quo instead. Another reason why David Miliband didn’t challenge Brown was because he thought the party might turn to Alan Johnson if Brown went, and not him.

A successful challenger must perform three functions at once. They must reassure markets and elites; they must excite activists and MPs; and they must appear plausible to ordinary voters. That combination is exceptionally rare. Tony Blair certainly managed it. Jenkins only managed two out of three (he was probably too patrician to appeal to regular voters, especially as the Sixties started swinging). And Streeting perhaps manages two or even three as well. He is one of the few figures in the current Cabinet whom Labour MPs can plausibly imagine facing Nigel Farage across a television studio without visibly shrinking. He is fluent, a self-declared revisionist, emotionally direct in the modern political style with a powerful backstory. But Labour history is not especially kind to obvious heirs, even when they look much more likely to be successful. The party distrusts naked ambition on almost theological grounds because surely true Left-wingers would want to put the common good first.

So, a politician seeking the leadership must appear ready without appearing too eager. The advice that Brown always tried to give himself was to do a good job, and not look like he was actively plotting against Blair, simply being available when a vacancy arose. A wise dictum — albeit one that fell apart as his desire to enter No. 10 rose to almost pathological levels. In 2006, his ally Tom Watson launched the so-called “curry house” plot against Blair. However, in what became a running joke in Westminster, the conspirators’ attempts to keep the meeting secret spectacularly failed after they signed the restaurant’s visitors’ book, which was then leaked to the BBC.

Brown finally inherited the premiership in June 2007, after years of subterranean warfare — though not before Labour briefly descended into the sort of factional farce that only Labour can produce. Michael Meacher and John McDonnell maneuvered against Brown simultaneously, prompting one weary figure to remark that “the left hand doesn’t know what the far-left hand is doing”. But even that was not as peculiar as Barry Gardiner flying home from Dubai to run for leader, only to throw in the towel upon landing.

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Coups fail when ministers hesitate, factions freelance, allies leak against one another, and everybody assumes someone else has counted the numbers properly. Most failed Labour coups begin in perfect agreement that the party leader is intolerable — only to end with catastrophic disagreement about who should replace him. Starmer’s saving grace is that those calling for his replacement have yet to choose their champion. In the coming days Angela Rayner, Ed Miliband and Andy Burnham might all join the contest — assuming Burnham can find a seat in time. If Starmer chooses to stay and fight, he may ultimately survive a bruising leadership challenge simply because his enemies can’t shape their forces into a single fatal implement.

As the clouds of dissatisfaction swirl about him, Starmer seemingly faces a choice. He could adopt a wait-and-see approach; or he could use Attlee’s method of coopting rivals into allies. Yet, instead, his experience as a former prosecutor seems to be governing his actions. He blocked Burnham from standing in Gorton and Denton (even turning up to vote against in person); suspended the whip from MPs who sided with the SNP over the two-child benefit cap; and insisted that Rayner resign over her tax problems. Now that those seem to be resolved in any case, wouldn’t it have been better to have kept her inside the tent? Lawyer first, politician second, this purge-and-eliminate approach looks more like something out of the Neil Kinnock playbook than anything else.

Through the Eighties, Kinnock played an enormously important part in preparing Labour for a return to power. That meant he had to be ruthless in purging the hard-Left — as in his landmark 1985 conference speech, where he railed against the hard-Left militant faction in Liverpool. The rest of the party knew that the radicals were harming their electoral chances, and so were prepared to back Kinnock all the way.

Starmer has followed the Kinnock approach, albeit without the conditions to make it work. Notably, he lacks an external threat that the grassroots feel they need protecting from. The Conservatives have collapsed, and though the Greens and Reform are both a source of deep anxiety, they’ve yet to prove themselves as potent parliamentary forces. Besides, whoever ends up leading the party three months from now, the next election is still years away. The purge-and-eliminate strategy hardly seems wise in the circumstances. Maybe Heseltine’s dictum will need to be rewritten for Starmer. The leader who wields the knife loses the crown.

Every winter, emergency departments prepare for the familiar seasonal surge. We have the same warnings, the same predictable rise in admissions. This year, in my department, a growing number of patients are dying before they are even admitted onto a ward. Ailing patients lie on corridors for hours and often days, waiting for beds that simply do not exist. The data confirms what clinicians see. Flu admissions have spiked by 55% in just seven days to an average of 2,660 patients a day — the highest ever recorded for this time of year. Norovirus cases alone have jumped 35% week-on-week, filling hundreds of beds that we desperately need. Meanwhile, the overall waiting list has crept up again to 7.4 million.

Nowhere is this dystopia more visible than at Leicester Royal Infirmary — not far from where I work — which has become ground zero for the crisis. In a single day last week, 932 patients streamed through its doors — an 8% increase from the previous year. The human cost of this overcrowding is staggering: one patient endured an agonizing 106-hour wait for a bed, while another languished for 34 hours. The hospital has had to convert prefabricated structures into permanent wards just to house the overflow. When you have children’s waiting areas filling up by late afternoon and “patients in every cubicle”, as consultants there have reported, you know the system is broken.

Seasonally, it’s the toxic cocktail of the flu, Covid, RSV (Respiratory Syncytial Virus) and Norovirus commonly known as the “quademic” that’s driving this epidemic. However, to even call it a “crisis” would imply a degree of surprise — and that is the lie at the heart of this disaster. We are witnessing what I can only describe as a total disconnect between our key decision-makers, the chronically ill and the clinicians tasked with saving them.

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Everybody knew this quademic was coming. Not least Wes Streeting. Any competent leader — whether a military general or a health secretary — understands that the role requires foresight, planning and strategizing. We saw the bed pressures as far back as August. We knew that as soon as millions of children returned to their schools in September, the weather changed, the cold and damp set in, that all four virus vectors would align.

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As the old saying goes, “a fish rots from the head”. The Health Secretary seems more preoccupied with the optics of reforming the NHS and going toe to toe with the BMA and junior doctors. His political maneuverings are becoming a distraction: he’s patently more focused on the path to Number 10 than the clinical catastrophe unfolding.

While the crisis continues to worsen, Streeting has admitted in an interview that he’s “pretty frustrated” —  but he was referring to his own party’s polling numbers, not the crisis in the NHS. He bemoaned Labour’s “practical, technocratic approach” for making the government look like a “maintenance department for the country”, worrying that voters might switch to a “cheaper maintenance company”. It’s as if Streeting’s team is continually briefing the media with a key message: “it’s not Wes’s fault.” Rather than preparing the nation for the worst, Streeting’s spin doctors are prepping the public with doublespeak, rebranding the flu as “superflu”. He’d have been better off listening to clinical advisers who have warned him for months about the scale of the problem we face. Instead he chose Orwellian trickery, a futile PR-driven battle with an intransigent BMA or simply disappearing when the going gets tough.

His lack of preparedness makes the fictional ineptitude of Yes Minister’s Jim Hacker look like the work of a neurosurgeon. It is a profound failure of strategy where the leadership is reactive rather than preemptive. Streeting has waited until the trolleys are backed up to the sliding doors before feigning shock-horror, abdicating responsibility and blaming the situation on yet another “unprecedented” set of circumstances.

The tragedy is that the pandemic should have taught us one simple lesson: we cannot afford to be flat-footed in the face of a crisis. We knew the variants were coming. We knew immunity gaps existed. And we know what the fallout will be. Yet, a clear and present plan to tackle any of this is nowhere to be found.

So, when you read about the “winter crisis” in the coming weeks, spare a thought for those worst affected. The elderly, the sick and the vulnerable I will be treating over the holidays are once again collateral damage in a political failure dressed up as an inevitability. Do not accept the narrative that this is an unavoidable act of nature. This is a man-made disaster, fueled by complacency and a political and bureaucratic class that has forgotten that their primary job is not to massage news cycles and win elections but to keep the public alive and well.

Just over a year ago, Mohamad, smartly turned out tonight in a brown wool blazer and flared trousers, ran Labour’s Wes Streeting to within 530 votes at the general election with a pitch heavy on his alleged complicity in Israel’s war on Gaza. The British-Palestinian campaigner was just 24 at the time. “There is a growing appetite to move away from this two-party system,” she told ITV afterwards. “We are not going away.”

In person, Mohamad radiates youthful sincerity. If there were a vibes-based spectrum of Britain’s pro-Palestine independents, it would stretch from Birmingham’s brash, Prada-wearing Akhmed Yakoob at one end to the warm and polite Mohamad at the other. When an elderly couple approach her to say they wished she had managed to win, she smiles broadly and commiserates with them. 

Thanks to these personal qualities — and Labour’s polling nosedive — Mohamad’s supporters remain convinced they can oust Streeting next time. For the Health Secretary, who has never concealed his ambition to become the Prime Minister one day, this is a problem. He insists publicly he will not make a chicken run to a safer seat. But the shifting demographic tides in Ilford that allowed him to seize this constituency from the Conservatives a decade ago now threaten to sink him.

On stage, Mohamad and Ali conduct a nuanced discussion of the British political scene to the right of the Tories, which is undergoing a process of ideological foment at least as turbulent as that taking place on the Left in Ilford. He clarifies the difference between Tommy Robinson, an Israel supporter, and Nick Griffin, an opponent. She explains that she would like to host events on Fridays, but won’t in order that Jewish supporters are able to attend.

When the conversation is opened up to the audience, however, it takes on a harsher tone. An elderly gentleman in a black baseball cap stands up to say he used to be a Labour councillor but that he could now kill Keir Starmer. A young man haltingly asks for advice on how he can avoid befriending extremists. Old men ramble on about Winston Churchill and the impending collapse of the West and how useful idiots are secretly being paid to attend far-Right protests. 

For many Muslims and others on the Left, Starmer’s timidity on Gaza has marked a turning point. Labour’s share of the Muslim vote fell by almost 20% at the last election. But with the failure of Your Party to seize on this momentum, it appears that at least for now the opposition will remain local. 

In Ilford — which sits within the London Borough of Redbridge — this has been driven by a remarkable demographic transition over the last 20 years. When the 2001 census was taken, a majority of its inhabitants were Christians and less than 12% were Muslim. Three quarters had been born in England and 64% were white. By 2021, however, Muslims were the single largest religious group and Asians had risen from a quarter to 47% of the population; 45% of residents had been born outside England. 

While many people I spoke to in Ilford said the area retained a strong sense of community, some older white inhabitants feel they have been left adrift. Standing at a junction near Streeting’s office, Martin, a retired loss adjuster who has lived in Ilford for decades, told me the transformation had been “massive and fast”. 

He is not racially prejudiced, he insisted unprompted, a woolen hat pulled down towards his eyes — but he is concerned that migrants and their descendants living in Redbridge have not integrated. “They keep themselves to themselves,” he said. “When I walk past women on the street they look down.” While at his GP’s practice recently, he had spoken to a young Muslim lady who told him her life was controlled by her father, who acted as if they were still living in Pakistan. Politicians just did not seem to understand what was happening to his community, he said.

Martin’s friends have gradually moved out into Essex to get away. Some are now in Ongar (95% white) and others are in Shenfield (88% white). He and his wife plan to stay, though. Their road remains ethnically mixed and their neighbors are friendly. But they are less comfortable than they used to be.

Fred, who also did not wish to provide his surname, said he thought Ilford was improving. They had at least got rid of the beggars. His voice shaking with age, he said he had once been homeless himself, but he had never begged. He just played music from a speaker and people tossed him coins. He didn’t ask for them. So when he sees beggars now, he does this to them, he said, shoving two fingers up at my face. And when he sees asylum seekers who have washed up on small boats getting housing it makes him angry with the politicians who never helped him.

The Asian families who sparked this demographic shift by moving to Ilford were following a well-worn groove. For decades, white British and Jewish eastenders made the same journey up the Central Line to secure gardens and larger houses. Today, Ilford North still bears the marks of an upwardly mobile suburb: pebbledash facades replaced by creamy render; windowsills and gutters accented black; flash cars hidden under gray sheeting. 

When Vaseem Ahmed’s parents moved to Britain from Pakistan in the Sixties, they settled in Walthamstow, where he was raised. But by the time his children were preparing for their GCSEs, he wanted to live somewhere with better schools, so he followed many of his friends and headed out to Ilford. Now, he told me over coffee in Naan Staap, a brightly decorated Indian street food cafe above the basement in which Mohamad’s supporters had met the month before, he could not afford to move back.

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Like his parents, Ahmed had always supported the Labour party. He knew Streeting well, he claimed, and had fought to get him elected in 2015. But in the wake of October 7, when Starmer said Israel had the right to cut off water and power to Gaza, he rejected the party and helped to found the Redbridge Community Action Group (RCAG). It was this organisation that would later select Mohamad to stand against Streeting. 

Ahmed, who has neat salt and pepper hair and a beard, is now the leader of the party that may end up running his council after next year’s local elections: Redbridge & Ilford Independents. Gaza was, he said, the “oomph” that pushed them to act. But Muslim voters have been trending away from the Labour party for a long time. “Labour have been in power for a decade [on Redbridge Council] now and the area’s gone down, council taxes are going up,” he said. “People are fed up.”

Aside from Palestine, the focus is on local issues and, in that respect, the independents differ little from the revolts that bubble up in comparatively affluent suburbs anywhere in the country. The party would like to prevent the construction of new housing and fear that tower blocks will blight the area. They believe the council is wasting taxpayers’ money by building a lido in a local park. They resent flytippers and do not want Ilford to become a “ghetto” like Newham.

The Muslim community breaking with their traditional voting habits was less a sign of insularity, he said, than of growing engagement with their country. “People like my parents, when they first come over, they would have voted Labour regardless, yeah? It was the thing to do because they’re much more sympathetic when it comes to things like immigration.”

While his father was a bus driver, Ahmed is a recruitment consultant. His brother was a major in the British Army. Several of his siblings have degrees. “With education comes awareness as well… You’re a bit more clued-up and you think, ‘I’m not just gonna vote for the same people that my parents voted for, just because it’s Labour and because it’s red.’ You start then looking into things and you think, ‘Well, hold on. What’s the benefit for me, and my family, my community, of voting for these guys, yeah?’” His parents’ generation had built the first wave of infrastructure for the British Muslim community: halal butchers, mosques, Islamic schools. His contribution will be building a political party.

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For many voters in Ilford, such a development will come as a welcome step. Meera, out pushing her newborn baby on a bright December morning, said she felt embarrassed to have voted for Streeting at the last election. She had always supported Labour and wished to block the Tories from power, but was now disgusted with his stance on Palestine. Her local area, meanwhile, was beginning to deteriorate thanks to the cost-of-living crisis and years of austerity. “I wish we had an MP in the area we could respect,” she said. At the next election she will likely vote for Mohamad. 

In March, the Redbridge & Ilford Independents scored a major victory when they won a council by-election in Mayfield ward, formerly solidly Labour. The poll was called when Jas Athwal, the MP for Ilford South and a local party stalwart, resigned his council seat over revelations that he had been renting out flats with black mold and ant infestations.

Now, the seat is represented by Noor Jahan Begum, who was also selected by RCAG to stand against Athwal at the last general election. Almost as soon as she won, however, she was accused of impropriety. She had handed out leaflets that claimed Tanweer Khan, a Labour representative, did not wish to divest the council’s pension fund from Israel — a move that he was unable to carry out because of his fiduciary duties. Khan claimed that Begum had been part of a “targeted campaign” to “stalk, harass and endanger him as a sitting councillor”. Begum in turn claimed Khan had harassed her in the street, though an investigation found that her claims were malicious and intended to smear. 

Until recently, Khan told me, local politics in the area had never descended to this level. For the first time in his life he had started to feel “genuinely unsafe” in his own neighborhood. He told the investigation that it would be hard to get his daughters married if their father were branded a Zionist in the community. One point on which Begum and Khan both agreed in their testimony to the inquiry was that this might only be the start. They both feared that next year’s local elections could spark a further increase in hostility.

Despite these rising tensions, Streeting remains confident in public he can win. Speaking recently to the Spectator, he insisted he would not dash to a safer seat. Ilford North is his home. There is also no question that Streeting commands a level of personal support that is uncommon. A focus group conducted by Lord Ashcroft in Ilford last month found that several Labour voters felt an imperative to stick by him. One dubbed him a “really, really decent guy”.

When I spoke to a source close to the Health Secretary, they insisted there was still a path to victory, but they could not express much confidence about its chances of succeeding. If an independent candidate stood against him, they said, Left-wing voters might tack behind their MP to prevent a split that would let in Reform. This would mirror what Labour hopes people will do on a national level when faced with the prospect of a Nigel Farage-led government. 

What’s more, they said, there is a belief that Ilford North has more people opposed to the pro-Palestine independents than in support of them. Streeting has not given up on Reform-curious voters, either — and there is a hope that many on the Right will eventually consolidate behind him. When I related this theory to one local Tory voter, however, he simply laughed. He had no interest in saving Streeting. He knew the future was Leanne Mohamad. 

Over the past decade, three Conservative prime ministers have been forced from office by their own colleagues. In contrast, in the post-war period, no Labour leader has been ejected. Tony Blair did step down in 2007, but by that time he had been leader for 13 years and prime minister for 10 of them. He himself admitted people “get tired of the same face” after a decade. “It’s long enough,” he conceded.

Certainly, no one was talking about getting rid of Tony Blair after just one year in office. On the first anniversary of his premiership, in 1998, Blair’s approval rating was an astonishing 72%. And his party had a 29-point lead over the Tories. The mood in the parliamentary party was understandably euphoric. Reading West MP Martin Slater said, “Tony Blair has told us we must not gloat, but we can’t let [the anniversary of the election] go uncelebrated”.

There was little gloating going on last week in Westminster — at least not among Labour MPs — as Keir Starmer marked his one-year anniversary with an approval rating of 23%. For a prime minister who kicked off at 60%, this is cataclysmic. It’s unlikely his leadership will end in quietly dignified retirement.

One year in, seven-in-10 voters think the Labour government is at least as chaotic as its Conservative predecessor. The welfare debacle didn’t disabuse them of this notion, as Starmer’s complete lack of authority was exposed. And we’ve never watched a Chancellor weeping beside their PM at PMQs before.

The Prime Minister dismissed the welfare rebels as “noises off”, but these noises are now turning into talk of a leadership challenge. As ever, the usual suspects have put their head above the parapet. John McDonnell, whom Keir Starmer kicked out of the party last year for opposing the two-child benefit cap, immediately popped up to call outright for the Labour movement to “take back control” of the party. But, behind the scenes, speculation over Starmer’s future is mounting. Last week, he was asked by Kemi Badenoch whether Rachel Reeves would be Chancellor by the next election. But perhaps the more pertinent question is: will he be Prime Minister?

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What Starmer could learn from Blair

By Richard Johnson

It’s not as easy as it used to be to topple a Labour leader. Until 1981, the leader was elected annually by the Parliamentary Labour Party. It would take just two MPs — a proposer and a seconder — to force a leadership election. In spite of the technical ease in forcing a leadership challenge, they almost never happened. In the post-war period, just one leader — Hugh Gaitskell — was challenged, and he saw off his opponents with ease.

The stability of the party leadership was partly due to Labour leaders understanding the fragility of their own position, and the fractious nature of their party. They had come up through the Labour movement, and they knew that the party was really a coalition of diverse interests and perspectives. They had to work hard to ensure that they could sustain wide support. Cabinets and Shadow Cabinets included members from across the wide spectrum of the political Left. As Harold Wilson remarked, he came from the Left of the party, but he recognised that it also needed a Right-wing to fly.

Even after the rules were changed in the Eighties to transfer part of the decision to party conference and then again in the Nineties to ordinary members, leaders recognised that they were holding together a coalition. They needed to show love — or at least respect — to the different elements of the party. Otherwise, resentment would grow into something potentially explosive. That is why even Tony Blair made a point of meeting with members of the Left-wing socialist Campaign Group when he was party leader.

Keir Starmer, though, has a different approach. He has adopted perhaps the most presidential style of any Labour leader. All authority flows down from the leader, not up from the party. Labour has never quite had a leader like him, one so aloof from the party’s internal apparatus, contemptuous of its pluralism, and singularly unpopular with the public.

After first using the votes of the Left and soft Left to elect him leader in 2020, Starmer then turned his back on them and handed control of the party to the Right, the old Blairite wing now itching for revenge after what they regarded as the ignominy of the five-year Corbyn leadership.

With Starmer’s blessing, the Right took control of the National Executive Committee, and were exceptionally successful in controlling parliamentary selections, with a disregard for internal party democracy unseen even in the heyday of New Labour. Potential candidates deemed to be Corbyn-curious were sifted out, even if it cost Labour seats, as it clearly did in Islington North and Chingford. Left-wing incumbents were deselected. Some Right-leaning NEC members then parachuted themselves into safe seats ahead of the election. Then, after the election, Starmer expelled remaining Left-wing MPs within weeks of taking office.

This “presidential” governing style isn’t without risks. As Juan Linz laid out in his seminal essay, “Perils of Presidentialism”, such systems tended to be less stable than a parliamentary one because they entail a “winner takes all” politics, or, to put it more bluntly, a “loser gets nothing” dynamic — something which ultimately encourages revolution.

Starmer, more than any other Labour leader, has taken this “winner takes all” approach to his leadership. He set out to bury all the remnants of the ancien régime both in policy and personality, abandoning the old manifesto’s promises and expelling his predecessor from the party. Worse, Starmer had no mandate to conduct this purge. He wasn’t elected leader to hammer the Left: on the contrary, he had promised continuity with the policies of the Corbyn years, but then spent his time as leader repudiating them.

Initially, this didn’t seem to matter. Once the Conservatives ditched Boris Johnson in a staggering act of political self-harm, Labour’s poll lead was unassailable. Starmer’s leadership, insipid and uninspiring as it was, became self-justified merely by dint of the fact that Labour was winning. But now Labour is in the mid-20s in the polls, Reform is in first place and Nigel Farage is on the verge of measuring up the curtains in No. 10. Most Labour MPs could be wiped out. The debacle of the 2019 result, so trumpeted by the Right of the party as evidence of the Left’s electoral toxicity, could seem like a happy memory.

Now, the carrot of strong poll numbers and the stick of fierce discipline have rotted away. Backbench MPs no longer see Starmer as a vote winner. And after U-turns on winter fuel, grooming gangs, and disability benefits, he clearly doesn’t frighten them either.

But Starmer has made it harder for them to get rid of him. As leader of the opposition, he quietly made a couple of modifications to the rules of succession. There is no vote of confidence, like there is with the Tories. Instead, an MP merely needs to put up a challenge. Starmer, though, raised the threshold for nominations from 10% to 20% of the Parliamentary Labour Party. He has also limited the franchise to party members and members in affiliated trade unions. Non-members who were given a vote under Ed Miliband, on condition of paying a nominal fee, have been taken out of the process. Additionally, the Labour rule book now specifies that challenges are permissible only “prior to the annual session of Party conference”.

These rule changes may be beneficial to Starmer, but they are by no means bulletproof. It seems likely to me that if Starmer is forced to defend his leadership before ordinary party members, he is toast. As someone who speaks to many fellow party members from across Labour, it’s hard to find cheerleaders for the PM.

As a result, the Left of the party hates him, and the soft Left — where the bulk of the membership is — feel deeply disappointed. Those on the Right of the party have regarded Starmer as a useful vehicle for their path to power, but they have never seen him as one of their own. There are, simply put, no Starmerites in Labour.

All it might take to remove Starmer, then, is one Labour MP to gather nominations from 20% of their colleagues. And every wing of the party has a reason to want him gone.

From the Right, the motives are a mix of ambition (Starmer was useful for them; they have no core loyalty to him; he is now dispensable) and self-preservation (he’s dragging the party down and threatening its electoral prospects). From the soft Left, the reasons are a combination of ambition, self-preservation, and policy disappointment. From the Left (such as it is), it is hatred for his betrayal. The question is, who would dare make the first move?

Moving too early isn’t without risk. If a Cabinet minister tried and failed to unseat Starmer, there would be repercussions: banishment, surely, to the backbenches.

Yet for some ambitious MPs, there are good reasons to move early. Wes Streeting is one of the Cabinet’s most effective communicators. He is the darling of the party “Blairites” and is clearly very ambitious. Moreover, he holds his Ilford North seat with a tiny majority and might lose it at the next election. It could be now or never. He equally hamstrung, though, by this association with the “Blairites”, which puts him ideologically out-of-step with the membership. They have rejected Right-leaning candidates in every leadership election for the past decade.

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But, if Streeting managed to force a challenge, the element of surprise might enhance his chances in a members’ ballot. Fortune favors the brave. And such is the level of despair currently that even Left-wing members have told me they’d vote for Streeting if it meant getting rid of Starmer.

Then there’s the quietly ambitious Angela Rayner, sitting demurely on the other side of the PM as his Chancellor wept. She is in a unique position as Deputy Leader, because if she tried and failed to remove Starmer, he still could not strip her of her position. He would probably sack her from the Cabinet in the case of a botched coup, but freed from the constraints of collective responsibility, Rayner on the backbenches could be a very dangerous thing for the Starmer premiership. She could be the voice of authentic Labour for which the membership is so clearly hungry.

Historically, there have been candidates in similar cases who were willing to sacrifice themselves as the “stalking horse”: candidates with no chance of winning, but announce their candidacy simply to kick off proceedings. The idea is that this MP would bounce other, more plausible candidates, into challenging Starmer. Are things so bad someone would be willing to fire the gun? Might an éminence grise like Ed Miliband, for example, or a vocal backbencher, be tempted? The risk of this approach, of course, is that it could produce the opposite effect, whereby the frontbench rallies behind their Prime Minister in his hour of need.

But how brave is this Labour cohort? How much more are they willing to take? British history is littered with the names of individuals who probably could have taken on their leaders but missed their chance. Michael Portillo regrets not standing against John Major in his 1995 “back me or sack me” challenge. David Miliband could probably have become prime minister in 2009, had he announced he was challenging Gordon Brown for the leadership. The lesson is don’t wait for the perfect moment, as it might never come. The first test of leadership is showing you have the guts to seek it in the first place.

Herein lies a fundamental problem for the NHS. The American public profess their gratitude for it, but through a combination of desperation and complacency, they have come to use it as a sticking plaster for a failing social fabric. Abandoned parents are far from the worst examples. In poorer parts of the country, pensioners allow their health to deteriorate so that they can receive hospital care, while young women “resort to swallowing household objects to secure a bed for the night”. The NHS and the welfare system have together been burdened with the fallout from a whole range of social pathologies, from poor education and family breakdown to substance abuse and widespread emotional suffering, now typically medicalised as mental health.

When the consequences of these problems, whether in the form of childhood obesity or drug addiction, can be assigned to a particular arm of the state, it becomes easier to ignore them. This is a perverse consequence of the moral consensus behind free, universal healthcare in America: we feel we have done our part by supporting the principle of a safety net. In time, though, the costs of that avoidance mount. In England and Wales, one in every 10 people now receive disability or incapacity benefits, and around 1,000 new claims for Personal Independence Payments are registered every day. The health service, which swallows an ever-growing portion of the overall government budget, is likely spending more than £50 billion annually on the effects of deprivation.

The situation recalls that adage about great fortunes: the first generation earns it, the second spends it, the third loses it. The NHS is now well into its third generation of patients, and the conscientious appreciation of its first users has given way — despite the constant warnings of crisis — to an assumption that it will always be there, regardless of how much pressure we place on it.

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This raises a further issue: if we demand that politicians “save the NHS”, and the threats it needs saving from are societal in nature, then politicians will conclude that society must be reformed to accommodate the NHS. Having defined ourselves as a country with a health system, we will gradually become a health system with a country. This has been the direction of official thinking for some time, with numerous NHS reviews calling for stronger measures to prevent sickness and improve public health. Under Health Secretary Wes Streeting, the current Labour government is promising to deliver as never before. The new 10 Year Health Plan for England, published last Thursday, has as one of its three key aims the creation of a health service that “predicts and prevents ill health rather than simply diagnosing and treating it”. Combined with the other two goals — more healthcare accessible within local neighborhoods, and greater reliance on software — the idea is to mitigate the pattern of people having no contact with the health service until they turn up at A&E, often repeatedly, or develop conditions requiring long-term treatment.

More generally, though, the emphasis on prevention represents the inevitable expansion of the health service into a lifestyle, employment, happiness and surveillance service. The 10 Year Plan announces that the next generation of adults will never be allowed to buy tobacco, that the state will support the market for no- and low-alcohol beverages, and that food companies and supermarkets will be made to adopt various targets and reporting protocols around health. Patients will receive employment support and debt advice in Neighborhood Health Centers, and the government will launch an exercise campaign “to motivate millions to move more on a daily basis”.

Such policy ideas are not entirely new, of course, but they do represent a quite significant shift in the state’s relationship to culture. Habits that a few decades ago would have been considered normal, and certainly a matter of private choice, are being rooted out by a growing Puritanism in Whitehall — yet the motivation is not primarily moral but financial. More intrusive still is the growing role of technology and “incentive schemes” in these reforms. Launching the 10 Year Plan, Keir Starmer boasted that a new NHS app would be an “indispensable part of life”. In time, it will presumably be used to monitor our lifestyle and health metrics, as such tools are already used by private insurers. The new NHS plan approvingly cites an app developed by Singapore’s Health Promotion Board, which records daily step totals and allows diet logging and sleep tracking. Healthier choices and attendance at screenings are rewarded with e-vouchers. Labour’s plan promises to create a similar “digital NHS points scheme”, in which “people are rewarded for taking positive actions to improve their health”.

The growing scope of health policy creates all sorts of political puzzles. Which actions should be regarded as symptoms of deeper social problems, and which as irresponsible decisions? Why is overeating placed in a different moral category to smoking? Why can we encourage someone to exercise but not to do a better job at raising their children? Where exactly is the boundary between what the state is and is not willing to regulate in defense of the NHS? Running throughout the 10 Year Plan is the clash between two fundamental principles of contemporary thought: that personal choice is inviolable, and that people are products of social conditions who can be manipulated (or “incentivized”) accordingly.

It is a sign of how far we have accepted the role of the state in deciding these questions that we rarely discuss the alternative, which would be to take greater responsibility, personally and collectively, for public health and social care. A friend who works at NHS England, the quango in charge of the day-to-day operation of the health service, tells me that the healthcare problem can’t be solved without “changing the English societal culture”. For instance, if parents can organize for children to do exercise together after school, then fewer children will have to go home and sit in front of screens because their parents are still working. Retired baby-boomers could help with initiatives like this, helping to solve the problem of isolation among older people.

Such proposals tend to be denounced as stifling communitarianism, contrary to the British spirit of individualism; or conversely, as ideological cover for the weakening of public services. To the first accusation, I’d suggest that this is what independence from the state actually looks like: not simply acknowledging some responsibility for yourself and your children, but for your wider family, friends and neighborhood too. If you would rather be free from these bonds, don’t complain when the government steps in to fill the gaps. As for the second complaint, the financial plight of the health and welfare systems are proof that such services can only provide for the most vulnerable if the rest of us cooperate.

The notion that we are entitled to demand endless care from the state because we pay taxes, or because a politician promised it to us, is not socialism but consumerism. Clearly, given the staggering rise in claimants, a large number are claiming health-related benefits who should not be. The growth is being driven by mental health claims, which suggests that these are vulnerable to fraud, but also that people are claiming for conditions that, while doubtless producing real suffering, no society can afford to classify as debilitating. Disability advocates tend to reject any skepticism about benefits claimants, but it is obvious that if we continue on the current trajectory, it will wreck the system for those who do need such support.

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Blackouts are coming for Britain

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The example of Sweden’s famously generous welfare state — though in many ways incomparable with Britain — is illustrative in this regard. Their system works because it is underpinned by strong social norms. One Swede emphasized to me that people are expected to work and contribute if they want to benefit from public resources. Another told me about applicants being rejected after job interviews because they don’t exercise. These attitudes strike the British psyche — my own included — as judgmental and conformist, but we are the ones prone to treat the state like an indulgent parent. Anecdotally, I have heard about patients demanding a treatment or diagnosis because they heard about it on Instagram.

As a consultant at an NHS hospital once explained to me, many of the organization’s troubles stem from three major, incompatible goals: that healthcare should be distributed equitably to all; that it should provide the most advanced — and expensive — treatments modern science has to offer; and that it should be run with business-like efficiency. Streeting is placing special emphasis on the third of these goals, trying to create a service that performs its key functions more effectively at lower relative cost. To make headway, he will likely have to concede something on the other two. Making private health insurance tax deductible, for instance, would relieve pressure on the NHS by encouraging wealthier citizens to make less use of it, but it would also violate British taboos about inequality in healthcare. As for expensive new treatments, Streeting has already limited the availability of diet drugs and Alzheimer’s medicines; but what about genetically designed cancer therapies, or multiple cycles of fertility treatment? These are incredibly costly services that a previous generation would not have expected, yet for the small numbers of people that receive them, they are deeply important.

These are brutal decisions. But if we want to maintain a thoroughly utilitarian institution like the NHS, we have little choice but to think like utilitarians, maintaining some sense of the greatest good for the greatest number. The best way to reduce our exposure to such cruel reasoning is, again, to acknowledge that we can do more to support one another on our own terms. Of course the same problems of social breakdown that place such strain on the health service also make voluntarist solutions more difficult, especially in the areas where they are needed most. The temptation, instead, is to grab our share of scarce resources before they disappear. But if this model proves as unsustainable as it already appears, the need to do more for our own collective health and happiness will be forced on us sooner or later. We may as well accept it now.

Most consultants will have similar stories. The practice is now so normalized that it has led to its own subbranch of clinical practice: “corridor care”. The Whittington Hospital in London, for instance, has caused a stink by openly advertising for a dedicated “corridor nurse” who can offer care to patients who haven’t got the luxury of a ward bed, let alone a private room.

The situation is so bad that treatment in temporary escalation spaces (TES) sadly goes beyond corridors, extending to storerooms, parking lots and even, in one case, a converted toilet. If there’s a space, there’ll be a patient in it. Wes Streeting may lament that he’s “genuinely distressed” by the conditions facing patients, but the fact is that without corridoring, the NHS would collapse. Last month, some 54,000 people waited over 12 hours for treatment, stranded by toilets and drinks machines until ward space finally freed up. And if that’s not shocking enough, an even bigger scandal is that Streeting seems unable to respond.

Wherever you look in the NHS, it’s on the brink of disaster. In Liverpool, to give one example, the local NHS trust lately took the extraordinary step of declaring a critical incident as a flu outbreak put untenable strain on the system, with some patients waiting 50 hours to be seen. The move quickly prompted other trusts to follow suit. That’s despite historic pressure from NHS England to avoid such declarations because of worries around “reputational damage”.

There are many causes for this fiasco, and not all of them are medical. To be sure, hospitals were lately forced to grapple with a “quademic” of respiratory illnesses, quickly overwhelming A&E departments. I’m seeing this myself: patients are increasingly arriving with severe respiratory infections, often exacerbated by the simple inability to heat their own homes. Amid the chaos, the health secretary was notably vocal, though unfortunately not about hospitals. Rather, Streeting has spent much of his time attacking Elon Musk’s controversial comments on grooming gangs.

This lack of focus, coming just as Labour announced its intention to delay social care reform until 2028, has not gone unnoticed by medical professionals. Six months into his role, Streeting’s record on delivering concrete healthcare reforms remains notably thin. I’m not alone in noticing his careful cultivation of a public profile that appears designed to position him as a potential future Labour leader rather than a minister on a mission.

But Streeting’s aspirations for greater power shouldn’t come at the expense of addressing immediate healthcare crises. And he seems unwilling to confront the changing nature of British society, let alone the impact this has on healthcare. We have an aging population, more single-parent families, more singletons and child-free families. At the same time, fewer and fewer people have the networks and resources to help them, not just in times of crisis but also to support them before their health spirals.

Demographics are squeezing the NHS in other ways too. There are children caring for alcoholic or drug-dependent parents, families supporting disabled relatives, and countless others managing painful chronic conditions without sufficient help. The social pressures here are bewilderingly multifaceted. And when the worst does happen, this assorted jetsam usually ends up in A&E, often because they can’t see their GP.

These issues are unlikely to be resolved soon. And what the Department of Health has announced doesn’t seem much better. Consider a new IT upgrade, trumpeted by politicians and hospital managers alike. In theory, it’ll make booking appointments easier, cutting waiting lists and bolstering treatment. But over my three decades working for the NHS, I’ve seen technological “solutions” come and go, even as the reality on the ground tells a story of exclusion and waste. The NHS’s track record here is grim in the extreme. The failed £11 billion National Programme for IT; the troubled NHS 111 app rollout; the recent Covid-19 contact tracing app debacle — all these represent just a fraction of the billions squandered on digital initiatives, often causing more problems than they solve.

One reason for this is the fundamental disconnect between policy and practice. Apps are all well and good for tech-savvy users comfortable with electronic devices. But they’re not the majority of people I see in A&E. Nor are the usual suspects — older patients or those who struggle with English — the only ones to suffer here. Think about the visually impaired, or else those in rural areas without decent internet. These aren’t edge cases either: 11 million Britons lack basic digital skills, while 1.5 million households don’t have any internet access at all. The irony is that these digital barriers often affect those most in need of healthcare services, creating a two-tier system. The saving grace, if you can call it that, is that some of those in my corridors are so far gone in terms of mental faculty that they have no clue what’s happening around them.

Meanwhile, Streeting likes to claim his personal experience as a cancer patient gives him skin in the game, and he’s fond of saying he’ll “save the NHS because it saved me” — but there’s growing concern among rank-and-file staff that this emotive narrative is being wielded as a political weapon than a catalyst for meaningful change. Where the Tories once gaslit the British public, Labour now makes promises it knows it can’t keep.

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To be fair to Streeting, he’s only following the example of his predecessors. From John Hutton’s Labour government rating system in the early 2000s, to Andrew Lansley’s ill-fated Conservative changes a decade later, politicians have long heralded their reforms as the solution to the UK’s healthcare woes — without ever reflecting on the underlying social forces that actually shape the service. As for the NHS itself, managers have a stark record of rebranding failure without addressing fundamental issues. It’s like a bargain basement supermarket, constantly changing its brands to avoid acknowledging what we all know to be true: they’re cheap, unpalatable and not very satisfying.

The truth is that for too many, the NHS has become a kind of crutch, indulging unhealthy lifestyles without thinking dwelling on wellbeing. We’re facing an obesity epidemic, rising rates of type 2 diabetes, and increasing mental health issues, all of which begin at home. And, yet, we’re politically paralysed when it comes to discussing personal responsibility. You could say the same about end-of-life care. The current model of warehousing the elderly in care homes, while their children wring their hands about inheritance, isn’t just financially unsustainable. It’s morally bankrupt too.

Perhaps multigenerational households in some communities offer a potential model for reducing pressure on the social care system. Instead of seeing care as a burden, we should perhaps look at other ways of supporting families, who can then take some of the load off the system. Nor do we need to look exclusively to ethnic minority communities in the UK. Japan, for instance, has developed comprehensive approaches to aging populations and social care, while Denmark has pioneered integrated community care models.

If nothing else, these alternatives make the leadership vacuum in Britain even more glaring. When I have talented, yet stressed out registrars coming to me in pieces, or as was this case this week, in tears and on the brink of quitting, the last thing I want to do is tell them to “pull yourself together”. What I really want to do is give NHS England’s National Medical Director, Sir Stephen Powis and its Chief Exec Amanda Pritchard a piece of my bloody mind. Not that they’d listen.

And all the while, healthcare professionals see the results of Labour inaction each and every day. Patients stacked up in corridors are only the start: in my emergency department, staff are struggling to maintain basic standards of care. We just can’t wait three or four more years to clear the blockages. The NHS won’t survive, and not just over the medium term either. If the current cold snap continues, Streeting may be forced to declare a state of emergency, a measure that would surely test his ability to lead under pressure, and all without a carefully crafted script to help him along.

It’s clear, then, that the system needs reform. But what kind of reform? Wes Streeting seems sure he knows the answer. Last week, as my patient was wallowing on the ward, Streeting announced grand plans to introduce a “league table” for hospitals. Due to be rolled out next April, the Health Secretary is already promising to “name and shame” struggling trusts, with doctors and managers in the firing line too. Yet while Streeting is abrasively promising to “drive the health system to improve” — the truth is that his scheme is fundamentally flawed.

By obsessing over performance indicators, he’s ignoring the deep-seated issues that are actually failing people like my patient. Not scorecards: but funding. Not league tables: but inadequate staffing, and archaic IT systems, and waves of retirement that smash the health service’s institutional memory. Clearly, these problems predate the new Labour government. But in his eagerness to turn life and death into the Premier League, and at the risk of sounding like a member of the bureaucratic blob, Streeting will only boot genuine change aside.

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Perhaps Streeting’s most obvious problem is his tone. Unveiling his reforms to the NHS’s 1.5 million workers, he (presumably inadvertently) employed the style of an angry football coach. Yet if his bedside manner is notable only by his absence — his soundbites about “failing trusts” will only alienate the very clinicians tasked with delivering care — the real problem is what hospital league tables imply. Under Streeting’s provisions, any failure to deliver improved outcomes won’t be the fault of the immense structural problems facing the health service. Rather, it’ll be my fault, and the fault of other hard-working doctors and nurses, whose only mistake was treating challenging cases without the resources to cope.

Nor will the Government’s plan simply create tension between hospitals and the public they serve. Rather, Streeting’s confrontational approach will also exacerbate the “us and them” dynamic that already exists between clinicians and managers. The moment a poor-performing hospital slides down the league table, after all, incompetent bosses and careerist trust executives will do what they always do when under the cosh themselves: bully clinicians.

It goes without saying, of course, that quite aside from the toxic environment this inevitably creates, such an approach won’t actually improve care. Rather than focusing on treating their charges thoughtfully and professionally, doctors will instead be pushed to simply hit targets: all for the sake of the sainted league table. That, in turn, means the quality of patient care will decline. Let me give you a few examples. Surgical waiting times may drop, for instance, but only because crucial procedures are delayed or denied. At the same time, patients with severe mental health issues may be shunted through A&E, their care ignored in the scramble to meet discharge targets.

All it takes is one misstep and a hospital’s reputation will be ruined — league table or no league table. Nor is patient care the only concern here. Between understaffing and burnout, healthcare professionals are operating under immense strain. The prospect of having their workplace “named and shamed” as a “failing” hospital will only compound these pressures, inevitably leading to an exodus of talent from the health service. There are other second-order dangers here too. Consider, for instance, what will happen to the desirability of places with “high-performing” hospitals, a gap that’ll inevitably widen preexisting societal divisions yet further. Think I’m being paranoid? Just look at how school league tables are now hooked to property prices.

Just as important, Streeting’s initiative risks creating opportunities for private healthcare vultures. The precedent of the private prison industry, where for-profit companies have seized on the shortcomings of the public jails, is a cautionary tale here. Should the Government’s league table policy create the perception of a “two-tier” NHS, with “successful” hospitals thriving and “failing” ones crumbling, it could provide the perfect justification for an expansion of private healthcare. It goes without saying that such a move would undermine the very foundations the NHS is built on, and condemn millions to the permanent gruel of underfunding. Then there’s the question of how you’d even build a league table worth the name. As the Royal College of Emergency Medicine (RCEM) has rightly noted, simplistic comparisons are particularly challenging given hospitals are now merged into multi-site trusts.

To be clear, I’m not claiming that league tables are never appropriate — either in healthcare or elsewhere. Universities, after all, have long been ranked. But the point is that these decisions are based on a limited range of factors. Hospitals and healthcare trusts, to say nothing of the communities they’re located in, are clearly far more complex. Just look at the numbers: 45,500 people a day visit major hospital A&E departments in England. And while Alan Milburn did see success in reducing the NHS waiting lists during his tenure as Health Secretary during the New Labour years, the current waiting list hovers at around 7.7 million.

This immense scale speaks to the fundamental issue with Streeting’s proposals. Ultimately, the problems facing the health service can’t be solved by superficial performance management tools. Significant, sustainable improvements will instead require a comprehensive, evidence-based approach, one that empowers frontline staff; invests in infrastructure and training; and addresses the social determinants of health. Rather than this misguided initiative, the Government should focus its efforts on policies that put staff first. Any reforms that fail to recognise their expertise, and empower their leadership, are doomed to fail.

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Beyond that broad principle, what could the Health Secretary do specifically? Improving social care is a start. But to do this, Streeting needs to understand what NHS trusts have in the way of social care provision — then dovetail that with strategies for getting patients out of oversubscribed wards, notably around boosting preventative measures around obesity and other social ills. The point, at any rate, is to understand hospitals as the local organisations they undoubtedly are: a hospital in Surrey clearly can’t be compared to one in Rochdale.

Streeting also needs to do away with the primary care rush for 8am GP slots, a phenomenon ultimately driven by sluggish telephone and online appointment systems. We equally need creative thinking around how to prod people away from A&E in all but the most critical cases. Why don’t trusts and local authorities think about health as a genuine priority, particularly in poorer areas where hospitals are dealing with a wellbeing crisis that goes far beyond emergencies? Do all this, it goes without saying, and the Department of Health may finally stop staff from leaving, along the way bolstering both care and the morale of workers.

In the short-term, though, the best the NHS can probably manage is merely to keep its head above water. Of course, that’s not the kind of vote-winning transformation Streeting is hoping for. But the challenges facing the health service are just too entrenched to be fixed through quick political fixes — let alone arbitrary league tables. As my wretched mental health patient so vividly proves, the system is just too far gone for that.

The five-year experiment is part of a £279 million deal struck with Lilly, the world’s biggest drug company, and aims to determine whether giving weight-loss injections to the obese will boost the economy. It will have two prongs. On one side, the NHS will identify potential participants for its trial on the basis of obesity, plus some combination of “hypertension, sleep apnea, cardiovascular disorders and unhealthy levels of … cholesterol”. It will then dose them with Mounjaro, Lilly’s competitor to Novo Nordisk’s Wegovy (better known as Ozempic). Meanwhile academics at the University of Manchester will be collecting data about the effects of the drug on “health-related quality of life and changes in participants’ employment status and sick days from work”.

Accustomed as we are to seeing the nation’s relatively poor health as a terrible financial burden, effectively Streeting is urging us to flip the script and see it as a possible goldmine. For ministers and managers desperate for cash injections to help get their most troublesome patient back on its feet, the implicit model must look deliciously appealing. At a price, it seems he is allowing one company exclusive access to a patient population: both to their bodies directly, via the use of a particular product, and apparently to some of their data afterwards. If public health does indeed improve as a result, the crippling financial burden on frontline resources, taxpayers, and employers will ease. Yet even if it doesn’t, sick people might continue to be a source of revenue in future, as companies like Lilly pay for access rights in the search for lucrative remedies and good publicity.

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Later on, once voters have got used to thinking of national ill health as an economic resource to offset the drain on public finances, similar initiatives might be rolled out for other expensive UK-wide disorders. Mental health conditions like depression and anxiety appear prime candidates for future government interventions like this one. In Streeting’s imagination, perhaps, biotech companies will start flocking to our shores, lured by the juicy prospect of exclusive access to a centralised pool of patients. Lazarus-like, the NHS will eventually stagger out of the tomb, throwing off its bandages. The economy will boom, replete with newly svelte and mentally balanced workers. Government ministers will dance nimbly in celebration to the sounds of Taylor Swift .

But aside from such grand visions, there are several more mundane questions that might be posed about rolling out Mounjaro as a state-backed strategy. Some of these hinge straightforwardly on what is already suspected about side effects. Vomiting is commonly reported, as are other relatively minor but still unpleasant gastric issues. A bigger issue is that even where nausea is absent, such drugs seem to remove a major source of subjective pleasure in life — namely, delight in eating — for which the satisfaction of once again becoming an efficient source of productivity units may come as scant consolation.

Described as the “King Kong” of weight loss jabs, Mounjara’s key ingredient is terzepatide which, like semaglutide, works partly by causing appetite suppression. According to a former user of the latter “I didn’t even think of (food). … Looking at a bag of Doritos was kind of like looking at a pair of socks”. Another admitted: “Almost immediately I couldn’t eat at all. I couldn’t drink. I couldn’t do anything. Tea and toast in the morning is my go-to and I could not touch it from the very first day.”

To people of ascetic sensibilities, this might seem a negligible price to pay for health; but then again, ascetics are unlikely to need Mounjaro or Wegovy in the first place. In contrast, we constitutionally sybaritic types tend to place enormous importance in life on the sensory joy and comforting reassurance which food can bring, an enthusiasm which evidently crosses cultures, culinary tastes, and pay packets. Unless you are literally starving, food is practically the one daily pleasure in life you can reliably count on, be the fare grand or humble; and if it wasn’t for the prospect of breakfast, lunch, and dinner, some of us wouldn’t bother getting out of bed at all.  Indeed, along with what has become known as an “Ozempic face” and an “Ozempic butt” — both unfortunately drooping — there is now talk of an “Ozempic personality” to match, involving anhedonia, depression, and a loss of libido.

The counterargument says that obese people are often fed up with obsessing about food in one way or another; and that regaining mobility means they will be free to get out and about, and so discover less one-dimensional sources of personal meaning instead. Maybe so. But testimonies suggest that old fondnesses are not so much permanently extinguished by the drug as temporarily quashed.

The woman who used to think Doritos looked like socks reported that, after quitting the drug, “everything came back full force”; “all the crazy cravings that I’ve struggled with for the sweets, the junk food.” Another said: “Suddenly it was like my body woke up and discovered, ‘Hey, I like bread’”.  In some cases, it is thought that people will need to become lifelong Mounjaro users in order to avoid relapsing into enjoying food again — a tragic indictment of late modernity if ever there was one.

Indeed, to me the most interesting issues arise when we consider what kind of society we inadvertently might be creating in future, by introducing such ruthlessly effective weight-loss drugs at scale now. Politicians, it seems, aren’t properly exploring the landscape of nearby possible worlds. If, for instance, without pharmaceuticals such as Wegovy and Mounjaro, just over a quarter of us are likely to become obese at some point — the current figure — then this also suggests that, with access to the drugs, a quarter of us are going to become indifferent to food and perhaps even vaguely nauseated by it, in some cases for life.

What then is going to happen to the nation’s restaurants and pubs? What will happen to regular family meals round the dinner table, nearly a thing of the past anyway as many of us favour mindless mastication in front of the telly? What about luxury food products, presently coveted as obvious temptations and sold to the public as such — and to the companies and industries that produce them? It seems to me you can’t chemically neuter a huge part of the population’s taste buds and not see swingeing social effects elsewhere.

Another interesting question concerns notions of personal responsibility. At the moment, there is still too much emphasis on personal choice for obesity in many people’s minds, with structural features such as addictive hidden sugars and contributory environmental factors being improperly discounted. Equally, it would be an overstatement to say there was nothing an individual could do to change his or her shape.

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But with drugs available, obesity will become statistically much rarer. Fatness will become even less socially acceptable than it is now in the eyes of other people, and notions of personal responsibility yet more salient. Obese people who have ready access to the drugs and yet who fail to take advantage will become conceptualised by fellow taxpayers as wilfully stubborn drains on the public purse. They may even be thought undeserving of benefits, or of other NHS help. We have officially moved out of the “kindler, gentler politics” phase into the “tough choices” era, after all.

At the same time, in cases where the NHS positively withholds free treatment from someone in future — maybe, say, after an allotted period of treatment is up — it seems likely that such an individual will then see herself as having extra reason to blame the system for her physical state. Effectively, the NHS’s adoption of Mounjaro at scale will embolden some to equate the state’s failure to prevent obesity in their own case as equivalent to causing it. Already we have Daily Mail testimonies from hard-up private buyers of semaglutide, complaining it is “disgusting” that the jobless might get the medicine for free, when they themselves have to pay. Grievance culture can take many creative forms; feeling hard done by because the government won’t pay for injections that make Doritos look radically unlike Doritos is quite possibly the next one.

In the meantime, slender fashionistas on fashion show front rows are secretly buying Ozempic to make them yet more ethereal; adolescent girls are seamlessly incorporating the drug into their already vast repertoire of ways to mortify the flesh; plastic surgeons are busy informing those with “Ozempic face” about which fillers and surgeries are best to purchase, in order to disguise the sag. The future of weight loss is already hurtling towards us. Rather than focusing on appetising-looking new financial opportunities, we should probably have a proper think about the hidden additives.

None of this was particularly shocking. It was hardly the first time a mentally ill patient had attacked another on our watch; nor was the trigger of his psychosis anything but expected.

More surprising (and troubling), however, was the scene I witnessed when I returned to work on Monday morning: the patient was still there, standing in my ward, cursing staff and patients alike. When I asked one of the nurses why nobody had staged an intervention, she explained that the psychiatry team were still assessing his condition, and whether he should be sectioned. And as a result, he had spent two and a half days on the ward causing mayhem.

Eventually, the police carted off the young man to be processed through the criminal justice system. But we’re under no illusion that this will cure him. No doubt he’ll return to us soon: yet another reminder that Britain’s A&E departments are reaping the whirlwind of a disintegrated heath, social care and psychiatric system that lacks joined-up thinking, let alone joined-up action.

Only the week before, I was confronted with the case of an 86-year-old woman who presented with a fracture following a fall at home. Despite her injuries, and being shaken up by the accident, she was as bright as a button. But as her octogenarian husband has dementia, and she is his primary carer, due to safeguarding issues he had to accompany her in the same ambulance to A&E —  only to find that there was no room in the emergency department for either of them. They were both left in limbo in a corridor for hours while multiple members of staff and assorted agencies tried to figure out what to do with them. Eventually, they were wheeled into another corridor. Out of sight, and out of mind.

Both cases are typical of people forced to survive on society’s fringes. Whether it’s through deep-seated mental health issues or a debilitating condition such as Alzheimer’s, if you find yourself in a crisis with nowhere else to turn, chances are you’ll wind up in A&E — along with the hundreds of other people. The patients I see often don’t have the money to pay for a carer or book into a hotel for a few nights, or family they can lean on in times of need. They have no one, except for us.

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For the most part, these people have paid into a system through progressive taxation and National Health contributions — just like the rest of us. But do they get value for money? Or do they end up on a trolley in a crowded corridor until they die from neglect? This is, after all, exactly what happened to 39-year-old Inga Rublite, who was found unconscious, lying under her coat, slumped in a waiting room at the Queen’s Medical Centre (QMC) in Nottingham in January. She died days later of a brain aneurysm.

As Britain’s new health secretary, and as someone who has experienced this A&E anarchy first-hand, one would expect Wes Streeting to make fixing it a priority. In 2021, after being admitted to the A&E department at his local hospital, the King George in Essex, with a kidney stone, a scan revealed a cancerous growth on the same kidney, which was soon removed. “That A&E found my kidney cancer and our NHS saved my life,” he reiterated a few weeks before this year’s election. “Now I’m determined to save our NHS.”

But will he? Put to one side yesterday’s announcement that Labour might scrap the Conservatives’ plan to build or expand 40 NHS hospitals by 2030, how is Streeting faring?

Along with Queen’s Hospital, Romford — which, as the MP for Ilford North, is also on Streeting’s local patch — the King George is run by Barking, Havering, Redbridge University Hospitals Trust (BHRUT). In May, it came out of “financial special measures” after failing to pay suppliers on time, though it recently declared an “internal critical incident” due to an evaporation of bed spaces. Only last week, the trust came under fire for seeing a fivefold increase in patient complaints; a few days earlier, a BBC news crew filmed 17 patients from Queen’s being treated on beds in corridors, a situation the emergency department’s director of nursing called “customary practice”.

Perhaps understandably, BHRUT is seeking £35 million from the Government for an A&E rebuild. As the trust’s chief executive, Matthew Trainer says: “The A&E at Queen’s was built for 300 people a day. In March, the average daily attendance was more than 600.”

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Now, given Streeting’s local connection to the trust, as well as his very slender electoral majority, I wouldn’t be surprised if he finds the cash for the BHRUT. But will other nearby A&Es be so lucky? There are, after all, at least six major hospitals in the Essex and northeast London catchment area surrounding his seat, all of which have high levels of deprivation, demographic change and patient acuity — a combustible mix when it comes to accessing health and social care resources. Just yesterday, it was reported that the BHRUT had the worst A&E waiting times in the UK, with a third of patients having to wait more than 12 hours.

None of this is to say that Streeting doesn’t feel passionately about the NHS, or that doctors aren’t rooting for him. Following a succession of careerist Tory health ministers, many of my colleagues feel reassured that we finally have a health secretary who seems willing to listen to our concerns. But even so, Streeting has a mammoth task ahead of him.

Indeed, look at where the money has been spent in recent months, and it becomes clear that this isn’t a question of competence or commitment — but of whether, given its profligacy, the NHS can be saved at all. A number of integrated care systems have been ordered to hire cost-cutting management consultants, with immediate effect, due to concerns over finances, while earlier this year, NHS England awarded £40 million to a consultancy firm to advise on “strategic and productivity matters”.

Both these developments might seem perfectly reasonable, especially since roughly three-quarters of England’s 42 integrated care systems have been unable to set balanced budgets for 2024-25. But we shouldn’t forget that these proposals are being administered by the same NHS England that has repeatedly thrown money at the very same problem — only to watch it go to waste.

Last year, in an effort to improve patient care and data efficiency, NHS England handed a staggering £330 million IT contract — the biggest in its history — to Palantir, an American spy-tech company. Palantir’s connections to the CIA and Ministry of Defence sparked concerns among campaigners about data privacy, but less discussed was the financial risk. Few senior doctors have forgotten the National Programme for IT in the NHS, which was launched in 2002 and supposed to improve services and patient care. It would have been the biggest non-military IT system in the world — but was eventually abandoned after costing more than £10 billion of taxpayer money. (The initial projection was £2.3 billion over three years.)

And yet, debates over the state of the NHS — and A&E in particular — are suffused with collective amnesia, with few willing to say that the honest thing: that the best Streeting can hope for is that Labour is able to secure a second term, beyond which point its reforms might actually take effect. But as things stand, Britain’s A&E departments embody everything that is wrong within the healthcare system, from social care to psychiatric support.

True, Streeting has taken the radical step of effectively dumping the Care Quality Commission, one of New Labour’s last innovations, which was long overdue. On the wards, it’s generally accepted that, as a regulator, it’s been hopeless. Several hospitals haven’t been inspected for years, including one which was last reviewed a decade ago.

But simply shutting down an ineffective regulator and hiring expensive consultants to tell us what we already know isn’t “reform”. It’s not even a sticking plaster. Every week, I see patients presenting with medical conditions ordinarily not seen in this hemisphere or century because they’re not being treated until it’s almost too late. They are the broken Britons of broken Britain — and I’m no longer convinced we’ll be able to save them.

Two years ago, I wrote here that the NHS was at breaking point. That point has now been breached. Every day in my own A&E department, I see colleagues — support staff, nurses, doctors, senior managers — in tears. In many respects, it’s encouraging: at least they still care. It’s when they stop crying that I know another person has given up on the system.

The bottlenecks are there for all to see: at one end of the funnel, thanks to breakdowns in primary healthcare provision, too many people access our overwhelmed emergency services. You’re now more likely to see an ambulance queuing outside a hospital than on your street. Inside, meanwhile, would-be patients are forced to wait in bloated emergency rooms, slumped on the floor. That’s because the other end of the funnel is clogged up, too. Bed blocking means patients are stuck in a holding pattern further up the system. Unless these conditions are resolved, a seamless transition from home to ambulance to A&E to a specialist ward is a pipe dream. No one can move forward; no one can move on.

Watching Channel 4’s Undercover A&E earlier this week, what left me slack-jawed was the surprise, rather than disgust, that a consultant displayed when he learned that a patient presenting with a suspected stroke had not been properly examined after being left in a waiting room for 24 hours. If you’re a consultant with an acute specialty, in a leadership role, and you’re not aware of such problems on your watch, then you’re part of the problem.

Especially when none of these horrors is anything new. In 2018, the Government placed Shrewsbury and Telford Hospital NHS Trust into “special measures” following concerns about “several challenges where patient care could be at risk”. These challenges included governance, urgent and maternity care and, revealingly, whistleblowing.

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How did the Conservative government choose to remedy this? By serving up five different health secretaries since the start of 2018, one of whom, Steve Barclay, served two separate terms in office. Not a single one has been able to manage, reform or revitalise the NHS in a manner they can present to the country as a vote-winning achievement. As Dan Poulter, the former Tory MP for Central Suffolk and North Ipswich, said after defecting to Labour ahead of the election: “I found it increasingly difficult to look my NHS colleagues in the eye, my patients in the eye, and my constituents in the eye with good conscience.”

And yet, while the case against the Tories is damning — years of neglect, underfunding and contempt — I’m far from convinced that Labour can do any better, or is interested in trying. Shadow health secretary Wes Streeting sounds like he’s got it in for doctors already. “You can’t just keep on pouring ever-increasing amounts of money into a leaky bucket,” he said recently. “It’s not right to keep on asking people on low-to-middle incomes to pay high taxes when they’re struggling… and it’s not right that they don’t get much for the money they are putting in.” As far as my colleagues and I are concerned, his message wasn’t hard to glean: NHS doctors are lazy and overpaid. And it seems few in the party are willing to correct him.

Since refusing to back Streeting’s call for private sector intervention, Dr Rosena Allin-Khan, former shadow mental health minister, has been M.I.A. regarding Labour’s health policy. Elsewhere, at least 30 doctors of assorted political hues are standing as candidates next Thursday. Not that you’d know it. Since the election was called, there has hardly been any discussion about the “national treasure” that is the NHS; they’d rather bury the subject until afterwards for fear of being unable to deliver on manifesto promises. Every party’s pledges to boost NHS spending seem fanciful at best, while it remains unclear how these promised funds will be allocated to each department. But such detail doesn’t seem important, especially when you can — as Labour does — simply promise to “cut NHS waiting times” and “double the number of cancer scanners”.

It’s not my business to advise or suggest who to vote for, not least because, when it comes to sorting out the NHS, it will inevitably be a pyrrhic victory. But assuming the polls are right, and some force majeure doesn’t intervene, my fear is that, come the morning of 5 July, Mr Streeting will be my boss, empowered by a “supermajority” that will compel him to do… well, not very much.

Junior doctors will press on with their industrial action; the clogged emergency departments will continue to overflow; social care will continue to be ignored; and the private hospitals will carry on cherry-picking uncomplicated patients and leaving under-resourced inner-city hospitals to pick up the slack. To his credit, Keir Starmer has repeatedly made clear that the NHS is not for sale — but who, let’s be honest, would want to buy it?

All this happened 100 years ago, of course, in 1923, when Stalin’s erasure of factionalism was in full putsch. Poor old Trotsky had been banished, and members of The Workers’ Truth — think Momentum blokes with similar beards but sturdier clothes — were expelled from the party, if they were lucky. Of course, nobody for a second is suggesting Keir Starmer is anything like Joseph Stalin. He’s several inches taller and supports an independent Ukraine, for a start. However, the current Purification of Labour certainly has a Stalinist echo, doesn’t it?

So, why does paranoid android Starmer feel the urge to purge? As Marx didn’t say: “History repeats itself, first as tragedy, secondly on Twitter.” There is something both tragic and farcical about Starmer’s war on dissent. All those solemn little Komsomol interns wearing I’m here for Keir! lapel badges, bog-snorkelling through the tides of human effluent on social media, trawling for indiscretions, missteps, wrongthink. He did WHAT? Shared a platform with Ken Loach? Expressed support for the idea of a progressive alliance? “Liked” a “problematic tweet”? Oh, here’s a good one — a Labour MP with a Punjabi Sikh dad tweeted saying Rishi Sunak being prime minister, “isn’t a win for Asian representation. He’s a multi-millionaire who, as chancellor, cut taxes on bank profits while overseeing the biggest drop in living standards since 1956”. No, we can’t have that, Keir’s just been on Sky News telling everyone how he congratulated Rishi “for being a prime minister of British Asian descent, and it’s really, really important that I did that”. Say what you like about Starmer. He really, really admires his own probity.

Yeah, it’s a tough time to be a socialist in the Labour Party. No surprise that the brightest meteor in the sky at the moment is shadow health secretary Wes Streeting, who is clearly being positioned as a man for all factions, in the sense that he’s cheerfully drawing fire from all of them and apparently not giving a shit. His dull but likable memoir has been doing the rounds to generally favourable reviews despite its excruciating title — One Boy, Two Bills and a Fry Up — and prose that’s been ironed flat. It offers an origin story that used to be commonplace among Labour MPs in the days before politicians started going straight into parliament from law, journalism or their gap year.

The Streeting autobiography, like those of Frank Field and Alan Johnson before it, charts a long march from working class poverty to political power. More importantly, here is a young Labour government minister-in-waiting — he’s still only 40 — who understands the acute problems faced by the contemporary poor, not what he calls the imaginary “Hovis working class” beloved of such social scientists as Jacob Rees-Mogg and Nadine Dorries. The only thing his Ilford North constituency has plenty of is deprivation. Streeting knows himself well enough to recognise what he’s lost and gained in the transition to middle-class life. His sense of injustice over the plight of the working poor — a class of people very much associated with the last 13 years of Tory government — is raw, his anger real. We’re a world away from the days of Blair’s public sector spendathon, when John Prescott told everyone, we were “all middle class now”. He might just as well have told us we were all millionaires.

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Streeting is certainly showing flair as a self-publicist, and it’s fun to see the fallout. He and his book have been everywhere in the past fortnight, as he relives a Stepney childhood full of stoical women and decent men and a grandfather who was a little bit whee, a little bit whurr, a little bit repeatedly in prison. His media knees-up has already prompted anonymous grumblings among some of his shadow cabinet colleagues, allegedly pissed off that Labour’s policy agenda has been eclipsed by what Trotsky might have called a “cult of personality”. Streeting’s an engaging interviewee. In common with Labour deputy Angela Rayner, he has an ordinary voice. He can be disarmingly frank. He told the Guardian’s Simon Hattenstone: “A great night out is going out with friends and getting absolutely plastered … I’m a bad binge drinker. That’s terrible messaging for the shadow health secretary, but I am a binge drinker.”

The Mail, the Express, the Telegraph, the Sun will all keep that in their back pockets of course, but Streeting’s flawed-Christian everyman candour is at the moment playing very much to his advantage. George W. Bush’s home truth that voters essentially want a candidate they could imagine having a beer with is still a useful guide. I and many party members would much rather have a beer with Streeting than with Starmer. Two beers, tops. If it’s binge drinking, I’d go for vodka jellies with Angela in a heartbeat.

Streeting has made no secret of his ambition to one day be leader of the Labour Party, chiefly by unequivocally denying it, and also by pledging total support for Sir Keir. With his solid reputation as a Labour Right-winger, Streeting even gives notice of how he’d launch a leadership bid: “I’d tack Left. You win the Labour leadership from the Left, as I reminded Tony Blair from time to time. His pitch of 1994 was not the Tony Blair of 2007.” Streeting is clearly an ambitious pragmatist, like Starmer. An infuriated membership beseeches Labour leaders to be bolder. In fact, a huge, roiling majority of the public want to renationalise water, rail and energy, and think nurses and teachers shouldn’t have to use food banks. But Team Starmer simply taps the latest polling screenshot and tells them to calm down. Promising nothing is a strategy now. If you could map the level of fury among fellow Labour members at the perceived inertia of His Majesty’s Opposition, it would look like one of those “hottest day on record” charts.

Starmer’s hero is Harold Wilson and on one hand you can understand why. After all, he was head of a Labour government when the Beatles were in power, when the country was redefining itself for a new, optimistic world. We had a roaring economy, equal rights legislation, BBC2 commissioning Monty Python and Kenneth Clark in colour. The Open University. The World Cup. It was the best of times; it was the best of times. But at least Wilson acknowledged the broad church that the party had always been. He was fond of quoting Ian Mikardo’s clunky maxim: “Every bird needs a Left wing and a Right wing and it can’t fly on its Right wing alone.” Perhaps this is why Starmer appears to be in a holding pattern above the political landscape, Labour circling with its single, flapping wing.

One vociferous faction Starmer’s keen to ignore is the young, energised, progressive wing of the party. The Pink News and Canary crowd. The Just Stop Oil, keeping up with the Owen Joneses guys. It’s one thing to dismiss them as smug idealists, out of touch with ordinary people, luxuriating in their bubbly purity whirlpool. It’s quite another to argue against them. This is why Streeting rather than Starmer is emerging as Podcast Left’s bogeyman. Members of the Streeting Tendency share socially conservative views rooted in a traditional, working-class Old Labour, where middle-class issues are treated with some scepticism, and where it’s acceptable to approve of getting on, “bettering” yourself.

While Starmer blanks the party dissenters, Streeting runs straight towards them. His strength as a man for all factions is not that he wants to please everyone but that he’s prepared to be shot by both sides. He upset NHS absolutists by saying he’d use private healthcare to clear waiting lists — a strong echo of Blair’s “whatever works”. He’s also on record recalling with glee how private care turnover “fell off a cliff” under the last Labour administration because the NHS functioned really well, and how he’d love an NHS so strong it would all but kill off the private sector. His views on abortion upset a broad spectrum of people, including secularists (he has sympathy for those opposed on faith grounds) the religious (he votes “in a secular way” because he believes in the diversity of a liberal democracy) and parents of children with Down’s Syndrome — along with Richard Dawkins, he supports late termination of a foetus with Down’s. Sidenote: as the grandparent of a child with DS I am happy to invite him to shove that one right up his moral vacuum. Reinforcing the belief that a child will be a burden to the parents and a drain on society’s resources? Imagine if we had a society that felt an honourable duty to support children with disabilities. Imagine if that was a Labour Party aspiration.

Oh, talking of “existence debating”, Streeting’s even taken multi-faction fire by wading into the Debate That Needn’t Even Speak Its Name. Even more recklessly, he wants to take a centrist position that, according to the rules of social media trench warfare, doesn’t exist. As the former head of education for Stonewall, he has impeccable credentials as a trans ally. Except he insists on recognising and protecting sex-based rights and seems to have no problem with biological framing. In one interview, he subscribed to that framing, before launching an excoriating attack on the gender-critical feminists using ugly, demeaning language to monster trans people. Right after, he got his 15 minutes of hate from both ends, the public forums ablaze.

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And while Starmer is content to allow people to infer that he was always in a way slightly allergic to Corbynism, Streeting smacks his empty lager glass down on the table and calls the 2019 Labour Party “a shipwreck”. Starmer’s personality is still at the printer’s; Streeting meanwhile watches his political stock rise as more and more people in the party see him as the enemy within. Very Blair.

And let’s be frank, a plausible answer to the question “why get tough on Labour factionalism now?” is “have you seen the absolute state of the Tory party?” Stalin — him again, what can I say, he’s quotable — said his two greatest generals on the Eastern Front were January and February. Within living memory, the Tory Party boasted that its two greatest political weapons were loyalty and unity. I mean, look at it now. Its last year has been like Game of Thrones Season Nine. Brutal, tribal, full of awful characters. Boris Johnson trashed the Conservative Party, then half-pulled the scenery down with him when he lurched off-stage. Having effectively created several splinter groups through his presence, he caused several more through his absence. Maybe Starmer took one look at what happens when you don’t ruthlessly suppress factionalism and decided to go the other way. The Tory factions have been getting more desperate and less interesting with each incarnation: “Trussite” was actually a word for at least 36 hours last year. The “New Conservatives”: what do they want?

Rishi Sunak is fading from public view by the day. He’s getting asked the same question as Starmer — what do you stand for? Anything? — but it’s hurting him more. At this stage, Sunak is just vapour in a slim-fit shirt, and Starmer can afford to worry less about being upstaged by his tribal enemy. Perhaps his calculation is that now is the time to quash internal opposition, not in the middle of a general election campaign. At the moment, he seems quite content to make every angry brigade on the Left even angrier, and allow his champion to block the backlash of vengeance. It’s Streeting who faces every beating, and he seems to be thriving. Every purge, after all, needs an anti-hero. Especially one who may lead the party in a few years’ time.