It was a veiled barb, but few could miss it. In the middle of PMQs, Keir Starmer told Rishi Sunak he wanted to “live in a society where people don’t have to go private to get a doctor’s appointment”.
MPs on both sides knew the line was a deliberate reference to a report this week that the Prime Minister was registered with a private GP that guarantees same-day appointments.
The West London clinic charges £250 for a 30-minute consultation, with evening and weekend appointments. It’s a far cry from the delays faced by millions in getting to see their local doctor.
Although Sunak today put in his strongest Commons performance since succeeding Liz Truss, he was certainly on the defensive as Starmer also taunted him over Labour’s plan to fund 15,000 more NHS doctors a year with a crackdown on non-doms.
And just as that policy lets the Opposition press on the bruise of the Sunak family’s non-dom controversy, the jibe about private healthcare was a bid to fuel an image of a wealthy Prime Minister out of touch with everyday concerns of the public.
Starmer’s attack was part of a wider strategy. Earlier this month, Labour’s Karl Turner asked Sunak: if he got ill would he start ringing his GP at 8am and risk not getting an appointment or go to A&E and wait 12 hours to be seen – or would he “use some of his £750 million—unearned wealth—to pay privately and see somebody there and then?”
Sunak made a rare reference to his private life, saying he wanted to put on record his thanks to “the fantastic team at the Friarage Hospital in Northallerton, who have provided excellent care to my family over the years”. But Labour spotted he hadn’t denied he used private healthcare too.
In his leadership campaign this summer, Sunak went to great pains to allude to his close links to the NHS. “You wouldn’t expect me to talk about my kids’ medical [history], but of course we use the NHS,” he said. Just as importantly, he often mentioned his father was a GP and his mother a pharmacist.
When asked directly during the G20 summit about his healthcare arrangements, the PM said it was “not appropriate” to talk “about one’s family’s healthcare”. Only this week he also said at the CBI: “I grew up in an NHS family, it’s in my blood, and as your Prime Minister I will always protect an NHS free at the point of use.”
If Sunak does use private healthcare while he’s in Downing Street, he’s certainly more coy about it than Margaret Thatcher was. Back in 1987, she said she had private health insurance because it was “vital” for her to “go into hospital on the day I want, at the time I want, and with a doctor I want”. Some even use the argument that the use of private schools and hospitals actually helps the state, as if it were some tremendous act of altruism rather than the self-interest it really is.
By contrast, David Cameron put the NHS at the heart of his sell to the public. In Opposition, he declared at a party conference: “Tony Blair once explained his priority in three words: ‘Education, education, education.’ I can do it in three letters – NHS.” And on becoming PM he revealed how he had spent nights sleeping on the floor of various NHS wards where his disabled son Ivan was being treated.
Cameron also made a big point of letting it be known that he sent his daughter to a state secondary school (rather incredibly becoming the first sitting Tory PM to do so). Michael Gove, as Education Secretary, sent his daughter to the same school. For them, the personal was the political.
Sunak, however, has sent his two daughters to independent schools. His elder daughter attends an exclusive private boarding school, with annual fees of up to £41,250. Both his daughters attended a £22,350 a year prep school. The PM himself attended Winchester College, the fees for which these days are an eye-watering £45,000 a year.
Now, it’s worth saying that many Conservatives feel that any attempt to highlight the Sunak family’s health and education arrangements is not just deeply unfair but misjudges the public’s wider view of such private matters.
And it’s true that many of the public really haven’t had much of a problem with their PMs being wealthy or privately educated. Cameron’s Etonian background didn’t seem to hold him back, and Boris Johnson actively leaned into his poshness.
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Sunak can also legitimately make the case that his background is a story of aspiration, even if it’s different from Starmer’s. Whereas the Labour leader came from a more humble home to reach the heights of Director of Public Prosecutions and a knighthood, Sunak’s immigrant parents made sacrifices to give him his expensive education. And the public like aspiration.
The PM was not born into riches, and anyone who has met him will say that while he doesn’t pretend he can “walk in the shoes” of those much less well-off, he has a genuine commitment to spreading wealth and opportunity.
In some ways, the real test of any Prime Minister is not how they spend their own money but how much money they give to public services we all rely on. It’s precisely because he’s vulnerable to the charge of using private health and education that it was crucial that Sunak signed off an Autumn Statement that included big increases in funding for the NHS (£3.3bn a year) and schools – even if part of the money came from overseas aid cuts and elsewhere.
The real problem for him and for the Conservatives more broadly is that the increases are only making up for the public services austerity after 2010. Cameron and Gove’s use of state schools didn’t persuade them to give them the money teachers needed. And Cameron’s personal use of the NHS didn’t stop it being absolutely squeezed under his reign.
Figures from the House of Commons Library, the Nuffield Trust and the King’s Fund think tank show how flat funding was under Cameron. One of the starkest charts shows how it took until 2018 to even start building back cash lost. Education too was hammered in the first half of the last decade.Schools are only just returning to 2010 levels of per pupil funding.
Although health is finally getting money it now needs, it has huge workforce capacity problems, insufficient hospital beds and lack of diagnostic tech that are the root cause of waiting lists and other delays. If flu and Covid hit hard this winter, that underfunding will come home to roost.
There’s also the question of just how much faith in our public services Sunak really has. The Prime Minister risks giving the impression that he doesn’t think our state schools or state-funded healthcare are good enough for his family – but are good enough for the rest of us. Despite the much-needed new cash, personal actions really can speak louder than public words.
But it’s the historic lack of funding that makes any personal use of private health and education more toxic. People have turned to private healthcare (one in ten in the last 12 months) out of desperation, not desire. Most see it as a breach in their social contract with the state. Going private is an indictment, not an endorsement, of the government’s record.