Wes Streeting turns 40 this weekend, so he has been steering clear of the debate on whether cake should be allowed in the workplace. “You’ve caught me red-handed,” the shadow health secretary laughs. “Tom in my office has brought in shortbread for my birthday.” Instead, he has spent much of the week defending plans for change in the NHS, with many on the left concerned they will lead to more privatisation. “Keir Starmer has joined the right in calling for ‘reform’ of the NHS,” the veteran leftwinger Diane Abbott tweeted. “We all know what that means.” But Streeting is unflinching. “The left surrenders the word ‘reform’ to the Conservatives at our peril,” he says. “Why was the Labour party set up more than 100 years ago? It wasn’t to defend the status quo. It was to reform the way our society works, the way our economy works, to build public services that work, to change things. “Reform is not a Conservative word. In recent elections, the left has given a lot of people the impression the answer to everything is to pour more money in. Of course investment is needed in the NHS, but ask any patient about their miserable experiences and it’s partly about culture and systems. That’s got to change too.” Streeting denies that reform automatically means more privatisation. “Not at all. My mission is to make sure the NHS Labour built 75 years ago, publicly funded, free at the point of need, survives the next 75 with those core principles intact.” He maintains that Labour’s plan to use the private sector to help tackle NHS waiting lists is a short-term measure that it will use “begrudgingly” to get through the current crisis. Longer-term, he wants the NHS to be “so good that people never have to go private”. The only role he wants the private sector to play in it is developing life sciences and technology. Yet Streeting is relaxed about senior politicians opting out of the NHS, after the row over Rishi Sunak going private. “Yeah. I’m not going to attack them for their own private healthcare. I am going to attack them for the way they have buggered up everybody else’s healthcare,” he says. “The reason I’m angry with Rishi Sunak is that he seems to settle for lower standards for other families that he would never tolerate for his own.” Streeting has admitted to using private healthcare, to which he had access as a student working for Comet. His treatment for kidney cancer over the last few years has shown him the true value of the NHS. He had a follow-up scan last month and was given the all-clear. While Labour’s plans for a dramatic expansion of the NHS workforce, paid for by abolishing non-dom tax status, have been broadly welcomed, its proposal for reforming GP services, in particular self-referrals, has provoked criticism from doctors. “Self-referral wouldn’t be appropriate in the majority of cases for the majority of conditions,” Streeting says. “But we’re trying to create more front doors in the NHS so that patients can get seen faster and reduce pressure on GPs.” He wants to stop patients “bouncing around the system”, wasting their time and taxpayers’ money, so in areas where it is “clinically appropriate”, such as gynaecology, ophthalmology and physiotherapy, they should be able to self-refer. “This is part of my frustration sometimes with the conversation around reform,” he says. “There are some people in the medical profession who threw up their arms in opposition immediately on hearing the idea mentioned. But it already happens in some cases.” Labour has announced plans to overhaul routes back into work for sick and long-term unemployed people, and the NHS will play a key role in getting patients treated and off waiting lists. “That’s 3.5 million people being held back from living their lives to the full. That is the cost of an NHS that is not delivering the standards of care patients deserve.” Starmer has put prevention at the heart of his plans for the NHS. But is Streeting worried about being accused of nanny-statism? “We don’t want to be the finger-wagging, pious people in the corner or become the fun police,” he says. “I do think we need to take more responsibility about our own diets, our own exercise, and the government’s got to help create the conditions in which people can do that. But we’ve also got to be careful as politicians that we don’t veer too far into the realms of banning people from doing nice things that they enjoy.” However, Labour plans to look at a “whole range” of public health measures this year, including consulting on phasing out smoking for young people, as in New Zealand. Other areas under consideration include minimum alcohol pricing, and the soft drink and junk food industries. Assisted dying is another contentious issue that could end up on his desk, with Scotland and France on their way to passing right-to-die laws and New Zealand and Canada among countries that already have them. Streeting voted in favour of the assisted dying bill in parliament. “This will always be a conscience issue. As an Anglican, I still feel conflicted about it, if I’m honest,” he says. “I’ve been persuaded through talking to families affected that people should have the choice and dignity through dying. As long as we can have the right safeguards in place.” But the most immediate issue is strikes. He is frustrated by what he sees as government intransigence, urging ministers to break the deadlock before the NHS faces more disruption. “It doesn’t need to be this way. They’re still refusing to have serious pay talks,” he says, with the Department of Health and the Treasury locked in disagreement over which funds a one-off payment for this year that insiders believe is inevitable. Streeting backs the unions for refusing to engage with next year’s pay process until this year’s is settled. The next Labour government would review the public pay review bodies that set salaries for workers, he says. “It’s one of the things we would be prepared to look at. How do we build confidence in the independence of the pay review body process? Clearly it’s not working.” He would work with unions to establish whether ministers should appoint members, set its remit and ultimately decide whether to accept recommendations. He warns that failure to reach agreement with the unions will further damage the NHS. “The risk isn’t simply that nurses walk out for a day, it’s that they walk out completely. The government has got to see these pay negotiations as [being as] much about retention as about cost of living pressures.” Streeting believes the extra money should come from the Treasury. “It’s hard to see how Steve Barclay will find money within existing NHS budgets which are already under pressure,” he says. “It does feel like a lot of this is about government positioning and Jeremy Hunt wanting to present himself as an iron chancellor. Why should NHS staff expect to be treated unfairly because the Conservatives have a credibility problem on the economy?”