16.01.2025

Wes Streeting (left): relying on profiteers

Where the Tories left off

The ‘elective reform plan’ clearly indicates that NHS privatisation and general deterioration will continue under this current iteration of government, writes James Linney

On January 6 Sir Keir Starmer headed to a surgical hub in Epsom to unveil Labour’s ‘elective reform plan’ - the party’s proposals for reducing the colossal National Health Service waiting times for non-emergency ‘elective care’ medical treatment.

There are currently 7.5 million cases on waiting lists, representing 6.28 million individual patients awaiting treatment; 3.1 million of these people have been waiting more than 18 weeks, with significant numbers (234,900) over a year.¹ Labour has pledged that by the end of this financial year 65% of patients will not have to wait more than 18 weeks for treatment and that by the end of this parliament 92% will be meeting this target - a target that has not been met since 2015.

The reform plan, we were told by Starmer at the conference, included opening more diagnostic centres; increasing the use of specialist consultant advice and guidance access for general practitioners to avoid patients having hospital appointments; expanding the use of the NHS App, so patients can check how long waiting lists are or pick alternative hospitals for their care; the use of AI in healthcare provision; and extending the use of private hospitals to provide elective care and operations.

Let us look at each one of these measures in turn, because, on the face of it, primarily focusing on bringing down waiting times and even the measures being forwarded in this plan sound fairly reasonable. Starting with the opening of more diagnostic centres - not a new idea, as has been pointed out by opposition MPs - this is basically a ‘copy and paste’ Tory policy, but, even so, more easy access to scans and other investigations for GPs without having to wait for hospital consultant appointments is not a terrible idea. The problem is that this is not really going to impact the overall workload in any meaningful way.

GPs already have direct access to most X-rays and scans, without having to wait too long to get them. More invasive or specialist investigation might be restricted to specialist consultants, but this is for a good reason: GPs are not specialists, and the problem with carrying out specialist diagnostics is that GPs still rely on hospital specialist teams to interpret the results and treat the patients, so they are still going to need hospital appointments.

Getting GPs to directly access more specialist tests shares the same problem with the second proposal of Starmer’s reform plan - ie, allowing GPs to access hospital consultant advice and guidance without the need of a formal appointment. This will mean 800,000 fewer hospital appointments, we are told, but in reality this is not actually reducing work: just transferring it from secondary (hospital) care to primary (GP) care.

As everyone knows, GP surgeries are currently in just as much of a crisis as hospitals. Proportionally, primary care has had its funding squeezed even more than other areas of the NHS - this, along with the severe staffing deficits and increasing demand for appointments, has left many GP staff burnt out and surgeries having to close down, and many more on the brink. The most recent GP contract proposal is only going to make the situation more dire and has forced GPs to vote to take industrial action, which started back in June 2024; we will likely see GPs vote in favour of renewing this collective action in the coming months.

Privatisation

Moving on to Labour’s proposal to use more private companies to provide elective care, such as operations, this should not come as any surprise - Labour has been promising to do this ever since Starmer became leader. Courting the private health industry has been one way he has been able to signal to the capitalist class in general that his leadership, and the subsequent purge of Labour’s leftwing membership, means a final end to Jeremy Corbyn’s ‘threat’.

Thus we are told that Starmer wants to make private health access to the NHS “broader” and more “comprehensive”. He frames this as a necessary and practical way of giving “working people” more choice and reduced waiting times and tells us he is not going to let anything as ridiculous as “ideology” get in his way. This contempt for ideology is another manifestation of Starmer’s one real obsession - his continuing crusade against the left. Of course, he and his health minister, Wes Streeting, are hardly setting aside ideology: they are simply choosing an alternative ideology - one where they do not just continue the Tory privatisation of the NHS, but actually supercharge it.

When Wes Streeting was challenged about this increase in private healthcare, he responded: “I’m entirely pragmatic about this … The independent healthcare sector isn’t going anywhere, and it can help us out of the hole we’re in. We would be mad not to.”

He went on to reassure us that the private health sector is going to have to “pull its weight”. Clearly he knows that private health has only one objective here: profit accumulation. So we cannot put his ridiculous statement down to stupidity or naivety - this can only be wilful deceit. Both Streeting and Starmer rarely talk about their reforms without reminding us how dedicated they are to the NHS, and how they will ensure it remains free at the point of use. It is indeed unlikely that Labour would introduce NHS charges, but clearly, expanding of the transfer of public funding directly to private health companies is just another way of privatising the NHS, and it is the “working people” (working class) who will continue paying for this, while their health deteriorates.

Even in the short term, the private sector’s ‘help’ in reducing waiting lists, which might help Starmer claim he has met his targets (although even this is unlikely), is clearly harmful to the NHS and its patients. As the Centre for Health and the Public Interest, which tracks NHS privatisation, has said, “Put simply, private hospitals are unable to deliver any operations without using NHS consultant surgeons or anaesthetists … Letting NHS consultants do the easy work in the private sector starves the NHS of both staff and income.”

In the reform plan announcement Starmer claimed the proposed increased use of private health will save the NHS as much as a million extra appointments a year. This would mean a 20% increase in private health’s NHS appointment provision (which already sees them provide about five million outpatient appointments, diagnostic tests and operations a year) and represents an extra £2.5 billion a year in government funding for private care providers.² As Dr Tony O’Sullivan, co-chair of Keep Our NHS Public, has said, these reform proposals are simply “feeding the parasite [which] undermines the health of the NHS host”.³

Regarding artificial intelligence, we have recently heard that Sir Keir wants Britain to become a ‘world leader’ in AI technology, and he plans on this becoming a major player in the NHS - providing technology that “works for the patient”. He was very light on any details, but we must be highly suspicious. This new technology will likely be another avenue through which private companies (this time big tech) get NHS funding, whilst not working ‘for’ patients but mining their data to sell it on to the highest paying interested party.

One thing very evident at the tightly managed, media-friendly event on January 6, which took place at a calm surgical hub, surrounded by hand-picked staff and media pundits: it was far removed from the reality of the NHS emergency rooms and packed wards up and down the country. On the one hand, Starmer promised us an NHS using AI to give patients personalised, high-tech healthcare at the touch of a button. On the other, in emergency departments up and down the country suffering and dying people are stacked up in corridors or strewn across waiting room floors for hours or even days, like victims of some kind of war.

The current winter season is leaving hospitals up and down the country on the brink of collapse, with more than 20 hospital trusts declaring ‘critical incidents’ in the past week due to the extreme pressure. A critical incident indicates that care is beyond the capacity of a particular hospital service and thus it will be unable to function normally. Usually this means having to discharge patients earlier than planned, cancel elective operations or divert patients to other hospitals. Such incidents have been normalised over the past decade. Normalised too are the astronomical accident and emergency waiting times, which are now often routinely above 12 hours. Recently the Royal Liverpool University Hospital reported waiting times of up to 50 hours. It has been estimated that A&E waiting times are associated with 14,000 excess deaths a year.⁴

Ambulance response times are just as harmful. As The Guardian reported, “Paramedics in England are unable to respond to 100,000 urgent 999 calls every month because they are stuck outside hospitals waiting to hand over patients, endangering thousands of lives.”⁵

Continuation

With these truly horrifying statistics in mind, let us remind ourselves that Labour’s October budget failed to include any additional support to mitigate this winter’s crisis. Additionally we heard last week that Labour now intends to delay its promise to try to help rescue adult social care until the completion of an independent commission in 2028 - by which time there might not be much left to reform.

Social care is in an even worse state than the NHS. Those too frail or sick to look after themselves have been getting sub-standard care for years, while care staff are woefully underpaid, overworked and not given the training they need. This commonly leads to people being neglected and vulnerable to deterioration. Those with social care needs often spend long periods in hospital, because of the lack of adequate care provision available in the community - all of which severely exacerbates the shortage of NHS beds.

In the media we have heard much about the ‘quademic’ - a term used to highlight relatively high levels of four circulating winter infections: influenza, respiratory syncytial virus, covid and norovirus. It has also been a year of high levels of flu: there were on average about 5,400 patients in hospital each day last week as a result. Although this clearly is a bad year for winter viruses, the numbers are not particularly unusual or unexpected. Flu infections vary each year and a bad year like this one happens fairly often - if, say, infections start earlier in the season or the flu vaccine has a slightly lower effectiveness against this season’s strain.

But let me be clear: the current crisis is not due to the ‘quademic’ or the recent bad weather - these are predictable, fairly normal seasonal variations and should not bring our health service to its knees. The problem lies with the state of the NHS - the continued and unrelenting defunding, which has taken place over the past 15 years, the lack of investment in replacing and expanding staff and the transfer of NHS resources to private health companies. None of these problems are touched on in Labour’s ‘elective reform plan’, but sadly there is plenty here to suggest that the NHS will continue to be treated no better under the current iteration of government than it was under the last l