“Streeting and Keir Starmer announced Labour’s new “partnership” deal with the private sector. This could mean funnelling an extra £2.5 billion a year out of the NHS into private pockets.”
John Lister, founder member Keep Our NHS Public, co-founder and co-editor of The Lowdown, reviews Starmer’s first year in office, picking apart the Government’s NHS plans and their continued use of the private sector.
July 5 should have been a day for celebration: the first anniversary of Labour’s dramatic landslide victory in the 2024 general election, and the 77th birthday of an NHS that we hoped it would have rescued and begun to restore after 14 years of austerity funding and disastrous privatising ‘reforms’ at the hands of Tory governments.
Instead, we see Labour governing as “Tory-lite.” We’ve got the same old delays in A&E departments; the same hospitals still crumbling for lack of maintenance; waiting lists still stubbornly above 7.3 million; thousands of newly qualifying midwives, nurses and physiotherapists unable to find jobs while local services are short-staffed – and Labour still in denial of the scale of the underfunding of the NHS from 2010.
The Ten Year Plan, due some time soon, was not promised in last year’s Manifesto: but it has been built up by ministers as a key moment in which Labour’s much-vaunted “reforms” would be spelled out. Given the limited extra cash Rachel Reeves was willing to offer it was obvious the Plan could not deliver much change.
But it’s worse than that: the editor of the Health Service Journal, having seen a leaked draft, summed up: “We have seen the government’s 10-Year Health Plan: it is a mess”.
This Plan was leaked in the midst of a succession of abrupt and contradictory zigzags in policy, including plans first to halve the staffing, and then to abolish NHS England; and to cut the number of Integrated Care Boards (the bodies that currently hold the purse strings for local health services) from 42 to 28, and halve their staff and running costs.
Almost all acute hospital trusts also face a double whammy of having not only to make drastic “efficiency savings” to hold down spending, but also cutting their overhead costs.
Thousands of jobs are being axed, many of them the “non-clinical” staff who are key to clinical staff being enabled to work efficiently. Tens of thousands of NHS staff are distracted by worry for their own future.
Health and Social Care Secretary Wes Streeting is determined to copy many of New Labour’s extravagant “reforms” from 2000-2010, bringing back the separation of purchasers and providers, and re-creating a new competitive market.
But what he cannot replicate is the decade of substantial above-inflation funding, which made it possible back then to deliver improved quantity, quality and accessibility of services… despite wasting hundreds of millions on stupid “reforms.”
In January, after years in opposition criticising Tory governments’ failure to make more use of the private sector to provide services for NHS patients, Streeting and Keir Starmer announced Labour’s new “partnership” deal with the private sector. This could mean funnelling an extra £2.5 billion a year out of the NHS into private pockets.
Wes Streeting’s mentor, former New Labour Health Secretary Alan Milburn, after 20 years of lucrative private sector work, has been put on the board of the Department of Health and Social Care.
Milburn’s idea of Foundation Trusts (later welcomed and built upon by Tory Health Secretary Andrew Lansley, who gave FTs additional ‘freedom’ to increase private patient income to half their total income) is being revived, giving FTs even greater “freedoms” – even in some areas to take charge of local health budgets and act as “accountable care organisations.”
Foundation Trust status from 2004 was only initially open to the best performing (and most financially sound) NHS trusts, as assessed through a system of ‘star ratings’. Now Streeting is establishing a ‘league table’ system of ratings, again consistently favouring and rewarding the best equipped, best staffed and best financed trusts.
The suggestion that some hospitals’ financial standing would be tied to patient satisfaction, with the possibility of failing trusts being paid less, has been swiftly condemned by the NHS Confederation, which warned that hospital trusts could be “penalised for more systemic issues, such as constraints around staffing or estates, that are beyond their immediate control to fix.”
Even more complex and controversial are suggestions that A&E departments’ funding might be tied to success in reducing waiting times, and the extent to which more care was shifted out of hospitals. This plan was revealed just three weeks after a Plan for Urgent and Emergency Services 2025/26, which in turn came out just AFTER trusts had decided on their plans and budgets!
Most NHS hospital trusts have no control over under-funded community health and primary care services, and even less say over social care provision, all of which are vital to ensure patients who need some support can be discharged from hospital, freeing up the ‘flow’ through A&E.
Two things stand out among the main “innovations” we have heard about so far.
Firstly, all of them would worsen health inequalities by rewarding trusts which are already the most successful, and penalising those that are already struggling to cope. A cash hand-out for the richest, a kick in the nuts for those that are failing. This plays strongly with neoliberals, but is an appalling way to plan or improve services.
And second, all of them mean even less transparency and accountability of the NHS to local communities, with fewer ICBs covering much larger populations; more trusts merging; Foundation Trusts potentially freed of the need to have (or listen to) governors; plus the planned abolition of the (largely toothless) Healthwatch England and local Healthwatch organisations.
It’s worth remembering that Healthwatch is the last historic remnant of the national network of Community Health Councils which for 30 years had statutory rights, resources and powers to represent local communities and patients throughout the NHS – and were abolished in England by Alan Milburn’s bill establishing Foundation Trusts.
It seems the past is coming back as both tragedy and farce – and the NHS is only clinging on thanks to the sacrifice and dedication of its staff.
- Over the next period, Labour Outlook is running a series of daily articles, reviewing one year of the Starmer Government across different key areas.
- John Lister is a founding member of Keep Our NHS Public and co-editor of The Lowdown. You can follow him on Twitter/X here.
- If you support Labour Outlook’s work amplifying the voices of left movements and struggles here and internationally, please consider becoming a supporter on Patreon.
