“Andy Burnham gave us the test. On health, his government is not yet passing it. The good news is that the answer sheet has been in Labour’s possession for seventy-eight years.”
By Rathi Guhadasan, Socialist Health Association
When Andy Burnham promised that his new constituency of Makerfield would be a “touchstone”, not a stepping stone, he gave British politics a new organising principle. The Makerfield test asks a single, deceptively simple question of every government policy: will this work for the people of Makerfield and for communities like it across the country?
For those of us campaigning for the right to health and healthcare, there is no better test – and nowhere does the test hit harder than on health. Healthy life expectancy is in freefall, now below state pension age in over 90 per cent of local areas, with an almost twenty-year gap between the wealthiest and poorest places. The people of Makerfield sit on the wrong side of that divide: shorter lives, more years in ill health and greater dependence on those parts of the NHS that have been in managed decline for decades. So, let’s take the Prime Minister at his word and apply his own policy to Labour’s health policy as it currently stands.
Waiting lists: data housekeeping, not patient care
“Bringing down waiting lists” – ostensibly Labour’s flagship policy and oft-cited achievement. As we set out in our response to Wes Streeting’s resignation letter, the celebrated 110,000 drop in March 2026 overwhelmingly comprised “Unvalidated Removals” — analysis by the Lowdown found that 90,000–100,000 of those patients were removed from the list for administrative reasons rather than because they were treated. NHS England paid trusts over £18.8 million — £33 per patient removed — for “validation” exercises between April and September 2025, during which more than half a million people were deleted from waiting lists although 10% fewer operations were carried out. This is not patient care; it is statistical housekeeping, financially incentivised. On this trajectory we will enter the next General Election with a waiting list still in the millions. For a Makerfield resident waiting for a hip replacement, the question is not whether the national spreadsheet looks marginally better, but whether they can be treated before their condition — and their ability to work — deteriorates.
To compound matters, the remedy – outsourcing elective treatments to private providers – worsens the disease. Peer-reviewed research links NHS outsourcing to excess preventable mortality; it widens inequality, with the poorest patients — those with the greatest need — waiting roughly twice as long as the most affluent; private provision of hip and knee surgery is associated with longer NHS waits, as private providers cream off straightforward cases utilising NHS-trained staff; and outsourced cataract surgery — with profit margins of up to 32 per cent — is decimating in-house NHS eye units that provide the only access to sight- and life-saving treatment for serious eye conditions. Every £1 of NHS money converted into shareholder profit is a pound not spent on NHS capacity — while the two-tier drift pushes those who can pay into the arms of Bupa, leaving those who can’t on stagnant lists.
The emergency care crisis
If the Makerfield Test means anything, it means asking what happens when a loved one collapses at home on a Friday night. The answer, in 2026, in one of the world’s wealthiest and largest economies, is shameful. In April 2021, 521 patients waited more than twelve hours on a trolley after a decision to admit; by April 2026 that figure was 47,750 — an over 90-fold increase, and a further 7% deterioration from the year before. The Royal College of Emergency Medicine associates more than 300 deaths per week in 2025 with long A&E waits — nearly ten times the 2015 figure — and we do not have a policy for that.
This crisis is the direct consequence of decades of A&E closures and downgrades concentrating pressure on the remaining units, a depleted and traumatised workforce, the substitution of doctors with cheaper, less-qualified replacements such as Physician Associates — a policy which carries genuine patient safety risks, and the absence of a National Care Service to allow patients to leave hospital safely. Emergency care is high-risk, complex and expensive, so the market does not want it — which is precisely why it must be publicly provided, publicly funded, and properly staffed by fully qualified clinicians.
Maternity scandals: reviews are not a policy
Maternal mortality is at its highest level in almost two decades, with the UK falling behind comparable countries and disproportionate risk borne by Black and Asian women and those from deprived communities. Maternity services remain in crisis: chronic midwifery understaffing, the continued closure and downgrading of units, and a review culture — the Amos review being only the latest — that documents failure while the recommendations of previous reviews go unimplemented. A health policy that cannot guarantee all mothers a safe birth in a fully staffed NHS unit does not pass any test.
Corporate capture: PFI, Palantir and the US drugs deal
Three further health policies that fail the test. Firstly, the “from-hospital-to the-community” shift of the Ten Year Plan is set to be funded through Private Finance Initiative (PFI) -style schemes for Neighbourhood Health Centres — even though the original PFI left the NHS with £44 billion in outstanding debts, trusts repaying roughly six times the original investment, and a projected £80 billion bill for buildings worth £13 billion. This is crippling Trusts, who in some cases are paying more annually in historic PFI debt than on nurses or medicines.
Secondly, the £330 million Palantir Federated Data Platform contract persists despite poor uptake by Trusts across the country, with many reporting inferior functionality to their existing systems and substantial hidden costs. The Government has the opportunity to act in the best interests of its citizens by exercising the contract’s break clause when it becomes available in February 2027 and invest instead in a sovereign, publicly led digital stack.
Moreover, its much-publicised push “from analogue to digital” must be matched by targeted investment in non-digital healthcare delivery for low-income and vulnerable households who use the internet minimally or not at all.
Thirdly, the US-UK pharmaceutical deal commits the UK to doubling spending on new medicines from 0.3 to 0.6% of GDP by 2035 — potentially £9 billion a year — while weakening the price thresholds that protect NHS budgets. None of this delivers a single benefit to the people of Makerfield. All of it extracts from them.
Underlying everything is the money: in 2024, the BMA calculated a real-terms NHS funding deficit of £423 billion. This is compounded by a repair backlog now approaching £16 billion – in many cases putting staff and patients at risk – and a health workforce on the frontline of a cost-of-living crisis who urgently need their pay brought in line with current inflation.
The agony and promise of social care
This brings us to Burnham’s first big health announcement as Prime Minister. We agree with him that past decades of inaction were a “major dereliction of duty” and care workers should be among the best paid in society rather than the worst. We welcome the pledge to expand the fair pay agreement into wider workforce reform.
However, a former Health Secretary who published a White Paper for a National Care Service in 2010 does not need another review to know what is required — and as we said of maternity, successive reviews without implementation are not the answer. Moreover, Baroness Casey has already signalled there is “room for a mixed market” in care, even while criticising private providers for “profiteering”. You cannot lament profiteering and preserve the market that produces it. A National Care Service worthy of the name must be built on the NHS’s founding principle: publicly funded and publicly provided, free at the point of need, with a workforce employed on national terms rather than by private equity portfolios extracting returns from the bodies of the elderly. Paying care workers properly while leaving them employed by extractive providers is pouring public money through a very expensive sieve. And declining to commit to progressive funding postpones the honest argument the public appears readier to have than the politicians are.
What passing the test would look like
Here’s the good news for Mr Burnham and the Government: there is a policy programme that passes the Makerfield test on every count, and Labour already knows what it is, because Labour implemented it in 1948 (with some help from the SHA!). Reinstatement of the NHS as a fully publicly provided, publicly owned, fully funded and fully free service, available to all on the basis of need. Concretely, that means:
- Restore the duty of the Secretary of State for Health to provide comprehensive care, re-establishing universal responsibility for health and for reducing health inequalities, and strengthening ministerial accountability to Parliament.
- Abolish the purchaser–provider split introduced in 1990, replacing commissioning with area-based planning and provision on the basis of need, led by regional health boards with community and local authority representation — and strengthen Healthwatch’s independence and powers rather than abolishing it, as the Health Bill 2026 proposes.
- Remove market mechanisms and competition law from the NHS, with no requirement to tender services, an end to foundation trust autonomy (so that they are no longer expected to operate as independent corporate entities with their own fundraising requirements and commercial interests to protect – a situation which often drives decisions counter to the public interest) and providers reintegrated under regional boards rather than operating as independent corporate entities.
- End private sector involvement — including PFI, LIFT and MIM models, the proposed public–private partnerships for Neighbourhood Health Centres, and private equity takeover of public services — and rebuild the in-house capacity that outsourcing has hollowed out.
- Restore full funding and resourcing, closing the £423 billion real-terms deficit and the £16 billion repair backlog, alongside a fully resourced national care service.
- Reform the pharmaceutical value chain — publicly funded R&D linked to affordable pricing, compulsory licensing where needed, technology transfer with low-income countries, and termination or renegotiation of the US-UK drugs deal.
- Guarantee NHS digital and data sovereignty, with technology serving skilled professionals rather than replacing them, review and exit of the Palantir FDP contract, and targeted non-digital provision for those excluded by digital poverty.
The 10Y Plan’s “three shifts” should be recast in the same spirit:
- prevention means investment in the environmental and social determinants that drive nearly 20% of deaths (versus 2% from genetic factors), with a fully funded public health service, Sure / Better Start and healthy homes, not an overstated bet on genomics;
- the shift to community must build community and social care services in their own right, fully staffed and publicly provided, not as a means of saving hospital costs;
- and digital innovation must remain a tool – not a replacement – for clinicians who are no longer overstretched.
None of this is nostalgia. It is the evidence-based position — from which the people of Makerfield, who depend on the NHS more and can buy their way around its failures less than almost anyone, would benefit first and most.
Andy Burnham gave us the test. On health, his government is not yet passing it. The good news is that the answer sheet has been in Labour’s possession for seventy-eight years.
- Rathi Guhadasan is the Chair of the Socialist Health Association (SHA). The SHA has been promoting health and wellbeing through socialist principles since 1930 and has been affiliated to the Labour Party since 1931. You can join or support their campaign here.
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