Context
As of May 2024, the waiting list for hospital treatment stood at a staggering 7.6m people and while this had been exacerbated by the backlog from the pandemic, there is evidence that shows the waiting list was on the rise prior to 2020. For example, between 2012 and 2019 the waiting list rose by 2m people which was an increase of 74 percent. Furthermore, trends overtime have shown a noticeable decline in the budget for health care. The budget for spending on the NHS by the end of the last Labour government sat at 5.5 percent of total government spending, falling to as low as 1.1 percent during the coalition period, and rising to 2.8 percent during the Conservatives’ time in charge.
One of Keir Starmer’s five key missions for government is cutting the NHS waiting list in England and upon Labour entering Parliament after a resounding victory in July, Health Secretary Wes Streeting expressed how he would take a pragmatic approach to tackling the issue. This includes using spare capacity within the private sector to cut the backlog, arguing that failure to do so would be a “betrayal of working class people who cannot afford to pay for care”.
Streeting’s Approach
The previous government indicated that they would oversee the opening of 13 new community diagnostic centers across the country to take on just under 750,000 scans, checks, and tests every year. The facilities would operate under a hybrid model through which the private sector owns some of the facilities (but would remain free for patients) and the NHS would own the rest. The private sector centers would mirror the NHS in the way they are run on a day-to-day basis, however the staff would be employed by the private operators who would also enjoy ownership over their buildings. The new Secretary of State for Health and Social Care Wes Streeting responded to this plan saying that the Government should be using the private sector more, leading to the Labour initiative of using this to help cut the waiting lists.
Other ways in which the private sector would be harnessed include using data from private health providers to highlight where they could take on more NHS patients to help clear the backlog, along with training junior staff. It is worth noting that aspects of healthcare such GPs have always been classed as independent contractors despite still being a part of the NHS so this concept isn’t entirely unfamiliar.
Clinics and hospitals in the UK also operate privately as well as publicly, with some services in the private sector still being free at the point of use for patients under the NHS, and others such as dental clinics being fully privatised. In response to criticism of his plans for a closer relationship between the NHS and the private sector, Streeting has accused “middle class lefties” of “ideological purity” and asserted that over his “dead body” would the NHS become fully privatised.
Over its 75-year existence, the discussion regarding how to fix the NHS has been a recurring topic, therefore unsurprisingly this is not the first-time reform involving aspects of privatisation has been suggested. Consequently, it’s important to consider what implications such reforms could have on the service as a whole.
Possible Implications
In 2012, as part of Andrew Lansley’s reforms to healthcare through the Health and Social Care Act, multiple arm’s-length and statutory bodies were created to de-centralise control of the NHS from Government, enabling greater local enterprise and autonomy. This involved intentional commercialisation and marketing of the health service to encourage competition, with the hope of driving down costs. This approach led to the creation of what is now known as NHS England, a commission board that oversees the NHS, to regulate and prevent anti-competitive behavior, as well as new bodies such as the Trust Development Authority, who were tasked with getting hospitals and services up to the level of foundation trusts.
The consequence of these reforms was the fragmentation of the NHS structure, closure of essential services to cut costs, and a demoralised workforce, leading to a nation that was sicker than its European counterparts. This is an outcome that Wes Streeting and the Labour party would want to avoid when merging with aspects of the private sector. Streeting’s reforms could arguably leave the NHS in a worse position and unprepared for future strains on the service, such as another pandemic. When reflecting on the 2012 reforms, Peter Thistlethwaite, Former editor of the Journal of Integrated Care, argued that some things were still “best done centrally” such as “setting standards of care, approving new drugs, planning medical training, securing adequate finance”.
Looking Back
The New Labour government (1997-2010) also explored aspects of privatisation in the healthcare space. In 2000, the then Health Secretary Alan Milburn signed a ‘concordat’ that allowed NHS trusts that were under heavy strain, to delegate simple elective cases to private hospitals for treatment. What seemed like a plan to lighten the load, led to resistance from the supposed beneficiaries as costs rose to 40 percent higher than equivalent NHS costs. Furthermore, it was later revealed that there were differences in pay, as Independent Sector Treatment Centres (ISTCs) were paid irrespective of whether patients turned up or not, whereas workers in NHS Trusts were paid by results and despite dealing with simpler cases, ISTCs were paid 11 percent above the NHS average.
Despite satisfaction levels within the NHS being at their highest under the New Labour government (70 percent of people were very satisfied with the NHS in 2010), it’s important to consider how that didn’t come without internal resistance and dissatisfaction, something which Wes Streeting and his department will have to consider and potentially deal with, as they implement reform.
About Dods Political Intelligence
We provide intelligence, insight, and impact through a comprehensive suite of policy tools. Our services comprise of three main elements:
- Intelligence – Dods Monitoring – our platform offers real-time alerts, diaries and legislative trackers, inhouse parliamentary coverage, and a powerful historical search function of policy information from over 13,000 sources in the UK, EU, France and Germany.
- Insight – Dods Consultancy – our sector-specialist consultants provide analysis, bespoke research, and impartial guidance on the latest policy developments and trends.
- Impact – Dods People – our constantly updated database of biographical and contact information for UK and EU parliamentarians, the digital version of the original who’s who in politics established in 1832, enables you to identify and address the right policymaking audience.
For further information and to request a complimentary trial, visit www.dodspoliticalintelligence.com or contact us at: customer.service@dodsgroup.com
UK customer service +44 207 593 5500
EU customer service +32 274 182 30
Political monitoring. Set apart by heritage, personal touch and breadth of coverage.