The Prime Minister began the first full week of 2025 by announcing an agreement between the NHS and independent healthcare providers which is intended to bring down waiting lists and help achieve an 18-week ‘standard’ for operations and other planned procedures. The measures put in place will, the Government claims, not only increase treatment capacity, but also offer greater choice for patients.
This is a vital task for Keir Starmer’s Government. The Labour Party’s election manifesto last year promised to ‘stop the chaos’ as part of its plan to ‘build an NHS fit for the future’, and that ‘Labour’s immediate priority on health will be to get a grip on the record waiting list’. This ‘grip’ means that ‘patients should expect to wait no longer than 18 weeks from referral for consultant-led treatment of non-urgent health conditions’.
Cynics might observe a few potential escape routes in the manifesto’s language: ‘expect’, ‘consultant-led treatment’, ‘non-urgent’. Nevertheless, with something like 7.5 million patients currently awaiting treatment, no-one doubts the scale of the challenge.
Starmer and his Health Secretary, Wes Streeting, know that involving the private sector will be controversial with those on the Labour Party’s Left and beyond: some are ideologically inimical to any involvement of the for-profit sector in delivering healthcare, while the phrase ‘creeping privatisation’ spurs others into reflexive conniption fits (for which the waiting list continues to grow). The Prime Minister, I suspect, perceives advantage in this, as he seeks to portray himself as a no-nonsense, practical champion of the public interest.
‘We will not let ideology or old ways of doing things stand in the way of getting people’s lives back on track… it would be a dereliction of duty not to use every available resource to get patients the care they so desperately need.’
Starmer desperately wants to be seen as a common-sense revolutionary. ‘Mission-led government’, he declared this week, ‘is about doing things differently’. Setting aside the fact that ‘mission-led government’ has so far been the dampest of damp squibs, it is simple nonsense to suggest there is anything new or groundbreaking about turning to the private sector to help address NHS waiting lists.
‘The NHS Plan: A plan for investment, a plan for reform’ set out a vision for healthcare which is almost exquisitely Starmerite in its language, and it included a ‘concordat’ with the private sector to increase capacity as well as the creation of ‘independent sector treatment centres’ (ISTCs) to carry out elective surgical and diagnostic procedures for NHS patients using private facilities. But the NHS Plan was published in July 2000, when Tony Blair was in his first term as Prime Minister.
These ISTCs were, in their own way, an admirable idea: the private sector’s capacity would be used – while remaining free for patients at the point of delivery – to undertake ‘bulk’ procedures which were routine and relatively low-risk, such as hip replacements, cataract surgery and MRI scans.
The devil was, as always, in the detail. When the House of Commons Health Committee examined the scheme in 2006, it found a number of problems (I oversaw the inquiry). The ISTCs were poorly integrated into local NHS structures, provided no medical training, had the potential to destabilise the finances of NHS bodies and did not fulfil some of the grander claims made for them, that they would promote innovation or efficiency.
The Government is committed to trying the same thing again: ‘a renewed relationship with the independent sector will help provide patients with a greater choice of providers for tests or scans, paid for by the NHS, so it remains free at the point of use’. This time, however, there are additional aims. The private sector will be charged with tackling more complex areas like gynaecology, and increasing provision for patients in socio-economically deprived communities.
Will this actually work? Private healthcare provision is often excellent, but its strength lies in dealing with relatively straightforward procedures, performed at high volume, and it depends on economies of scale. It can make a significant contribution to waiting times but cannot be a panacea. The agreement also overlooks the fact that many doctors and nurses in the private sector also work in the NHS, and cannot be in two places at once.
Unexpected emergencies are transferred to NHS facilities where they can be dealt with comprehensively. And the benefits of private provision in terms of elective care rely in volume, not on a wider governmental agenda of social and economic need. But the Government seems unwilling to acknowledge this.
Starmer has placed enormous hopes on this new agreement. We are told very clearly that these are not ‘targets’, but the private sector will contribute to the ‘aim’ of providing 2m additional procedures by July 2025 and to the NHS’s ‘roadmap to meeting the 18-week standard [for waiting times] this Parliament’. Does the public distinguish between targets, aims and standards, or are we anticipating another ‘working people’ fiasco?
This all feels very Starmerite. The Prime Minister has identified a problem, and a partial mitigation, but goes on to believe, through some mysterious process, that private enterprise will simply accommodate itself to his agenda and deliver what he needs at minimal extra cost. It was his mantra at the International Investment Summit last October. Is it too long after Christmas to advise that the proof of the pudding will be in the eating?
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