The founding principles of the NHS have been breached. Universal access to healthcare – based on clinical need, available at the right time and free at the point of use – is less and less meaningful to the millions of people stuck on waiting lists. Over one million undocumented residents in the UK – 200,000 of them children – are denied free hospital and mental health care. Many people ineligible for free care cannot afford an NHS dentist, prescriptions or vision services. Some procedures important to patients, such as earwax removal, are now restricted or only available privately. Hundreds are dying each week due to delayed access to treatment along the acute pathway from home to hospital emergency care.
As outlined on the previous pages, successive governments have gradually nudged the NHS towards privatisation. Even before the Covid-19 pandemic, 18 per cent of total NHS expenditure on clinical care, including NHS trusts’ funds (but excluding GPs) was outsourced to the private and voluntary sectors and local authorities.
As with the wider pandemic response, parasitic private companies have been awarded contract after contract of public money. The controversial US company Palantir has won a £480 million contract for the NHS ‘federated data platforms’, controlling patient and other data across England’s 42 integrated care systems. Data rights campaigners have highlighted concerns about privacy, data sharing and the use of medical data for private gain – previous estimates have valued NHS patient data at almost £10 billion.
There is now a growing reality of a two-tier health system, with those who can afford it paying for their health care privately. Recent surveys suggest that one in ten adults have turned to the private sector for healthcare over the past year, with two-thirds of those doing so as a result of long delays or lack of access in the NHS. Now, in addition to the UK’s two-tier education system helping to maintain a class-ridden society, that society will in turn be served by a two-tier health system, exacerbating inequalities in life expectancy and years spent in ill-health.
As well as providing privileged treatment for those who can afford it, the private sector drains resources from the NHS. There is no separate set of qualified nurses, doctors or clinicians that it uses – they are NHS staff that have been taken out of the system of universal, public healthcare. The Labour Party is willingly blind to this fact as it promises to use spare private sector capacity to alleviate the pressures on the NHS. There is no solution to the NHS crisis without major investment in staff and facilities – you need only speak to NHS workers themselves to understand that.
Unfortunately, shadow health secretary Wes Streeting has already made it clear that he is no friend of health workers, telling The Telegraph in late 2022 that he does not agree with nurses’ pay demands and will take action on ‘hostile’ unions. Instead, he cosies up to private healthcare lobbyists, receiving tens of thousands of pounds in donations from backers of UnitedHealth and CVC Capital Partners. Both organisations unashamedly promote private sector involvement in the UK health ‘market’.
An alternative vision?
It is worth remembering that when New Labour left power, the NHS was regarded as one of the best healthcare systems in the world. Of course, that government also introduced problematic reforms to the healthcare system and even returning to those levels of funding will not solve many of the inequalities in NHS provision.
Take, for instance, the galling disparities in the risk of stillbirth, maternal and infant mortality experienced by black mothers in the UK. Or the discrimination experienced by trans people in the UK, of whom 41 per cent have said that healthcare staff lack specific understanding of their needs. Cash alone will not solve all of these complex problems, but it will certainly help.
Shadow health secretary Wes Streeting has already made it clear that he is no friend of health workers
Labour’s wider platform is sorely lacking a convincing vision, not just for the NHS but for wider public health. If we are to believe them, they remain committed to a ‘fair pay agreement’ (a form of collective bargaining) in social care, which should improve pay and conditions across the sector. Yet over 80 per cent of social care provision is currently in the private sector, and integration between a mostly public NHS and a fragmented private sector will continue to cause problems down the line. There is also very little detail on how the party plans to reform the parlous state of NHS dentistry.
Labour has also promised to move to a model of public health that is as focused on prevention as cure. This includes problems related to poverty, such as, for example, overcrowded housing, although campaigners have already noted that the party has not committed to capping rents in the private sector and its new deal for workers has been criticised by some unions for lacking the kind of radicalism that would truly transform work.
Only bold and transformative change can rescue the NHS from its current crisis. Yet these reforms cannot sit alone. Investment in social care, housing, education and good quality work all strengthen public health. Without a much wider approach, Labour risks tweaking around the edges of a crumbling system and letting our health suffer as a consequence.
This article has been amended from its print version to reflect the fact that Palantir has now won its NHS contract. The print version stated that Palantir was on the verge of winning the contract.