There’re many NHS problems Labour still needs to solve – but privatisation not the answer, doctors say

The government has hit a crucial NHS target early – but the health system still faces a “deep crisis”, campaigners have warned, and outsourcing to the private sector is “not the answer”.

Before the 2024 general election, Keir Starmer pledged that Labour would deliver two million extra NHS appointments in England in its first year.

The health service has met that target: between July and November last year there were almost 2.2 million more elective care appointments compared to the same period in 2023.

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Health and social care secretary Wes Streeting described the milestone as a “promise made, a promise kept”. But on Monday (17 February) morning, he told BBC Radio 4 that there is a “hell of a lot more to do.” 

Campaigners and doctors have agreed with this latter point. 

Julia Patterson, founder and chief executive of EveryDoctor, echoed the cautious praise – but stressed that elective appointments are only one metric of health system success.

“There are a few other metrics that aren’t getting enough attention,” she said. “For example, bed occupancy levels are at 96% which is really unsafe and extraordinarily high. We should run at 85% occupancy.”

“A very high number of these beds – one in seven of adult hospital beds – are occupied by people who are medically fit to go home, but they can’t go home, because we don’t have an adequate social care plan.”

Labour’s pledge to increase elective care appointments was included in a list of six first steps it would take in office. In the July to November period last year, NHS England carried out 31.3 million operations, appointments and tests – compared to 29.1 million over the same period in 2023.

The 2023 period coincided with a period of doctor strikes, limiting the number of available appointments. Labour attributed the latest uptick in availability to increased evening and weekend working – partly secured by its pay deals with doctors. 

Dr Emma Runswick, deputy chair of British Medical Association (BMA) council, said that these pay deals were crucial. 

“Government needs to remember how it got so bad: an understaffed, underfunded NHS that cut pay for its workers for more than a decade,” she said. 

“Last year’s pay deals for doctors showed that progress can be made. If this year’s pay awards continue to restore pay for doctors then fewer will leave for other countries, none will be forced into industrial action and progress on waiting lists will continue.”

Meanwhile, accident and emergency departments continue to struggle. The latest figures show 73% of A&E patients were treated or assessed within four hours in England in January – well short of the 95% target. Nearly 160,000 waited longer than four hours for a bed. 

This kind of wait can kill: In 2024 Lord Darzi published a report suggesting that the “awful state” of A&E causes an additional 14,000 deaths a year. 

Emergency physician Dr Jahangir Alom described the elective waiting list reduction as “of course” important – but it cannot be the government’s singular focus.

“It’s all about elective procedures,” he told Big Issue in December. “But those of us in accident and emergencies feel really demoralised. We are drowning.”

What is the government’s solution to these problems?

Earlier this month, the government set out plans to set up NHS hubs in community locations and to use the private sector to help reduce hospital waiting lists. 

Earlier this year, Starmer announced a 20% increase in the number of appointments provided by the independent sector. Handing private operators an extra £2.5bn a year – up to nearly £16bn – in government funding to do so.

“I’m not interested in putting ideology before patients and I’m not interested in moving at the pace of excuses”, the PM declared.

On radio on Monday, Streeting again signalled support for greater outsourcing of services.

“I certainly want more patient choice, more patient power, more patient control over where they’re seen, how they’re treated, the nature of their appointments,” he said. “I think there is a role for private investment, but the terms of those arrangements, that’s where you’ve got to tread really carefully. But I’m open to serious proposals from the NHS, or indeed anyone else.”

These ouvertures to private investors have spooked health campaigners.

Outsourcing is a “deeply worrying” trend, said Patterson. 

“If they truly want to rebuild the NHS in the way they say, they need radical reinvestment in our public service. They need to stop funnelling money into the private sector that could be spent rebuilding public capacity.” 

The NHS has been increasingly privatised since 2012, when the Tory’s Health and Social Care Act required that all NHS contracts be put on the ‘open market’ for private sector bidding.

It’s worsened healthcare, research shows. A recent University of Oxford study published in Lancet Public Health has linked NHS privatisation to the preventable deaths of 557 people.

Diarmaid McDonald, director at patient advocacy group Just Treatment, described the logic behind outsourcing as “misguided”.

“It will ultimately undermine the NHS as a public service, it will make it less efficient and less safe,” he told Big Issue.

Private hospitals now carry out almost one in five health service-funded operations on people stuck on the waiting list. But private ‘spare capacity’ relies on NHS staff and funding to resource their expansion,” McDonald added.

“There is no way that the private sector can deliver NHS care without basically poaching NHS staff. And whenever privatisation is pushed within the system, private providers cherry pick the most cost-effective, profitable interventions, which mean that the NHS provision that’s left behind is picking up the most expensive, most complicated care.”

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