With no long-term NHS workforce strategy on the horizon, the government’s default policy on slashing elective waiting lists – pushing more NHS patients towards private hospitals dependent on NHS-trained staff and with only 8,000 beds – seems driven by nothing more than political dogma. How else to explain the 133,000 vacancies, with at least 12,000 hospital doctor and 50,000 nursing and midwife posts left unfilled, that remain across the health service?
Rishi Sunak’s ‘elective recovery taskforce’ project, launched two months ago with the aid of Circle Health and the Independent Healthcare Provider Network, fails to address the lack of a workforce strategy, and is likely to end up just augmenting the four-year £10bn elective surgery deal with the NHS that the private sector already enjoys.
Last year the BMA concluded that this earlier recovery plan was set to significantly increase the outsourcing of services to private providers, in the process threatening “the clinical and financial viability and sustainability of the NHS”.
NHS procedures being carried out by the independent sector is, of course, nothing new. Before the pandemic, commercial operators were already responsible for a third of all state-funded hip operations and a quarter of knee replacements, as well as more than 20 per cent of gastroenterology, trauma and orthopedic NHS treatments – and soaked up more than 20 per cent of CCGs’ budgets in the process. Pressure group We Own It more recently estimated that NHS trusts’ spend on independents rose by 659 per cent between 2012 and 2021.
And Labour, despite last September’s launch of the party’s ten-year plan for the NHS, continues to bear some responsibility for the independents’ ascendant position within the health service. As the Health Foundation wryly noted last year, ISPs (independent sector healthcare providers) have been delivering NHS-funded elective care at ‘independent sector treatment centres’ and private hospitals since the early years of the Blair administration.
That perhaps goes some way to explaining shadow health and social care secretary Wes Streeting’s revelation on LBC back in December, when he told listeners that he would be prepared “to use the private sector to bring down NHS waiting lists faster”.
But nevertheless, Labour’s ten-year plan does actually address the workforce issue head-on, offering a commitment to raising the numbers of district nurses and health visitors, as well as nursing and midwifery clinical placements. As part of this strategy – to be paid for by reintroducing the 45p additional rate of income tax for those earning more than £150,000pa – the party is also promising to double the number of medical places each year.
For the moment however – at least until the general election next May – waiting lists will continue to grow and the independents will continue to make money, effectively creating a two-tier healthcare system to the detriment of the less well-off.
Just consider the following: Lib Dem MP Tim Farron told the Commons last week of one dental practice in Grange-over-Sands that had stopped offering NHS healthcare to its 5,800 patients, effectively depriving them of funded treatment because there are now no NHS dental places available anywhere in the whole of Cumbria. No surprise then that, in the same week, Nuffield Trust chief executive Nigel Edwards told the Financial Times that around 50 per cent of dentistry, by value, is now carried out in the private sector.
And earlier in January, the Observer discovered that several trusts with record waiting lists were promoting “quick and easy” private healthcare services at their hospital premises, offering patients the chance to jump 12-month-long queues
Maybe it’s facts like these that led the former Labour PM Gordon Brown to warn last month that the Tories “seem to find more joy in one person joining Bupa than 60 million people using the NHS”.
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