Labour’s delayed and much vaunted Ten Year Plan for the NHS, Fit for the Future, has 150-plus pages rammed full of ideas, some good, some bad – but barely a word on how any of them are to be implemented, and not one word on how social care can be developed to keep pace with changes in the NHS. Any serious discussion on that has been shelved until at least 2028.
We can see Wes Streeting has been preparing for a full marriage between Labour and the private sector, following the engagement announcement back in January. In the jumble of half-baked and half-hearted ideas in the plan, there is a vague pattern: something old, something new, something borrowed, and something blue.
Something old
There is plenty of old stuff on show – as the Plan revives several of Alan Milburn’s more expensive and less useful policies from his time as Health Secretary under Tony Blair. However the chapter Milburn was apparently due to write (on how to deliver the Plan, despite the lack of any extra money) is conspicuously absent.
Nonetheless the Plan is an extended tour of old dead ends and extravagances. One that stands out is to “reinvigorate and reinvent” Milburn’s brainchild Foundation Trusts (FTs).
There’s also another unwelcome blast from the past, with the suggestion that Public Private Partnerships (PPPs) could be the way to finance new Neighbourhood Health Centres (NHCs).
Something new
This seems at first sight to be well catered for in the Plan. It uses the word “innovation” no less than 122 times. But not every innovation is really that new.
This Plan shows boundless faith in Artificial Intelligence (AI) as an all-purpose (and apparently no-cost) panacea for every problem faced by the NHS: but although AI itself is relatively new and much more developed than it was two decades ago, the faith in IT – even at enormous cost – is not new at all. In 2002 Tony Blair’s government signed up for an ambitious £11·4 billion National Programme for IT, which by 2007 had abandoned its key aim to create a fully integrated centralised electronic care records system and become a byword for costly failure.
Another “new” idea rehashed from the Blair era is the plan to remodel the NHS around a network of Neighbourhood Health Centres. These prove on closer inspection to be a scaled down version of Lord Darzi’s ambitious 2007 plan for Polyclinics, initially in London, and then on a national level across England. The fact almost nobody remembers this, and that there is now no trace of them shows how unsuccessful it proved to be.
The one remaining really new idea is genomics: this is referred to 130 times in the Plan, and clearly relates to new science that has come on leaps and bounds since the noughties. But here too there are warnings from the medical profession and from public health experts that seeking a technical ‘fix’ that can predict and help prevent ill-health in an increasingly unequal society is quite likely a vain quest – and a diversion from simpler, cheaper and more beneficial policies.
Something borrowed
One of the few unambiguously positive aspects of the Plan is the series of public health measures beginning at the bottom of page 61, borrowed from Professor Sir Michael Marmot and other public health experts who have otherwise been largely ignored or sidelined by successive governments.
Sadly, with public health still desperately underfunded, and no explanation of how the positive proposals might be funded and implemented, there is nothing to show these are more than worthy words on a page.
Something blue
Lifted straight from Boris Johnson’s Tory government, the Plan embraces the Integrated Care Boards as set up in the most recent 2022 Health and Care Act. However it goes much further than the Tory Act, by committing to include private sector organisations in local NHS planning and decision-making – something Tory ministers were willing to rule out. The Plan also seeks to re-create a competitive market by transforming the ICBs into purely commissioning bodies on the opposite side of the purchaser/provider split from NHS and foundation trusts.
Private sector marries into money
The private sector comes out of this Plan in a much stronger position, with a range of new options to make profits from contracts with the NHS: to lend money to foundation trusts; to finance PPP projects for building Neighbourhood Health Centres and other local and community projects; to provide technical expertise and IT systems to enable to AI revolution and the expansion of NHS digital systems; and to provide more elective treatment to NHS patients.
Moreover now the Commissioning Support Units set up in 2013 are being scrapped, the big private sector consultancy firms can also expect to pick up even more lucrative contracts from NHS trust and ICB bosses as they struggle to cope with the complex agenda emerging from the Plan.
Cast aside: failing trusts
While new profit streams are opened up for the private sector, trusts which are now struggling to cope with demands for care, and especially those in crumbling hospital buildings that are part of the massive £13.8 billion backlog of maintenance face a painful future of penalties.
The Plan includes proposals for patients to decide whether the treatment they receive should be paid at the full tariff price, or a deduction made, which would flow out of the local system into a regional pot. Financial penalties are also apparently being discussed for A&E units that fail to meet target performance.
At the same time there are promises of new financial freedoms and even bonus payments to trusts that are already doing the best. There are even empty promises of a future in which all NHS providers are foundation trusts, and all somehow delivering a surplus, although how this might be possible is not explained.
The Plan also carries a continuing threat of penalties and intervention, culminating in a new failure regime “where local services consistently underperform”. But of course, these threats apply only to NHS providers, which face the main brunt of pressure to treat emergency patients and those with the most serious and complex needs, while the private sector bids only for contracts to treat the least serious and risky elective cases.
That lop-sided “partnership” seems set to lift off once again: it’s always clear that it’s the private sector that “wears the trousers” in its relationship with the NHS.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
