8 out of 20: Burnham inherits a health plan built on private sector delivery

Without announcing any details, the new Prime Minister has made his opposition to privatisation plain. And yet he arrives at Downing Street to find a Labour health plan, which, according to a LowdownNHS analysis, has eight of 20 headline commitments that depend on private companies to deliver them.

We looked at 20 headline policy commitments from Fit for the Future: the 10 Year Health Plan for England (July 2025), the Neighbourhood Health Framework, and ex-Health Secretary Wes Streeting’s parliamentary statement, and categorised them according to their reliance on private-sector involvement.

Eight commitments in the 10-year plan are not only reliant on the private sector but also expand its role in key areas of: buildings, data, and elective and diagnostic capacity. Cancer standards, obesity, and private companies are integral to delivering the plan’s commitments.

Andy Burnham has signalled a shift away from the UK’s reliance on privatised “essential” services, yet his team has not clarified whether this will entail reversing NHS outsourcing. 

Inheriting a ten-year plan from Starmer and Streeting that favoured private-sector involvement. He and the new Health Secretary, Yvette Cooper, will now have the opportunity to convert rhetoric into real decisions around capacity, investing in buildings and in preventative health care without over-relying on commercial partners.

The buildings

A central idea in the 10-year health plan for England is to lift pressure on hospitals by transferring health services into the community, by building 250 new neighbourhood health centres

The centres will be one-stop shops that give patients access to a range of services, and the Treasury confirmed the use of private finance to help deliver them.

They will “ bring together GP practices and a mix of community, local authority, adult social care and civil society services” and be expected to “meet the expectation set out in the 10 Year Health Plan to be open at least 12 hours a day and 6 days a week providing access to coordinated services locally”

NHS England’s guidance states that new buildings will be funded through a mix of public capital and PPPs, with around 20 per cent from public and the rest through PPP. 

He has publicly opposed PFI in the NHS, but while Health Secretary (2010) approved PFI schemes, later expressing regret that Labour pushed PFI as the only way to deliver its hospital-building programme.

 “We shouldn’t have been told ‘PFI or no hospital’ [when Labour was in government].”

Burnham told a BBC Question Time audience in 2018

This will be an important test to see how Burnham delivers on his anti-privatisation stance.

The data 

The NHS 10-Year Plan’s promise of a digitally connected, data-driven health service is based around the Federated Data Platform, which controversially involves Palantir – a US defence-linked contractor in a consortium (including Accenture, PwC, NECS and Carnall Farrar) to run it.

Critics, including NHS data specialists, parliamentary committees and health unions, argue that ministers are getting into a deep dependency through this contract before knowing for sure whether the platform will deliver: on cost, on integrating with existing systems and without disruption. 

UNISON head of health Helga Pile said:

“Allowing a morally dubious firm like Palantir to work with the NHS is damaging public confidence. Ministers should rule the controversial tech firm out of the running to develop the Single Patient Record.

“The government must also remove the clause in the bill allowing the health secretary power to increase the scale of private provision of health services on a whim.”

The long-term strategy seems to avoid building permanent expertise within the NHS, in favour of reliance on the private sector and the software that it owns.

The current controversy is whether ministers should deepen the NHS’s reliance on Palantir, or use the 2027 break point to pursue a publicly controlled or UK-based alternative.

The Federated Data Platform is already being used across much of the NHS for managing waiting lists, hospital flow and performance. 

The FDP does not currently run the NHS App, the Single Patient Record or the NHS’s underlying clinical-record systems. It is already becoming a common operational layer for waiting lists, theatres, discharge, cancer pathways, ICB management and national reporting—and it is this growing web of data connections, applications and working practices that creates the dependency on Palantir.

Elective and diagnostic capacity

Labour Ministers have promised to use all forms of capacity to help me tackle waiting lists.

The January 2025 elective reform plan, Reforming elective care for patients, commits the NHS to meet a target of 92 per cent of patients treated within 18 weeks by March 2029.

It signed a partnership deal with the Independent Health Providers Network And instructing integrated care boards to put contracts in place to help reduce waiting and promises to review NHS prices to help get the private sector involved.

The health plan aims to improve access to diagnostics. The Department of Health confirmed that 35 per cent of the diagnostic capacity the NHS needs between 2026/27 and 2028/29 — roughly two million additional tests — is expected to come from the independent sector. Around half of the new community diagnostic hubs are to be privately operated.

The plan commits to discussions with private providers to expand provision in the most disadvantaged areas.

A 15 per cent rise in the price providers can charge the NHS was put in place on ENT and gynaecology procedures (2025/26 payment scheme) payable to both NHS trusts and private providers. The same plan sought to increase referrals to private hospitals by reducing the exclusion criteria that they impose.

Overall, though, the figures suggest that the elective plan is failing. Independent-sector elective activity for NHS patients was lower year-on-year in every month from October 2025 to May 2026. Across the eight-month period, activity fell from 3.99 million to 3.75 million, a reduction of 244,755 episodes/attendances, or 6.1%.

Lowdown has consistently pointed out, there is a flaw in the plan, as the private sector has only 8,000 hospital beds, a large proportion of which it reserves for the more profitable work with private patients, and so there is a ceiling to how far they will help. The only carrot the NHS can offer is to increase prices, allowing the private hospitals to make more money.

The obvious question for Burnham and Cooper is why not change course to invest more in NHS beds and the extra staff to operate them?

The cancer standards.

Three commitments around cancer standards show a more hidden private-sector dependence. They are timing standards: the 28-day Faster Diagnosis Standard, the 31-day decision-to-treatment standard and the 62-day referral-to-treatment standard.

Hidden because published cancer waiting-times data does not show what proportion of cancer tests, scans, pathology or endoscopy are delivered by NHS, private or jointly. Which means we don’t know the exact degree of reliance. However, we can see that private diagnostic providers are heavily embedded within the system.

Pathology services are run through arrangements involving Synnovis, HSL, The Doctors Laboratory/Sonic Healthcare and SYNLAB partnerships; imaging and PET-CT capacity includes firms such as Alliance Medical and InHealth; endoscopy capacity is also provided by independent-sector operators; and scan reporting is supplemented by teleradiology companies such as Medica and Everlight.

The reliability and performance of these companies will have a direct impact on the achievement of these cancer timings and on the degree to which the NHS chooses to develop its own capacity and the extent to which it is reliant on these contracts.

Obesity

The 10 Year Health Plan commits to expanding weight loss services and treatments to tackle obesity. The government is planning to expand the managed use of weight loss medications. Tirzepatide is prescribed by GPs, but all patients using the drug in primary care must be referred to a 9-month programme of behavioural, nutritional and psychological support, provided by private providers; if patients don’t attend, the drug is stopped. It is also possible for NHS patients to be referred to private companies directly – consultant endocrinologist-led teams of obesity physicians, dietitians, nurses and psychologists who prescribe the drug themselves and take over medication safety monitoring from the GP, under CQC regulation.

Xyla is a commercial provider under Healthier You: NHS Behavioural Support for Obesity Prescribing programme. It supports over 6,000 individuals across England within the digital weight management programme, and describes itself as the UK’s largest National Diabetes Prevention Programme provider, with clinician-led teams having supported over 800,000 people and operations in 17 areas of England.

Oviva claims to support over 300,000 NHS patients, runs consultant-led Tier 3 services with prescribing, and accepts referrals from every ICB, including NHS Devon, Hertfordshire and West Essex, under Right to Choose.

The national digital weight management programme, a twelve-week behavioural service, is delivered by six providers — Liva Healthcare, MoreLife, Oviva, Second Nature, Slimming World and Xyla Health & Wellbeing — under a contract originally worth £22.8m over three years and re-tendered in 2025 at a reported £21m to £42m.

This is small-scale compared with how the government intends to expand it. There are currently about 73,000 patients in the system each year, but the estimated eligible population is around 3.4 million. The NHS intends to reach all of them within 12 years.

Private provider capacity is already embedded in the pathways, and this will only expand unless the NHS develops its own weight-management resources. This is small-scale, with about 73,000 patients currently in the system each year, but the eligible population is estimated at around 3.4 million. The NHS intends to reach all of them within 12 years. Private provider capacity is already embedded in the pathways, and this will only expand unless the NHS develops its own weight-management resources.

Embedded relationships on which policy relies, but without planned expansion

Four commitments rest on private provision that already exists without any stated intention to expand their involvement. That is not to say that these sectors are not worth addressing in terms of establishing the effectiveness of outsourcing and its value, but this is not done within the NHS 10-Year Plan.

The promised 1,700 additional GPs will arrive through the partnership model, in a sector where corporate operators such as Operose already hold more than sixty contracts, but this is a small percentage of the overall market and is not expanding.

Dentistry is being addressed by funding existing contractors to do more NHS work rather than by more salaried workers.

Pharmacy First extends the clinical role of a community pharmacy network including Boots, Well and around 10,500 independents.

Urgent care: NHS 111 lines, out-of-hours GP cover and urgent treatment centres across England are run by private companies, a dependency the plan inherits but does not address. When one of those companies, Totally plc, collapsed in June 2025, its NHS contracts were transferred to a competitor via an administrator’s sale rather than through commissioning.

Six further commitments carry a private role – paramedic-led community care, the Category 2 ambulance standard, personalised cancer vaccines, screening and HPV catch-up, the £29bn funding settlement, and the pledge to cut out-of-area mental health placements.

Only two are delivered wholly within the NHS: maternity reform through the National Maternity and Neonatal Taskforce, and perinatal mental health. Notably, the out-of-area placements pledge is the only commitment in the plan that would, if delivered, reduce private sector involvement rather than increase it — in a sector where independent providers already hold close to a third of NHS-funded mental health beds.