The NHS England ‘Delivery Plan’ to tackle the growing backlog of waiting list treatment, announced on February 8, is not a plan at all. It lacks sufficient investment and – most important of all – a workforce plan, without which none of the promised improvements will happen. 

Indeed as the House of Lords has worked through the committee stage of the Health and Care Bill one topic in which ministers have refused to give any ground at all, for fear of antagonising the Treasury, is on the need for a workforce strategy, as proposed by Jeremy Hunt in the Commons, backed by over 90 professional and other organisations, and by former NHS England boss Simon Stevens and other peers in the Lords. 

The new 50-page Delivery Plan also admits from the outset that it doesn’t cover mental health, GP services or urgent and emergency care – all of which are facing dire and worsening problems after a decade of underfunding compounded by the 2-year pandemic. 

And while it talks in abstract terms about expanding the NHS workforce and “physical capacity” it does not even discuss ways of reopening the 5,000 or so NHS beds which closed in March 2020 as part of the pandemic preparation – and are still not being used. They cannot be reopened because the NHS lacks the capital investment required to reorganise space within hospitals and refurbish buildings to allow social distancing and infection control. 

Instead NHS England’s so-called “plan” is focused on long-term reliance on the “capacity” of the private sector, which means funnelling even more NHS cash into private hospitals and private sector providers, which have already shown themselves during the pandemic to be dreadful value for money. 

NHS England appears to have learned nothing from the huge, remarkably unproductive spending supposedly block-booking up to 8,000 private hospital beds in 2020. Recent figures have confirmed brought a huge 25% increase in NHS spending on private providers that year, which bolstered their profits – but resulted in the 27 private hospital companies delivering “43% less NHS-funded healthcare than they did in the in the twelve months before the pandemic.” 

Nonetheless, insofar as there is any plan at all for expanding capacity it is based on a long-term “partnership” with this same private sector – effectively institutionalising NHS dependence on costly and inefficient private sector hospitals and beds.

A 2-page section of the document is focused on “Making effective use of independent sector capacity.” It makes it quite clear that the need for the private sector is the lack of adequate NHS capacity, stating from the outset: 

“a long-term partnership with our independent sector partners, including charities, will be crucial in providing the capacity we require to deliver timely and high quality care for patients.”

It goes on to insist that:

“Systems will include local independent sector capacity as part of elective recovery plans, and will work in partnership with independent sector partners to maximise activity to reduce waiting times sustainably.”

Except of course the reliance on private beds and services means that that NHS itself will NOT have sustainable capacity to run as a coherent and comprehensive public service. Despite all the rhetoric about “integration” it will have to rely on profit-seeking private companies.

The most recent 3-month deal signed with private hospitals recognised that the private sector can make more money selling operations to ‘self-pay’ private patients seeking to skip over long NHS waiting lists than from treating NHS patients at normal NHS tariff prices. 

To use the private sector as additional capacity therefore means the NHS paying over the odds to make it profitable for them – and leaves a lop-sided “partnership” with companies with a very different agenda from the NHS, since they benefit either way from a lengthening NHS waiting list. It also means dividing up the already over-stretched NHS workforce to send teams from major hospitals to deliver operations in small-scale private hospitals miles away.

The other problem with this reliance on private hospitals is that they are not evenly distributed across the country, but concentrated in London, the south east and more prosperous populations. Many more deprived areas which are supposedly to be “levelled up” have no significant access to private hospitals – and will be left out of this aspect of the recovery plan.

Where private hospitals are available as “partners” the Delivery Plan (p22) makes clear that in the long term the NHS would be confined to a role of providing emergency services, medical care and more costly, complex treatments that the private sector has always avoided:

“… joint regular reviews of demand for services and available capacity will support the clinically appropriate transfer of high volume and low complexity conditions, as well as some cancer pathways and diagnostics, to the independent sector. The extra capacity created within the NHS will be used to undertake more complex work such as cardiac, vascular and neurosurgery ….

But while the NHS is trapped and restricted, the private sector will be free to pick and choose the level of care it sees as most profitable and wishes to provide:

“More complex cases can also be treated in independent sector sites that can deliver this level of treatment.”

This long term “partnership” even means that the private sector – which trains no staff, and has always relied on poaching NHS-trained staff – would be drawn in to designing “a joint approach on workforce…”

Meanwhile the promises in the Delivery Plan, even though they are based on highly optimistic and questionable assumptions (not least the ability with no significant investment in workforce to deliver “30% more elective activity by 2024/25 than before the pandemic”) are meagre.

Cancer patients are promised that numbers waiting more than 62 days from an urgent referral will be reduced “to pre-pandemic levels by March 2023” (by which time many will have died waiting). But even before the pandemic the 62-day target to start cancer treatment had only been met once in five years, and more than one in five cancer patients waited more than two months for their first treatment. 

Waits of over a year for non-cancer treatment won’t be eliminated until 2025– after the next election. Numbers waiting are expected to rise – perhaps as high as 9 million – until 2024. 

This plan will be welcomed by private sector hospitals and providers: but it offers no real hope to patients or stressed out NHS staff, and threatens to consolidate the biggest-ever expansion of spending on private providers as a permanent feature of the NHS going forward.

It underlines the need for the £20 billion extra emergency funding demanded by SOSNHS, the campaign backed by health unions and campaign groups, which is staging a Day of Action on February 26 and a rally in central London on the eve of the Spring Budget.

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