Comment by John Lister – 

Unlike his predecessor Jonathan Ashworth who was keen to engage and work with campaigners, Labour’s current shadow health secretary Wes Streeting has kept his distance, and relied on other advisors. 

They seem to be doing him no favours, since he has repeatedly made statements that are widely seen as – at best – leaning towards further use of the private sector in preference to expanding and improving the NHS. 

On December 8, Streeting was again banging the drum for more use of the private sector in an Opinion piece in the Guardian, arguing:

“If Labour were in government, we would be pulling every lever available to bring down NHS waiting times, including negotiating to avert strike action. We would also be using spare capacity in the private sector to bring down waiting lists. Private providers have capacity for 130% of the procedures they were doing for the NHS before the pandemic, but the government hasn’t utilised it.”

This is compounded by his refusal to demand any increase in the NHS budget, despite the clear evidence that after a decade and more of real terms cuts in funding it is desperately lacking in resources and capacity: his most recent speech for example, included his assertion that: “We cannot continue pouring money into a 20th-century model of care that delivers late diagnosis and more expensive treatment”.

This was in a speech to right-wing think tank Policy Exchange (set up by Michael Gove).  Again it stressed the need for “reform” that appears once again to centre on using private hospitals and contractors.

But when accused on Twitter by veteran left wing MP Diane Abbott of trying to push “inch by inch” for a privatised/insurance based NHS, Streeting’s reply was an indignant denial: 

“I have consistently argued against an insurance-based or privatised model. It is in defence of the NHS’s founding principles – publicly funded, free at point of use – that I make the case for reform.”

However Streeting’s proposals are as unhelpful as his ways of expressing them. A well-argued response to the call for more use of private hospitals came in a Guardian article by David Rowland of the Centre for Health and the Public Interest which begins: 

“You can only assume that Wes Streeting’s recent embrace of the private hospital sector as a solution to the current health crisis stems from naivety about how UK private healthcare works, or is part of the Labour leadership’s attempts to turn it into a party of the centre right. It is certainly not based on evidence.”

Rowland’s article does an excellent job of demolishing Streeting’s depiction of private hospitals as some kind of extra untapped resource that ideologically ‘left wing’ unions and others refuse to make use of. He exposes private hospitals’ reliance on largely hidden subsidy and support from the NHS:

“… safety risks include the fact that the vast majority of private hospitals do not have any ICU facilities to look after patients if something goes wrong after an operation. Even at the height of the pandemic, 6,600 patients were transferred to NHS wards after treatment in a private hospital – a fact that suggests that far from assisting the NHS during the pandemic, the support went the other way. It is also an arrangement that costs the NHS an estimated £80m a year.”

Rowland also refutes the claim there is any “extra” pool of staff in the private sector: 

“… in all the private hospitals operating in the UK, the doctors are NHS doctors, working in their spare time. In commercial terms, because the private sector contributes nothing to the training of the 17,500 doctors who work in its hospitals, this amounts to a free subsidy to the private sector of about £8bn.”

But Rowland does not go on to explore the economics and financial reality of increased use of private hospitals while the NHS, starved of capital to expand its own services and facing a growing £10bn-plus backlog bill even for maintenance of existing hospitals, pays for patients to get treatment in otherwise empty beds in private hospitals.

CHPI and The Lowdown have previously highlighted the costs and knock-on consequences of ill-conceived deals struck by NHS England for use of private hospitals during the peak of the pandemic, that have proved rotten value for taxpayers, but a windfall for the private sector.

The fact is that the average private hospital is so small (average size just 40 beds) and with such limited facilities they can only treat the most simple elective cases – leaving all of the most costly, complex and of course ALL emergency cases to the NHS.

So even while private hospitals can profitably treat patients on this basis at average NHS tariff costs, the reality is that this siphons vital resources out of the NHS, and perpetuates the chronic lack of front line capacity – effectively baking-in dependence upon private providers.

Streeting is too young to remember when New Labour first set out views similar to his, beginning in 2000 with Health Secretary Alan Milburn’s disastrous ‘Concordat’ that sent NHS patients at hugely inflated costs to private hospitals in the winter peak period.

Milburn went further in the mid 2000s and squandered hundreds of millions on establishing new “Independent Sector Treatment Centres” (ISTCs) that were given preferential 5-year contracts to treat the simplest elective cases and an average of more than 11% above the NHS tariff rate

NHS trusts and foundation trusts were banned from applying for these contracts, which made only the most marginal contribution to the reduction of waiting lists and waiting times achieved by a decade of investment. 

But Streeting who has argued for a big expansion in training of new doctors should be told that the training of NHS doctors was made more difficult by the transfer of so many routine operations to these small new private units – where no training could be given. And only an increase in NHS funding can create sufficient employment opportunities for the additional new doctors.

The ISTCS were eventually recognised as an expensive irrelevance by most NHS commissioners and all but a tiny handful have since been brought back into the NHS.

But with Integrated Care Boards and hospital trusts in many areas now looking to save money by “repatriating” caseload and revenue from private sector providers as they face up to another round of brutal austerity, it’s also worth noting that the failed New Labour experiment in use of the private sector took place in the context of a sustained decade of major investment in the NHS from 2000, which ended abruptly with the Cameron government in 2010. 

Streeting’s failure now to recognise the need for a similar sustained investment to reverse the decline since 2010 means he is picking up only the most controversial and questionable aspect of the Blair/Brown years: rather than reinventing the wheel he is reinventing the flat tyre. 

If he wants to protect and restore the NHS with its core values intact he needs to start from a commitment to address today’s crisis with increased resources – cash, capital and staff – rather than making more statements that raise cheers only from private hospital bosses and the Daily Telegraph.

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