Run-up to Conference
In the weeks running up to Labour’s annual conference there was confusion between NHS England and the Department of Health and Social Care over key aspects of the DHSC’s policy agenda.
SubCos – now you see them, now you don’t
In March this year, the interim Chief Executive of NHS England, Sir Jim Mackey, told Trusts to create subsidiary companies (a SubCo is a private company owned by the trust) as a way of improving their finances. Immediately before the Labour party annual conference in Liverpool, Wes Streeting, the Secretary of State for Health and Social Care, reversed Mackey’s directive and announced that Trusts would not be expected to move their facilities staff into SubCos. The NHS England website explains this is not a ban on SubCos as such, but confirms that ‘new subsidiaries involving the transfer of NHS staff will now only be approved in a limited number of circumstances….’. It adds that the pause in SubCos is currently subject to consultation, with any future transfer of staff being approved only where there is clear union support, as well as protection of NHS terms and conditions for workers, including pension arrangements.
SubCos save Trusts money by tax avoidance (VAT) and paying staff less. However, the Treasury has already made clear it wants to close the VAT loophole, and Mackey had stated that staff should be maintained on NHS terms and conditions. As KONP has pointed out, this raised the question of just why SubCos were once again being promoted? Possible answers include that SubCos are seen as having other potentially useful roles such as allowing publicly owned assets (e.g. buildings, plant and equipment) to be transferred out of the NHS, and providing a means of accessing funding, equity, borrowing and other external investment, with the parent trust being isolated from any financial risk.
It may be premature, therefore, to think that we have seen the last of SubCos, and there is no intention of moving workers currently in a SubCo back into the NHS. This is the focus of a dispute by GMB staff at Airedale Hospital in West Yorkshire where 70% of SubCo staff are no longer on NHS terms and conditions. KONP has a fact-filled booklet on SubCo available as well as a new exhibition for loan.
Treasury wrecks plans to cut manager numbers
Mackey has also been wrong-footed by the Treasury over job cuts to Integrated Care Boards (ICB) and Trust staff. NHS bodies had been asked to make extremely high and unrealistic efficiency savings in order to balance their budgets. As many senior managers were set to lose their jobs as a result, the question arose of who would pay for the redundancy packages (estimated as £1-1.2bn) of thousands of axed posts? Since the Treasury has now stated it will not provide funding for this, increasing numbers of ICBs are saying that they cannot afford to progress with workforce reductions. Meanwhile, their staff have been left anxious and confused because they do not know how much longer they will have a job, with some taking sick leave through stress.
It is worth remembering that Lord Darzi strongly advised Labour against reducing management capacity without a clear plan as this could undermine the NHS’s ability to deliver quality care. His warning that underinvestment was driving poor performance was also brushed aside. The current situation is a challenge to the premise of the Ten Year Health Plan for England that the recent below-average rise in NHS funding will be supplemented by deriving and reinvesting billions from ‘cutting waste’ and slashing ‘unnecessary bureaucracy, giving more power and resources to the frontline’. The lesson the current government refuses to learn from New Labour’s time is that it is investment in the NHS that will improve both services and public satisfaction, as set out in the Rational Policy-maker’s Guide to the NHS by the 99% Organisation.
The NHS at the conference
At the conference itself, Streeting gave a speech acknowledging that setting up the NHS in 1948 was ‘an act of courage as well as conviction’ (while not promising either of these from the current government). He went on to elaborate areas of progress over the last year which appear to fall far short of expectations, given the improvements promised in the manifesto. These included getting the NHS back to meeting performance standards (specifically ensuring most non-urgent referrals received consultant-led treatment within 18 weeks); clearing the backlog of patients waiting more than 18 weeks; delivering two million extra appointments annually; doubling the number of NHS cancer scanners; 8,500 additional mental health staff; a ‘Dentistry Rescue Plan’; return of the ‘family doctor’; delivery of the NHS Long Term Workforce Plan, etc. While five million additional appointments have in fact been delivered, historic NHS data shows the rise since July 2024 was actually more than a million less than the rise of the previous year, and represents in all only around a 3-4% increase in activity.
According to John Lister writing in The Lowdown and reviewing the latest NHS performance figures, referral to diagnosis time for cancer has improved while time to treatment remains well below the 85% target. The number of other elective patients treated within 18 weeks has increased by only 1.2%. Patients waiting over 52 weeks dropped by 34% but has now shown a worrying rise. The total waiting list number fell by 220,000 (3%) but has now gone back up to over 7.4 million. Should the last 12 months’ progress continue unchanged, the total would still be at a huge 6.75 million by the time of the next election in 2029 – and at this rate would take 86 years to clear the waiting list! In July 2019, 85.8% of treatments were delivered within 18 weeks whereas in July 2025 this figure stands at 61.3% (the target is 92%).
Queues for community services have increased sharply and attendances at major A&E departments in August were the highest on record, with just 62% being seen within 4 hours (the target is 95%). The number of 12-hour trolley waits for admission has sky rocketed – nearly 36,000 in August, standing at 96 times the number in 2019. The average ambulance response time to conditions such as strokes and heart attacks is nearly 30 minutes, when the standard is 18 minutes. All these figures argue strongly for investment in extra capacity if patients are to be treated in a timely and effective manner – an argument which appears to be falling on deaf ears
Streeting also announced the ‘reform of general practice’, so patients can request appointments online at any point during the day. He recently described GPs who have concerns about opening up online access throughout core hours as ‘laggards’. Writing in the British Medical Journal, GP Helen Salisbury argues this represents a failure to listen to overworked GPs’ concerns about supply-induced demand. Making it so easy for patients to submit requests to be seen or for advice without contact poses the real risk that GPs will be swamped with non-urgent issues and have less time for the patients who are most in need.
Labour likes to present a caricature of the NHS as frozen in time and staffed by Luddites who argue that modernisation is ‘a betrayal of Bevan’s legacy’. For example, the pre-election ‘Build an NHS fit for the future’ stated wrongly: ‘The reality is that the NHS is still designed for the world of 1948, where people needed short-term treatment for infectious disease or injury’. Similarly in the Ten Year Plan we read that the era of ‘more money, neverreform’ is gone, glossing over the fact that the NHS has been constantly subject to reform, with seven system wide and structural reorganisations since 1948.
This is said to justify Labour’s current ‘modernising’ agenda, supposedly aimed at ‘giving patients more power, more choice and more convenience – for the many, not just for the privileged few’, but in reality further entrenching the role of the private sector and pinning hopes on technology, genomics and artificial intelligence. The 1948 model of health care is rejected, including public provision of services, with the new ‘care model fundamentally … about empowering the individual patient, citizen, to take greater control of their health’.
A white rabbit is pulled out of the hat
Keir Starmer’s speech to conference was wide-ranging, with one surprise announcement on the NHS: ‘A completely digital NHS trust online that will offer millions of … convenient appointments … a new chapter in the story of our NHS … harnessing the future … patients in control … waiting times cut … for every single person in this country’. The online service will not have a physical site but patients will be able to make digital appointments with clinicians throughout the country. If patients then need a scan, test, or procedure they will be able to book these at their local community diagnostic centre or hospital. What was missing was any indication of how this amazing feat might be accomplished.
Questions rapidly followed: where will the doctors and nurses to provide the service come from? What about the 6 million people (by government’s own assessment) who are digitally excluded? Where will the funding come from? Will it be an NHS organisation with NHS staff? Could it destabilise other vital services? How will it pass on patients who need care from digital to physical services? Will GPs be paid for the workload it generates for them? There is clearly a lot more work to be done on this before it can be taken as a serious initiative rather than an attention-grabbing stunt.
A plan that is ‘harmful, divisive and xenophobic’
In her speech, the Home Secretary Shabana Mahmood, made pledges to conference that have profound implications for both the NHS and social care. She reiterated a plan to increase the time in which someone must have lived in this country from 5 years to 10 to earn ‘indefinite leave to remain’ (or to claim any kind of benefit, including tax-free childcare, disability living allowance or housing support). This will be linked to ‘a series of new tests, such as: being in work; making national insurance contributions; not taking a penny in benefits; learning English to a high standard; having no criminal record; and finally, that you have truly given back to your community, such as by volunteering your time to a local cause’. Voluntary organisations see the latter as a worrying attack on migrants’ and refugees’ right to lead safe, secure lives in this country, and say it reinforces the false, racist narrative that people who’ve made the UK their home need to evidence a greater ‘contribution’.
Currently, around one in five staff in both the NHS and social care are from abroad, and there is a combined workforce vacancy gap of nearly a quarter of a million. The Royal College of Nursing was quick to describe the plan as ‘ignorant’ and ‘pandering’ to Nigel Farage’s Reform UK. RCN general secretary, Prof Nicola Ranger, pointed out that ‘Health and care services would cease to function without migrant nursing staff. While other countries offer immediate paths to settlement for nurses, the UK is going in the opposite direction.’ In a letter to the Guardian newspaper, more than 800 NHS workers criticised the plan as ‘harmful, divisive and xenophobic’ and warned that the health service would ‘crumble’ without them.
Conclusion
The Nuffield Trust noted that Labour’s manifesto promises were ‘important aspirations that were let down by a stunning lack of detail on exactly how the party intends to deliver these pledges and tackle some of the most profound problems facing our health and care services in 75 years’. After a year in office, the Health Foundation considers the government still has much to do to deliver its promises on the NHS and social care. The lamentably small improvements in NHS performance cited above illustrate just how true this is.
What we await are evidence-based policies, clear delivery plans, strengthening of the NHS by reversal of privatisation, significant investment that acknowledges that was the basis for success of New Labour’s NHS recovery, sound workforce planning, a reinvigoration of cash-starved public health services and plans for a cross-government assault on the inequalities generated by the social determinants of health. We may agree with Streeting when he said ‘It was Labour that built the NHS out of the ashes of war, it was Labour that saved it in 1997 and it falls to Labour to save it now’ – but time is running out and a new approach that will deliver an end to the current crisis is needed fast.
John Puntis, Co-Chair Keep Our NHS Public
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