On the morning of Thursday 13 March, ‘Labour’ prime minister Sir Keir Starmer assembled the national media and began lifelessly intoning a keynote policy speech that had been billed as announcing a “bonfire of the quangos”.
He opened with his usual refrain of making “change in the country” as “working people do not feel like the state and public services are working for them”. Indeed! He moved directly to the National Health Service and cited its management body NHS England (NHSE – introduced by the Health and Social Care Act as recently as 2012) as an example of “duplication of bureaucracy”, before announcing it would be abolished, and, even as the watching nation was thinking ‘What on earth does that mean?’, went on to assert that the NHS is being “brought back under democratic control” within the Department for Health and Social Care (DHSC) and that this would “free up money for frontline services”. (What does NHS England do? Your questions answered on health reforms by Nick Triggle and Helen Katt, BBC online, 13 March 2025)
Since many of us have campaigned against the ballooning of management costs under recent ‘reforms’, and against the ‘Tory’ Health and Social Care Act 2012 and its removal of ministerial accountability for healthcare; about chronic NHS underfunding, outsourcing and PFI; about NHS England and its chief executives Lord Simon Stevens and Amanda Pritchard being the vehicles of privatisation in general and the cyclopean US insurance company UnitedHealth in particular, should we welcome these developments?
Well … no. Sadly, life is not so simple. And there is no indication whatever that Labour plans to reverse or retard the privatisation of the NHS. Rather the reverse: it is an accelerating process.
In fact, NHS confederation members, notably ‘integrated care boards’ (ICBs) and ‘provider trusts’ (hospitals, but also such diverse groups as ambulance and community mental health services, community care trusts, etc), have been told to make further cuts, with ICBs told to make 50 percent reductions in their running costs by the third quarter of 2025-26 and trusts being told to cut their management budgets back to pre-pandemic levels. (Abolishing NHS England: what you need to know, Briefing by NHS Confederation, 13 March 2025)
150,000 jobs to be cut in the NHS: doctors, nurses and allied professionals of all kinds
On 8 April, health secretary Wes Streeting revealed a little more of his “NHS plan” for “increased efficiency” and “massive cost cutting”.
“Hospitals in England could axe more than 100,000 jobs as a result of the huge reorganisation and brutal cost-cutting ordered by Wes Streeting, the NHS’s new boss.
“The scale of looming job losses is so large that NHS leaders have urged the Treasury to cover the costs involved, which they say could top £2bn. [Actually, the delivery arm of the NHS has been asked to save closer to £7bn!]
“Sir Jim Mackey, NHS England’s new chief executive [who will also oversee the demise of NHSE], has told the integrated care boards (ICBs) to cut their running costs by 50 percent by the end of the year. Alongside this the 215 trusts that provide healthcare across England have been told to reduce their ‘corporate cost growth’ (across functions such as HR, finance and communications) by half the amount from the year before the pandemic.
“But the NHS Confederation, which represents trusts, said some trusts believe complying with that edict [a monetary cost-saving figure directed to each trust] could force them to shed anywhere between 3 percent and 11 percent of their entire workforce.
“If replicated across the 215 trusts, that could lead to job losses ranging from 41,100 to 150,700, given they employ 1.37 million people …
“NHS England [still in place at time of writing] told all 215 trusts to save 5 percent of their budget for this year through ‘cost improvement programmes’, while asking for an increase in treatments of 1 percent.”
“A DHSC spokesperson said: ‘… We are investing an extra £26bn in health and care [the merging of the budgets for the NHS and social care disguises the scale of the cuts, and Streeting has said he will spend NHS money on social care, which is of course privately provided – meaning a cut to the health budget and further payments to the private sector] and have already made progress on our mission to cut waiting lists – delivering an extra two million appointments [we will see how!] seven months early and cutting the waiting list by 193,000 since July.’” (Hospitals in England could shed 100,000 jobs in response to cost-cutting orders by Denis Campbell, The Guardian, 8 April 2025)
To put this in context, waiting lists for treatment currently stand at 7.39 million. So this ‘reduction’ is actually negligible, and the scale of medical job losses is likely further to decrease the ability of the NHS to meet demand.
In fact, the relentless financial pressure generated across NHS trusts by round after round of annual cuts is not new, but has driven every trust in the country into debt. This process has been ongoing for over a decade, despite apparent ‘increases in the NHS budget’ as a whole (which do not take account of inflation, or of the relative and compound underspend in healthcare compared to population need. (Government’s efficiency targets ‘ineffective’ and ‘caused long-term damage’, Healthcare Leader, 15 March 2025)
Wes Streeting and Keir Starmer are claiming that the abolition of NHS England alone will save money, but this is insignificant in comparison to the further massive cuts to NHS trusts (‘the frontline services’) which, as we have seen, are being told to make savings of £7bn while also treating more patients. The budgetary cuts will actually mean that clinical staff will be axed across the country, making increased productivity impossible.
“A survey of 160 senior managers from 114 NHS trusts found that:
• 47 percent were cutting services and another 43 percent were considering doing so [in other words 90 percent will do so nationally].
• 37 percent were cutting clinical posts and a further 40 percent may follow suit [in other words 87 percent will do so nationally].
• 26 percent were closing some services and 55 percent more may do so [in other words 81 percent will do so nationally].
“These findings show that trust leaders are having to think the previously unthinkable in terms of cutting posts. These include clinical roles.” (Hospitals in England reducing staff and services as part of NHS ‘financial reset’ by Denis Campbell, The Guardian, 9 May 2025)
Hardly a picture of health
Matthew Taylor, chief executive of the NHS Confederation, said: “NHS leaders and their teams have been working incredibly hard to cut waiting lists and improve productivity. But one of the biggest barriers to achieving this is the health service being starved of capital funding for more than a decade.
“As Lord Darzi highlighted in his report, this lack of capital funding has led to a £37bn shortfall. This has left the health service having to deal with crumbling buildings, out of date equipment and a lack of digital infrastructure. We know that these factors make it difficult to provide the most efficient care to patients, and our members tell us that additional capital investment is vital to unlocking greater productivity.” (Capital funding vital to boosting NHS productivity, NHS Confederation, 5 March 2025)
Taylor then predictably went on to seek “radical solutions” – such as taking yet more loans from the corporate banking sharks that are already feasting upon the financial lifeblood of the health service via private finance initiative (PFI) contracts. His prescription for the malady, in other words, is more of the primary pathology!
And this explains very well both Labour’s overall plan, and Mr Taylor’s part in it.
Free-market fundamentalism
A speech by health minister Streeting entitled ‘Our vision for a new model of NHS care’ delivered in Manchester on 12 June 2025 was not reassuring. Among the measures he outlined (of which more below), he opined:
“The NHS operates as a centralised state bureaucracy, attempting to run an organisation of 1.5 million staff with 50 million users from two central London offices. It is a product of its time.
“Government no longer attempts to control public services or industries from Westminster. Except when it comes to the NHS. The experience for you is disempowering and demoralising. There is no reward for being the best. Little freedom to be entrepreneurial or innovative …
“It stifles your creativity and means the patient voice goes unheard. With the publication of our Ten-Year Plan, we will bring this era of top-down control to an end. You might think it’s slightly odd to pledge to end the era of Soviet-style statism [mark you!] with a ten-year plan. You’d have a point.”
What does ‘efficiency’ look like?
The question is: what exactly is meant by ‘efficiency’? You and I might imagine attending a well-staffed and well-run GP surgery or hospital, appointments being readily available, our queries being answered by well-rested and well-trained, patient and competent staff in control of their environment, and offering the best and most evidence-based, unbiased, effective and prompt advice and treatment.
That is certainly not what the government in the service of big business means, however. It just means ‘profitable’.
There is a legal adage: ‘Justice delayed is justice denied’. Translating to medicine, we might say: ‘Treatment delayed is treatment denied’. It is rationing. And in some instances, where treatment might have been lifesaving, then that rationing may be fatal.
Indeed in August 2023, a paper was published that estimated “More than 120,000 people in England died last year [2022] while on the NHS waiting list for hospital treatment.” One hundred and twenty thousand deaths a year waiting for care. And that list remains at 7.2 million. (‘National tragedy’: figures show large rise in people dying while on NHS waiting list by Denis Campbell, The Guardian, 31 August 2023)
It’s a powerful incentive to pay, is it not? And as you’ve already been taxed for the NHS, it’s a powerful incentive to pay twice.
To a capitalist, efficiency means ‘maximised profit’. And therein lies the problem.
Bonfire of the quangos – or a luxuriant growth of parasitism?
After NHS England is abolished, the integrated care boards (ICBs) will remain, under the loose supervision of the Department of Health and Social Care, currently led by Wes Streeting, who will do no more than oversee the general direction of travel and ensure it continues on its current path – as he has made amply clear.
What are the ICBs? Essentially, they are quasi-autonomous non-governmental organisations (quangos) – and there are 43 of them!
Where did they come from? Groups of GPs were, under the guidance of NHS England, Sir Simon Stevens and successive governments, organised into fundholding practices and brought together with management companies and accountancy firms to form ‘clinical commissioning groups’ (CCGs). There were initially almost 200 of these CCGs, which were gradually merged until there were 106 of them left.
They were responsible for around two thirds of the NHS budget, around £80bn. They were to be the ‘purchasers of health services’. That is, when they referred their patients for treatment, they could ‘choose’ (together with their patients) where to ‘buy care from’. (What were clinical commissioning groups?, NHS Confederation 17 August 2021)
So the referral from your GP to your local hospital became a ‘choice’, one of many, including the ‘choice’ not to refer you – or, indeed, to purchase care (your hernia operation, your cataract operation, your neurology opinion, your scan) from a private provider. This ‘purchaser-provider’ split enabled the NHS financial river to be divided and diverted into more and more rivulets, increasingly siphoned towards profit-driven enterprises rather than a planned and nationally-provided service.
The CCGs have now been further merged and concentrated and been thrown together with representatives of private health companies, private insurance firms, data analytics companies (including Palantir – see below), and some tokenistic representatives from local councils. They have been made responsible, in addition, for the care industry (which is already overwhelmingly privatised), and in this way the concept of self-paying care has been increasingly reintroduced into the health sector also.
Despite their sprinkling of clinicians and politicians, the ICBs are vehicles in which the businessmen are very much in control, and all the incentives are towards rationing on the one hand and outsourcing on the other.
What does Labour’s plan really mean?
Behind all of this stands the real agenda, and it is not one of change so much as continuity. That continuity is the ongoing 45-year-long drive to privatise and carve up the NHS – or more accurately, the cash flow that is currently branded as ‘the NHS’.
Operating a healthcare system at a profit involves minimising the service to the public, continuing to downgrade and deskill its staff and the reduction of staff pay and conditions. In a skilled medical setting, particularly a hospital setting, there is a great deal of expertise and a great deal of expensive diagnostic and treatment, complex emergent and elective, cancer and trauma care. The private sector cannot provide this level of expertise and complexity at a profit. It will have to go.
It is notable that even former US president Joe Biden’s son’s gold-plated insurance denied him chemotherapy when the need for it became prolonged. Mr Biden was vice-president to Barack Obama at the time, and his son Beau was himself the attorney general of Delaware (Joe Biden: Obama offered money to help support my ailing son’s family by Amanda Holpuch, The Guardian, 12 January 2016)
Making a profit from the NHS also often involves causing it take exorbitant loans from banking consortia under the PFI scheme, and contracting out first peripheral and then core NHS services. This process started with cleaning. (Cleaners used to be the direct employees of the NHS trusts, part of the ward team and under the direct supervision of the ward sisters and matrons. Infection rates under that system were low. No longer!)
It then moved on to ground and building maintenance staff, replacing them with huge contracts for logistics companies, management and hotel service companies (Serco, Sodexo, G4S …); then to the building of entire hospitals (PFI). And it culminated in the contracting out of entire regional services, such as ‘primary care’ (Babylon Health, Virgin, GP at Hand, AT Medics), ‘urgent care centres’ (Practice Plus Group, Health Care of America / HCA, The Hurley Group), ‘screening services’ (InHealth Group), out of hours primary care (Care UK, Vocare – now part of Totally, and Practice Plus Group), hospital and surgical services (Virgin, Care UK, Circle Health, Bupa, HCA Healthcare, Nuffield Health, Spire, Circle Health group, and Ramsay Health Care), maternity services, paediatric services, gynaecology, radiology (InHealth, Medical Imaging Partnership, Diagnostic Healthcare, etc) and pathology services (Synnovis – notable for the crisis they caused in London Hospitals including Guy’s & St Thomas’ and King’s College Hospital in 2024, when they suffered a data-hack that made transfusing patients with blood, among other things, a virtual impossibility, which brought the surgical services to an abrupt halt.
Also outsourced are IT (Epic) and patient information management (Palantir, KPMG, Content Guru, Deloitte, Graphnet Health, and System C Healthcare), as well as the enormous outlay on medicines (AstraZeneca, Glaxo Smith Kline, Pfizer, Novartis, etc), medical devices and implants, and all manner of supplies.
Chronic underfunding and a huge decrease in bed numbers (cut from 240,000 to just 100,000 acute beds over the last 35 years) have been built into the system, and the perpetual crisis in frontline services and consequent lack of access to care is used to drive the better-off sections of the working class and petty-bourgeoisie into the self-paying and insurance-based private health sector, where the monopoly players are Bupa, AXA Health, Aviva and VitalityHealth. These four companies dominate the market, capturing 95 percent between them. The true bourgeois have, of course, always kept their private provision.
“Eight million people in the UK can now access private healthcare using insurance, once the spouses, partners and children of policyholders are included. That represents 11.8 percent of the UK’s 68.3 million population, the highest percentage since 12.3 percent in 2008 – before the financial crash prompted a fall in firms paying for private medical cover for their staff and individuals opting for it.” (Almost one in eight Britons now has private medical insurance, say healthcare analysts by Denis Campbell, The Guardian, 30 January 2025)
Why was NHS England introduced, and why is it being abolished?
The transformation of our health service from a nationally planned and commissioned service, paid for by national insurance taxation, which delivered comprehensive, high quality and economically efficient healthcare, free at the point of use from the cradle to the grave – into a much diminished, chronically short-staffed and underfunded system of privately contracted, rationed and profit-driven corporate and insurance-based care was not an accident. Nor was it the people’s ‘choice’.
Indeed, it needed a great deal of cunning on the part of those who wished to achieve this outcome. And those who wished to achieve it were, of course, Britain’s ruling monopoly class and their political representatives.
NHS England was an arms-length management organisation responsible for day-to-day delivery of care within the NHS, its delivery of service, and the appointed ‘chief executive’ took the place of the elected health minister as the person responsible for overseeing not only delivery of care but also the commissioning of services, and the strategic remodelling of the National Health Service in England.
NHSE was brought into being under the HSCA 2012 in order to create the conditions for the introduction to Britain of the American model of healthcare provision, the ‘accountable care organisation’ (ACO), or ‘health management organisation’ (HMO) that was initially rolled out in the USA by Kaiser Permenante under the notoriously and rabidly reactionary presidency of Richard Nixon.
This the NHSE has now quietly accomplished. Its work is done. The promised further ‘major reorganisation’ is no such thing, it will be merely a shuffling of the deckchairs on the Titanic, while acting also as a useful distraction from what’s actually happening and giving a talking point to Labour ministers, who are claiming – quite falsely – to have “undone disastrous Tory health policy”.
ICBs – Britain’s HMOs
In a now infamous taped conversation in 17 February 1971, domestic policy advisor John Ehrlichman briefed US president Richard Nixon on what he viewed as the advantages of relying on health maintenance organisations (also known as accountable care organisations) as a key component of the US healthcare system. Using Edgar Kaiser’s Permanente as an example he noted: “All the incentives are toward less medical care.”
That is: the less care that is delivered, the more the profit will be made by the HMO and its administrators in the health insurance industry.
It was this model of care denial – and in particular new computer algorithms that had increased the rate of care denial to an astounding 80 percent of privately insured applicants – that earned UnitedHealth CEO Brian Thompson three bullets in the back. (How UnitedHealthcare and other insurers use AI to deny claims by Bruce Gil, Yahoo News, 6 December 2024)
It’s even more astounding when one realises that we are talking about those who have health insurance cover, the employed and better-off US workers. The poorest 40-50 million US workers, of course, cannot access healthcare at all.
The mottos of the health insurance industry executives – ‘delay’, ‘deny’ and ‘depose’ – were inscribed onto the cases of the bullets with which Brian Thompson was executed by the young US citizen Luigi Mangioni. So universally despised are the health insurance administrators, who have been responsible for hundreds of thousands of corporate murders through their profit-driven policies of care denial, that Mangione rapidly became a universally acclaimed hero of the US working class – to the great chagrin of reactionaries everywhere, and the US monopolist ruling elite in particular.
It seems that Mangione himself struggled to access care for a bad back, having sustained a surfing injury, and his transition from a privileged and well-off US citizen to an assassin of one of corporate capital’s highest-ranking employees was on the surface an unlikely one.
President Nixon’s laconic reply, when briefed about the plan for HMOs, had been: “I like that!” Of course he did. And so did former health ministers Andrew Lansley and Jeremy Hunt when they introduced and oversaw the implementation of the Health and Social Care Act 2012, which explicitly created the ground for introduction of HMOs into Britain.
The plan to privatise the NHS – ‘Britain’s biggest enterprise’
With the demise of the USSR and the defeat of the 1984 miners’ strike, the neoliberal economists were set to roll back Keynesianism in favour of the post-Pinochet coup Chilean model of Milton Friedman. And in the spirit of the times, prime minister Margaret Thatcher’s then young ministers, fresh from their training and service to the monopoly financiers in the City of London, planned the campaign against the public provision of healthcare – the conspiracy against the NHS.
The plan was explicitly outlined in John Redwood and Oliver Letwyn’s 1988 Centre for Policy Studies document Britain’s Biggest Enterprise, which outlined a strategy to privatise the NHS that has been faithfully followed from the time of Thatcher’s administration to the present day, with full cooperation from the Labour governments of Tony Blair and Gordon Brown – and now that of Streeting and Starmer.
That plan rested upon:
- Diminishing the role of the NHS consultant and clinicians in general as the managers of the NHS. Clinical need as perceived by experts had to be sidelined as the driving force behind provision in favour of economic considerations – profit over patients.
- Removing the NHS’s ability to plan strategically and provide its own services, while allowing the business and insurance industries in to do this work and introduce systemic outsourcing to corporate health – something that would have seemed unthinkable even 20 years ago – yet now barely raises an eyebrow.
- Introducing an ‘internal market’, with a ‘fundholding’ group on the one hand and a ‘service providing group’ on the other, along with an army of managers and accountants to supervise the buying and selling of ‘services’ – or patients – from one to the other. This could make no sense unless there was a further plan – ie, to then outsource and privatise the services.
- A revolving door of management being introduced to rotate business managers from banks and private healthcare companies through the senior ranks of NHS management to oversee and force through the changes.
- All hospitals and all GPs being turned into businesses (as fundholders or trusts) in order to merge them in form with the corporate world.
Corporate management and the NHS internal market have ballooned to such an extent that overall management costs have risen from 3-4 percent to 15 percent of the health budget. Such are the wonderful ‘efficiencies’ to be made from the ‘competitive market-practices of the private sector’. Corporate managers now exist at every level of the NHS and are deeply involved in contracting and overseeing budgetary calculations and targets that simply did not need to be made when the NHS was centrally and regionally planned and operated as one unified service, under the managerial control of its medical and in-house health-economics experts.
Starmer’s so-called ‘bonfire of the quangos’, the rolling out across the country of ICBs or HMOs (now under the direct guidance of UnitedHealth), far from expelling corporate managers and financially-driven care from the NHS, will see them entrenched. To the extent that any ‘management cuts’ are made, they will simply reinforce the dominance of the well-funded health insurance industry – in particular, UnitedHealth’s UK subsidiary Optum.
In their own words: “Our experience of running 26 accountable care organisations in the USA and providing analytical and advisory support to a further 50, has given us a clear framework for creating an ICS, through the entire journey toward integrated care at scale. Moreover, our approach and experience are focused on creating sustainable models of financing [our emphasis] and care delivery that balances the burden across all stakeholders in a geography [a pleasant euphemism for the veritable feast of corporate capital upon the funding stream of the NHS], allowing for incremental, ongoing gains in the pursuit of the triple aim.”
It’s all for the wellbeing of the patien, naturally! For anyone that has any knowledge or experience of the corporate US healthcare system, these innocuous-sounding words take on a truly sinister meaning.
The internal market will ultimately allow for the individual budgeting and billing of patient journeys within the NHS and allow ‘fund holders’ to choose non-NHS ‘providers’ to care for NHS patients – paid for by the NHS budget and at taxpayers’ expense.
Jeremy Hunt’s role in the adoption of the HMO
Parliament produced a quiet report on the introduction of the HMO during Hunt’s ‘leadership’ of the NHS. The July 2018 report made clear that, like US President Nixon, Hunt favoured the Kaiser Permanente model, with a single system and payment mechanism across all types of care.
According to a 2014 analysis of US ACOs by the King’s Fund, outcomes are mixed, particularly with regards to cost savings. Dr Ashish Jha, director of the Harvard Global Health Institute, has argued that in order to import the ACO model successfully to Britain, there will need to be a change in IT delivery and in working culture. These are points that neatly dovetail with the second Darzi report, which is being placed at the centre of Labour’s 2025 ‘Ten-year plan for the NHS’.
Hunt’s report defined the ACO as “an area-based model of healthcare provision, where a single body takes responsibility for the health needs of its entire population”, with several key elements:
• They involve a provider or, more usually, an alliance of [private +/- NHS] providers that collaborate to meet the needs of a defined population.
• These providers take responsibility for a budget allocated by a commissioner. [The ICB will allocate government funds. Overseen by Optum (UnitedHealth), Optum will take control of NHS data and both mine it and use it to justify its spending – in all likelihood increasing private contracting. Patients may well be able to supplement and ‘upgrade’ their care with use of their additional insurance packages.]
• ACOs work under a contract that specifies the outcomes and other objectives they are required to achieve within the given budget, often extending over a number of years. [The DHSC/government sets targets, and provides taxpayers’ cash, but has no control and no responsibility for the quality or amount of care delivered.]
So: the amalgamation of various CCGs – groups of fundholding GP practices – into area-based health boards ‘ICBs’ has essentially become the new model for health provision in Britain. The health boards now control the central government allocated funding and the administration – that is the rationing, commissioning and contracting of private health provision or ‘NHS trusts’ to provide care.
They also deal with social care, which has been overwhelmingly privatised.
The ‘alliance of providers’ will increasingly be private providers, and the overseeing ‘board’ includes various groups of people including NHS doctors and GPs of a managerial and entrepreneurial stripe, but also managers of private healthcare companies, who can thus directly access, bid for, and administer the national NHS budget. UnitedHealth’s UK-based Optum is heavily involved in the running of the new ICBs.
A Health Service Journal report highlighted various organisational forms the ACO could take, including:
- A GP-owned organisation, which could take the form of a company whose liability is limited by shares or limited liability partnership.
- A corporate joint venture in which GPs and some organisation come together to form a new legal entity.
- An existing NHS body, for example a foundation trust or NHS trust.
- ‘host arrangement’, in which an organisation hosts the ACO contract but decisions are made through a ‘forum’ of partners from other providers.
Precisely this model of corporate GP merger and takeover was introduced for the GP out-of-hours service when a group of St George’s medical students turned GPs formed ‘AT Medics’ – a company that went on to swallow up some 49 GP surgeries and over 370,000 patients in the Greater London area (US company in takeover of network of GP practices, The Lowdown, 21 February 2021)
The GPs at these surgeries become salaried employees while the managing partners became millionaires. They sold out to the second-largest US and global health insurance firm Centene (with an annual revenue of $111bn), which operates in the UK as ‘Operose health’.
Were patients asked if they wished their ‘NHS’ GPs to be taken over by this rapacious US health insurance company? Of course not! It was approved by the North Central London CCG – the forerunner of the ICB.
As to how NHS GPs are allowed to sell surgeries to US health companies? Well – they are selling only ‘their own business’ (AT Medics) which has ‘won contracts’ with the CCG/ICB. They are selling ‘their model’ of accessing the ‘NHS’ funding stream that accompanies the patients.
Down-skilling … and up-risking
Operations on this scale, similar to the merging of our schools into corporate ‘educational trusts’, result in the reduction in care and the maximisation of profit – the intended ‘perverse incentive’ of Kaiser Permenante’s HMO. Interestingly, US health giant Centene has recently put up for sale both Operose and Circle (its hospital privatisation scheme, which at one time held the contract to run Hinchingbrooke Hospital in Cambridgeshire) citing a lack of profitability!
Which brings us back to the need to reduce pay and conditions and deskill workers – or, as Hunt’s report would have it, “change working culture” in the NHS!
Down-skilling the workforce has become a major bone of contention. The US model of having a ‘physician’s assistant’ is being increased. These PAs are performing tasks previously performed by doctors – from seeing patients in clinic to prescribing medicines and even anaesthetising patients and performing surgical procedures.
PAs have not been to medical school, but have attended a rather less stringent ‘PA course’ at one of the participating universities – perhaps equivalent to holding a masters’ degree in healthcare. The General Medical Council (GMC) has proposed that it should control the licensing of PAs, further reducing the distinction in the public’s mind between them and the more highly-skilled and rigorously trained doctors.
The British Medical Association (BMA) has expressed serious concerns about the risks of PAs working unsupervised in many clinical contexts. A recent review of doctors’ and patients’ concerns brought to light instances of:
- PAs making incorrect clinical decisions in place of doctors;
- PAs introducing themselves as doctors;
- PAs dangerously prescribing medication (something they are not permitted to do);
- PAs taking part in surgical procedures for which they were not qualified.
Nurse practitioners are also increasingly playing the roles doctors used to fulfil, while volunteers are employed by trusts and may take some ‘nursing’ roles – eg, taking observations on wards and clinics. In this manner, a cascade of down-skilling is cheapening the workforce. All this is taking place while forced cuts to medical staff are being pushed through nationally as ‘cost-cutting measures’ and more patients are being pushed into the private sector – to tackle waiting lists, naturally!
Contracting out: milking the NHS cash cow
A raft of such measures, including the independent sector treatment centres (ISTCs), which famously were commissioned at great expense to deliver the simplest operations and often failed to deliver even those – but were paid handsomely nonetheless – were introduced.
This was followed by the wholesale privatisation of services with, for instance, Richard Branson’s Virgin Health becoming for a time the largest GP in Britain, with three million primary care patients in Kent, Surrey and Sussex. “Branson’s Virgin Care has won almost £2bn worth of contracts since 2010 and at least one commissioning group is spending more than a fifth of its budget with the company.” (How Virgin became one of the UK’s leading healthcare providers by Hilary Osborne, The Observer, 5 August 2018)
Branson notoriously sued six clinical commissioning groups (CCGs) in Surrey, Surrey county council and NHS England after it lost out on a £82m contract to run children’s services in the area in 2016.
Trustification: turning hospitals into businesses
All NHS bodies were converted into private businesses (‘hospital trusts’), allowing them to contract out care and services to private providers, and to seek extra funds by bidding for private contracts and engaging in private (self-paying and insurance-based) health provision.
The key to all this ‘transformation’ has been the purchaser-provider split – the creation of an artificial health market within what was once a publicly planned and provided NHS.
The health needs of a population are calculable. Experience helps to refine the provision, but the NHS was famously efficient and was indeed modelled around a socialist model of provision – one that led Tory backbenchers in particular to denounce it as a ‘Stalinist institution’ – all while fighting to privatise it, naturally!
Margaret Thatcher oversaw the introduction of this split, of the reduction in the power of NHS doctors, and the introduction of the ‘rotating door’ between private business and NHS management. First ‘payment by results’ and finally across-the-board financial rationing engineered a situation in which every NHS hospital trust was in debt.
The Covid effect
The huge government spend, thought to total around £450bn, during Covid was largely a bailout of the corporate world and a convenient mechanism for hiding the general financial crash that took place, triggered by the pandemic but by no means caused by it alone. To the extent that funding increases were made available, the government states that just £62bn went on ‘health spending’, of which £18bn went to the NHS.
The vast majority of government expenditure was not given to the NHS directly, but rather to private companies to provide all manner of personal protective equipment (PPE), including £40m to then health secretary Matt Hancock’s pub landlord, and intense lobbying to pass on a billion or so to Greensill Capital, which pledged a backhander of £30m worth of shares to former prime minister David Cameron in return for his help in landing a deal.
Billions went to pharmaceutical corporations (AstraZeneca, Pfizer, Moderna) and private testing and tracing services (Serco), security management (G4S), as well as for the construction of ‘Nightingale’ new-build but unstaffed hospitals (Sir Robert McAlpine, Kier and Balfour Beatty, Interserve, Bam and Vinci, etc).
The administration of ‘Covid’ funds was almost entirely beyond the control of the NHS doctors who would have been best placed to manage the crisis. It was a great bonanza. Notoriously, £10bn was granted to the ailing private system ‘to keep capacity’ … for nothing. Private hospitals were literally paid to remain idle, while NHS hospitals in many parts of the country were sagging under the weight of admissions.
Two million extra appointments – ‘to tackle the waiting lists’?
During Covid, essential changes were made in patients’ expectations. Access was limited – at first seemingly with some justification. Telephone and video appointments were introduced. It became much harder to see your GP.
The Babylon Health model of transferring your GP to a mobile app was introduced, with Radio 4 waxing lyrical over the “convenience” of this “innovation” as former private schoolboy Mobasha Butt, with whom this author went to medical school at London’s Royal Free hospital, and who worked as an executive officer for Babylon, expressing his hope of cashing in by reducing provision for patients. (Babylon medical director named most influential GP in UK, Pulse, 28 August 2018)
Health secretary Hancock was beside himself with joy, since the Babylon model dovetailed neatly with his plans for reducing access to and cutting the costs of health provision. An enormous ‘backlog’ or waiting list was built up, which has proven to be a most useful political tool to further beat the NHS into submission and grow the insatiable private sector.
Wes Streeting has demonstrated the continuity of Labour’s plan for the NHS with “plans to address the waiting list” by increasing private provision of ‘NHS’ appointments: “A major expansion of the private sector’s role in providing elective NHS care in England risks diverting finite staff and resources from elsewhere in the service, experts have warned.
“As part of a package of new measures designed to lower waiting times for planned NHS treatment in England, the government wants the private sector to deliver an additional one million appointments a year for NHS patients. The expansion, which is based on the private sector’s projections of what it can deliver, would increase the total number of NHS appointments, tests and operations delivered by independent providers from around five million to six million each year.
“The waiting list for planned NHS care in England currently stands at 6.4 million people waiting for 7.5 million treatments.” (Private providers to deliver more care to NHS patients under government plan by Gareth Iacobucci, British Medical Journal, 7 January 2025)
This, incidentally, is the basis of the claim that Streeting has “delivered a million new appointments” – which have mysteriously barely touched the waiting list. More is still to come!
The second coming of Lord Ara Darzi of Gerrards Cross – another prescription for the HMO
Streeting and Starmer, like Blair and Brown before them, have commissioned Lord Ara Darzi, a reactionary London surgeon of Armenian origin who was formerly professor of surgery at St Mary’s Hospital in London, to write yet another ‘report’ upon which Streeting is claiming to base his latest recommendations.
Lord Darzi was famous for introducing the concept of the ‘remote ward round’, in which his face would follow a group of doctors trailing the ward on a small computer screen, atop a 1970s’ sci-fi looking robot, obviating the need for him to actually attend the hospital. And perhaps that is a good metaphor for his entire attitude to the NHS – the less physical contact with patients the better; the less money spent on their actual healthcare the better; the greater the personal profit drawn from the medical practice, the better.
Darzi’s report has come up with three great overarching ‘principles’:
- From hospital to community.
- From analogue to digital.
- From treatment to prevention.
The report mirrors his 2008 suggestion that care should move from centralised hospitals to local ‘polyclinics’.
Darzi is also frank in pointing at the NHS waiting lists and stating that the NHS is in a fundamental crisis – which he attributes solely to the Health and Social Care Act pushed through parliament in 2012 by Andrew Lansley (also ennobled for the services of corrupting the national budget and serving up enormous profit – carved out of the NHS budget – to the great and the good: the bankers, insurance monopolies, accounting, marketing and logistics monopolies and big health) and enacted by his successor, Jeremy Hunt.
1. ‘Hospital to community’ or ‘Central to local’
This may simply be interpreted as the ‘local’ contracting and subcontracting of services via the ‘geographically local quango’ ICB, as opposed to the centrally-located quango NHSE. Each ICB will have control over population groups of around one and a half million patients and all the services in their geographic area.
Even more savings and profit can be made if this care is administered in an outpatient setting, away from costly and expert hospital-based medical care.
2. Analogue to digital
To a large extent, this has already happened. The NHS has gone digital.
Of course, its systems famously don’t integrate well and vary from trust to trust. But the new drive is towards introduction of ‘Epic’ in particular – via a contract that cost King’s College Hospital alone £450m, and Guy’s and St Thomas’ a similar amount. This digital platform was promoted strongly as being necessary for the introduction of paid-for services. The famously expensive ‘Epic’ software package is provided by the US firm that manages the medical records for 179 million Americans – or 56 percent of the country.
‘Going digital’ also encompasses the introduction of algorithm-based healthcare for the management of chronic conditions and will facilitate the supplying of drugs, advice and treatment to patients without the need for expensive medical examination and expertise. This may incorporate the use of AI (cutting out the physician), as in the case of the much-hated 111 ‘emergency care’ service, which has proved to be extremely poor at triaging and directing patients safely (Lives are at risk when algorithms go wrong by Phil Whitaker, New Statesman, 4 February 2024)
To this end, Wes Streeting recently attended the Bilderberg group meeting of billionaires and Nato militarist ministers, where he met with tech billionaires like Palantir CEO Alex Karp, who warned recently: “We are likely to end up in a three-front war with China, Russia, and Iran.” These three nations, says Karp, are “are working together against us and we have to work together against them”.
Streeting has declared himself “an enthusiastic convert” to the use of artificial intelligence (AI) in the NHS, pledging to “bring our health service into the digital age” and vowing to “cut unnecessary red tape [ie, safety testing] around the implementation of new technology”.
Palantir is a US company that “specialises in AI-powered military and surveillance technology and data analytics. The company describes its military technologies as offering customers ‘mission-tested capabilities, forged in the field’.
“In January 2024, Palantir signed a new deal with the Israeli Occupation Forces (IOF) to supply technology to support the genocide in Gaza. Palantir’s CEO Alex Karp says he is ‘exceedingly proud’ of Palantir’s involvement in what he calls ‘operationally crucial operations in Israel’.
“Palantir supplies Israel with racist ‘predictive policing’ tech used to harass and detain Palestinians. NHS England has handed them our health data and public money.” (No Palantir in the NHS, appeal by Amber Hourigan, Change.NHS.uk, 27 November 2024)
That relationship is set to continue under the ICBs and Wes Streeting’s overtly Zionist leadership of the NHS, which we will examine elsewhere.
3. ‘Treatment to prevention’
There is no indication that ‘prevention’, in this instance, means exercise, healthy food, local work, adequate rest and a peaceful, meaningful and secure social, cultural and working life. It is likely to mean the administration of medicines for management of chronic conditions in the community.
Control of blood pressure and cholesterol by widespread prescription medication to ‘prevent heart attacks, strokes’, for example.
The final stage of the privatisation plan is at hand
Leaving aside the pantomime politics that would seek to discern some difference between Labour’s health policy on the one hand and the Tories’ on the other, we can see that every recommendation of the Darzi report dovetails precisely with Labour’s ten-year plan, and with the really underlying project – as laid out 35 years ago in ‘Britain’s Biggest Enterprise’ – to introduce the insurance-based model of mixed-payment HMO care to Britain.
This is quite clearly why there is such ‘broad cross-party support’ for Wes Streeting’s ‘radical plan’ for the NHS – notably from such ‘radicals’ as Tony Blair, Alan Milburn, Simon Stevens, Michael Gove and Jeremy Hunt.
The reality is this: Medicare has come to Britain. The National Health Service is no more.
US healthcare is the most expensive in the world and delivers among the worst health outcomes.
What we are witnessing is not the ‘failure of the Stalinist NHS’ or of the ‘Soviet-style statism’. What we are witnessing is the final stage of the wanton destruction of our public health system – a blood-sacrifice to the Moloch-like greed of finance capital.
