Union Safety - Official Website of NW BT Union Health and Safety Coordinators Committee: Starmer’s Cuts And Privatisation Plans For NHS Elective Care And Out-of-Hospital Treatment Is US Model

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Starmer’s Cuts And Privatisation Plans For NHS Elective Care And Out-of-Hospital Treatment Is US Model

Here, Jenny Green of campaign group NHS Matters, provides the true aim of the Government's NHS announcement to tackle the hospital treatment waiting list - privatisation of majority of so-called 'elective treatment' services, based on the denial of hospital care:

The government’s Reforming Elective Care for Patients document, published today, states that among meaures to “slash” elective care waiting times, GPs will be able to refer patients directly to community diagnostic centres without requiring a prior consultation with a hospital consultant. And they will be paid to incentivise them to do so.

In his speech today on the new plan, which he delivered to NHS staff at the Elective Orthopaedic Centre at St Helier Hospital in Epsom, Keir Starmer reportedly described the initiative to bypass GP referrals to hospital consultants as:

“allowing GPs to communicate directly with specialists to seek advice and diagnose people more quickly [which] will save more than 800,000 “unnecessary” appointments and referrals every year.”

Rebranding the Advice and Guidance scheme that GPs rejected in 2021

Is this just rebranding the Advice and Guidance scheme that GPs rejected in 2021 when Sajid Javid introduced it, and have continued to protest, with a threat last summer to stop using it as part of their “collective action”?

A look at the Reforming elective care for patients – January 2025 document indicates it is just that.

On p 23 it says it will: “reform elective care by optimising referrals using Advice and Guidance and triage”.

GPs would receive £20 per Advice & Guidance request, in the hope that this would deliver up to 4 million advice requests from GPs in 2025/26 (up from 2.4 million in 2023/24). The government and its NHS England quango expect this could increase patient diversions from hospital elective care to primary and community care, from 1.2 million in 2023/24 to 2 million in 2025/26.

Where are the physical resources and staff coming from to deliver this 800,000 increase in patient referrals and treatment in primary and community care over the coming year?

Is this going to be part of the “NHS and Independent Sector Partnership Agreement – the first of its kind for 25 years”? (p22)

It’s Blair’s 2000 “Concordat” all over again. We know how the 2000 Concordat opened the NHS to a massive wave of privatisation. This aims to finish the job. Soon only the very costly and unprofitable acute and emergency sector will be publicly provided by the NHS.

Starmer’s rebranded Advice and Guidance scheme continues Rishi Sunak’s 2023 elective recovery task force plan for giving private companies a bigger role in running and funding diagnostic centres for the NHS.

For example, the Community Diagnostic Centre in Oldham was developed in partnership with Alliance Medical. The medical imaging company was given a headstart in NHS diagnostic services in 2015 when NHS England selected a Collaborative Network, led by Alliance Medical Ltd, to provide PET/CT scanning services across 30 locations in England.

Starmer’s Reforming Elective Care for Patients document states,

“Integrated care boards will…ensure contracts with the independent sector are in place to mitigate the waiting list challenges in each system, as well as a broader range of diagnostic tests” ( p 10)

Caroline Molloy, micro-blogging today on Bluesky, points out that,

‘Industry lobbyists (the kind of folk Streeting listens to) are saying in a few yrs pharmacy chains will have replaced GPs for many things & will employ our “nurses, phlebotomists, technicians, physiotherapists, mental health specialists”. Privately run, natch.’

“Boots fancies doing everything from “NHS” phlebotomy to “NHS” bowel cancer screening in the new “NHS” Community Diagnostic Centres, plus private GP services. With the profit motive at play & less regulated, unionised & qualified staffing as a result.

“Lest we forget, Boots endorsement of Starmer was front page news, though most headlines focused on the fact that the Boots CEO was a Bullingdon club mate of Cameron’s rather than on Boots plans to scoop up lots more NHS services. Here my piece )see the 2nd half)”

“When I was writing this report on Tory back door NHS privatisation via “Diagnostic centres” / with a tech figleaf, I tried & failed to get then shadow health secretary, Jon Ashworth, to comment. Despite the alarming plans for a huge takeover of NHS services by the likes of Rutherfords & Boots.”

Here is what CK999 wrote about this Tory backdoor NHS privatisation at the time.

It’s a rubbish idea for NHS primary and community health services to be run by profit-driven private equity companies with unethical practices towards patients

But this is the way the wind blows.

For example, in November 2024, after expanding Boots pharmacy practice to provide over 160 healthcare services for both private and NHS patients, the Starmer-endorsing Boots Managing Director Sebastian Jones quit, as the parent company Walgreens Boots Alliance stalled sales talks for its subsidiary.

Jones jumped ship to become group CEO of Veonet, a German private-equity owned chain of ophthalmology clinics and owner of SpaMedica, a UK private company which over the past decade has muscled in on NHS contracts to perform high volume, profitable eye operations. In 2021 Veonet was put up for sale by its private equity owner Nordic Capital in a potential 2 billion-2.5 billion euro ($2.4 billion-$3 billion) deal. It was bought by Ontario Teachers’ Pension Plan and PAI Partners. According to a Guardian article, the results of private equity ownership of German opthalmology and other health care companies should be concerning to anyone who cares about public health:

“Eye doctors have described how they face pressure to make ‘as much money as possible’ by selling patients additional services, such as special examinations and cataract operations. One dentist told the German version of Panorama that she drilled into perfectly healthy teeth. Investor-run medical practices disputed the idea that they were looking to make ‘quick money’, but because this industry is notoriously opaque, it is difficult to tell how much money is being made or even how many practices have been bought out.”

Although Starmer- endorsing Sebastian Jones left Boots after its New York owner Walgreens Boots Alliance stalled sales talks for the company, in December it was reported that Walgreens Boots Alliance could itself be taken over by private equity giant Sycamore Partners in a £10m deal, that could involve selling off Boots separately from the rest of the company.

Where there’s privatisation there are also cuts, since private profit doesn’t sit well with comprehensive health care for all.

True to form, Starmer’s Reforming Elective Care for Patients document directs integrated Care Boards to,

“expand remote monitoring across all long-term conditions where clinically appropriate, helping to remove up to 500,000 lower value follow-up appointments per year from 2026/27 onwards.”

This assumes remote monitoring is an adequate substitute for in-person appointments. Many medics as (well as patients) dispute this. Medics point out that they treat a whole person, not a specific bunch of symptoms. If they lose sight of the whole person, not only is the whole clinician-patient relationship erased, but they’re going to miss many crucial opportunities to pick up on what’s embodied but unsaid, or is only said because a human relationship is in play.

We have protested for years about increasing limitations to so-called lower value NHS treatments. In a universal public health care system like the NHS, where treatment is supposed to be based on patients’ clinical need, how is economic value an appropriate criterion to use when deciding whether patients should receive treatment? That is how private insurance companies work.

It is also how the state-funded Medicare and Medicaid schemes work in the USA. These provide a limited range of health care through Accountable Care Organisations, to people who cannot afford to buy private health insurance. Who said it was ok to turn the NHS into a UK version of Medicare/Medicaid? With all its attendant problems. Did anyone ask us, the public?

Well, the Tories will say yes, in the 2022 Health and Care Act. And it was a terrible piece of legislation that Labour peers raised no effective opposition to, with Blair’s former Health Special Adviser, NHS England and United Health Chief Exec Simon Stevens elevated to the House of Lords to make sure it had free passage there.

(Published under the terms of the Creative Commons Attribution-Noncommercial Sharealike 3.0 licence. Here: http://creativecommons.org/licenses/by-nc-sa/3.0/) Originally published 6th Jan 2025 by NHS Matters Change to headline title only. Original: Starmer’s cuts and privatisation plans for elective care community referrals and out-of-hospital treatment complete Sunak’s work