Health Secretary Wes Streeting yesterday announced that NHS waiting lists have been cut since Labour came to power last year. It’s an early record of which he can be proud. Patients have been waiting for too long, often in pain and to the detriment of their long-term health, for various procedures. Half a million patients have been seen using private healthcare under the NHS since January alone this year — an impressive feat, but a far cry from resolving the six million-plus who remain in purgatory. Streeting, for his part, has said that he “refused to be bound by outdated ideological battles”, and that he would be open to using more private hospitals and services within the NHS. But how would this work in practice?

The situation at the time of the general election last year was unsustainable, and on balance the decision to use more private providers within the health service was the correct one. The Government, spurred on by the latest statistics, is expected to announce a further commitment to the private sector in its hotly-anticipated “10-year plan”. But what happens when we reach the 2030s, with an ever-ageing population, a social care industry in crisis which could be worsened by scrapping visas for workers, and a waiting list which is expected to at least double during that time? These problems are systemic, and not easily solved by the private sector.

In 2023/24 the NHS spent £188 billion, and in December 2024 it was reported that the service spent a record £12 billion outsourcing patients to private hospitals. Yet caution is required here. If the NHS becomes addicted to using this as a permanent solution, the cost of procedures and managing backlogs will remain permanently high. It also drives staff away from carrying out NHS work; they can charge higher rates when working privately, even though the money may still be coming from the taxpayer. These are expensive problems for the Department of Health to solve once they become the norm.

In a speech in May 2024, Streeting said: “If you want to understand my appetite for reform, think New Labour on steroids.” At the same time, he refuses to be contained by “outdated ideology”. Labour politicians often love to point to its record during the mid-2000s, especially on health policy, but the long-term damage of some of these policies is easily forgotten. Take the Private Finance Initiatives (PFI), first introduced by the Tories in 1992 and adopted by Labour in 1997. PFI involves sub-contracting the design, building and operation of public services to private-sector companies. To this day, many trusts are still paying off these debts, which are a lasting parasite to their financial books. For example, it was reported in 2022 that some trusts are spending more on PFI repayments than actual drugs in hospitals.

With NHS trusts constantly teetering on the edge of bankruptcy, it’s hard to defend the cost of leaning on the private sector without fixing fundamental capacity issues and learning from past mistakes. While Streeting’s New Labour on ‘roids approach currently only involves the use of private clinics, it was reported last year that PFI 2.0 strategies are being considered for building hospitals.

There is some hope, however. The scrapping of NHS England, combined with strong pushes for rooting out inefficiencies and increased funding announced by the Chancellor, should lead to a healthier financial situation for the NHS. Yet, as soon as Labour makes a positive suggestion, the party has an uncanny ability to then introduce a policy which is misguided.

The elective care reform policy, announced earlier this year, gave anecdotal examples which seemed to introduce additional steps for the process of referring patients. This could end up increasing pressures on waiting lists and causing further delays for patients. It’s why the messaging of “radicalism” and “outdated ideological battles” seems weak. It’s not about ideology: it is about making changes which are in the best interest for the future of the NHS and its patients.

Streeting is in a difficult position. The NHS is and will continue to be under immense pressure, but that’s why there has to be a suitable plan for the future. However, the expansion of outsourcing to the private sector is likely to be an expensive mistake.

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Dr Ammad Butt is a freelance writer and doctor working in the UK.

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