Would a Labour government fix the crisis facing the NHS?

During Prime Minister’s Questions today, Labour leader, Sir Keir Starmer, accused Rishi Sunak of refusing to admit the NHS is in crisis.

He drew attention to the long waits for ambulances and urged Sunak to apologise for the “lethal chaos” which has ensued “under his watch”.

Labour say they have a plan to tackle long ambulance waiting times, reduce the elective care backlog and increase GP capacity. But this plan will involve “change” and “reform”, Sir Keir has said.

Under the plans, the Labour party says they would introduce self-referrals for some patients; double the number of graduating doctors and district nurses; provide thousands more training placements for nurses, midwives and health visitors; and free up GPs to focus on patients.

Starmer has also backed plans proposed by Wes Streeting, the shadow health secretary, to partner with private providers to reduce waiting times for elective care.

The NHS waiting list currently stands at 7.2 million, and Starmer says this waiting list could be cut by more than 200,000 patients per year if private healthcare was better utilised.

Could the NHS become privatised under Labour government?

However, Labour’s plans for the NHS have been heavily criticised by healthcare workers and even some of Starmer’s own backbenchers, such as Diane Abbott.

The Labour party MP recently accused Starmer of “join[ing] the right” in calling for reform of the NHS. She tweeted: “Keir Starmer and Wes Streeting have fallen for the idea that a bigger role for the private sector is the answer to the problems of the NHS.”

But Sir Keir holds that partnering with private providers would be a “short reprieve” to reduce waiting times, and would not lead to the privatisation of the NHS.

“My Labour government would give Britain its NHS back, through a decade long programme of renewal and reform, to make the health service fit for the future. No more sticking plaster politics,” he said.

In an interview with the Laura Kuenssberg for the BBC, Sir Keir said: “[The NHS] will always have to be free at the point of use, it, of course, should be a public service. But that doesn’t mean we shouldn’t use effectively the private sector as well.”

“The reason I want to reform the health service is because I want to preserve it. I think if we don’t reform the health service we will be in managed decline,” he said.

He added that the Labour want a “preventative” healthcare model which treats people early and allows patients to receive safe and timely care when they need it. This would mean focusing on primary care and ensuring patient can easily access GP appointments, instead of having to go down more expensive routes like secondary and emergency care.

Will allowing patients to self-refer help to cut the NHS waiting list?

However, Starmer has come under fire for suggesting that more patients should be able to self-refer to specialist services, bypassing GPs.

In the interview with Kuenssberg, Starmer said: “One of the proposals we put forward was [to consider] self-referrals, so that individuals don’t have to … use up a doctor’s time in order to get referred to specialist health.

“If you’ve got back pain and want to see a physio, it ought to be possible, I think, to self-refer. If you’ve got internal bleeding and you need a test, there ought to be a way which doesn’t involve going to see a GP.”

But some NHS staff don’t agree with the proposal, arguing that self-referrals could put patients in danger. Dr Ellen Welch, a GP and co-chair of DAUK, tweeted: “If you’ve got ‘internal bleeding’ then you really don’t want to guess which tests you need or which specialists you should self-refer to – you may bleed to death while deciding.

“Doctors train for 10 years or more to become GPs to assess what’s going on and help patients in the best way possible. It’s shocking that Labour would suggest this. It puts patients at risk while simultaneously devaluing the expertise of GPs”.

Sir Keir has defended the policy in an interview with LBC, however, saying that he was “trying to be delicate” during the interview, and was referring to blood in the stools or urine.

The Labour party are suggesting that instead of going to a GP to get a test, and then having to book another appointment to discuss the results, you could get the test and then go to the GP once you have your test results back. This cuts back on unnecessary GP appointments, freeing up doctor’s time.

Others have expressed concern that Starmer’s plans won’t do anything to reduce the NHS backlog, and could actually increase waiting times for specialist care.

In an interview with Sky News, BMA Council Chair Phillip Banfield said that the shadow health secretary, Wes Streeting, “doesn’t understand general practice” and said the plans could actually “widen existing health inequalities”.

He explains that the “worried well” will be the group that self-refer unnecessarily, and those that need medical attention won’t seek help as they don’t want to take up a doctor’s time. “You then end up, paradoxically, with a widening health inequality,” he said.

Professor David Oliver, a consultant in Geriatrics and General Internal Medicine at the Royal Berkshire NHS Foundation Trust added that without GP ‘gatekeeping’, elective care lists will grow.

He explains: “With 7 million patients already on waiting lists for elective care, a major and growing clinical workforce crisis, how are those specialists already trying to get waiting lists down going to cope with a load of self-referrals who have bypassed GP gatekeeping?

“And how many of those self-referrals will be for things that primary care could comfortably deal with (if it was properly resourced and staffed)? Or a GP would have helped steer to a more appropriate specialty?”

But Sir Keir says that there will be strict guidelines in place for self-referrals, and these guidelines will be “subject to discussion with the professionals as to what would work and what wouldn’t.”

“We’ve got so many examples of people going to a GP and then being referred elsewhere and there are examples where we think we can cut that down. And we’ve got to … GPs are overwhelmed … we’ve got to think differently about the future of the NHS,” he told LBC.

Recruitment and retention: how do Labour’s policies hold up?

Starmer has made it clear that one of Labour’s primary goals is to increase the number of staff working in the NHS. “There is no solution that doesn’t involve expanding the workforce,” he wrote in his article for the Sunday Telegraph.

Labour plans to double the number of graduating doctors and district nurses and provide thousands more training placements for nurses, midwives and health visitors.

Mr Streeting also recently announced that Labour would recruit more doctors and commit to delivering better pay, terms and conditions for care workers.

However, Labour’s plans have been criticised for failing to focus on workforce retention. Dr Farah Jameel, BMA England GP committee chair, said: “Increasing medical school places is a good policy, but won’t result in any newly-qualified GPs for another decade; all the while we are haemorrhaging early, mid-career and senior GPs.

“We urgently need a plan for retention, as well as recruitment, supporting GPs to stay in the workforce, which includes addressing unsustainable workloads and burn out, and long-term solutions to the pension tax trap that is leading doctors to retire early.”

Starmer and Streeting are now being urged to engage with healthcare staff and medical organisations to discuss how a Labour government could improve retention as well as recruitment.

Holly Turner, a registered nurse, told Nursing Times that Starmer’s “lack of understanding” of the main issues affecting the workforce are “troubling and disappointing”.

“We would urge all staff to continue mobilising with their trade unions to fight for what we desperately need, as we clearly can’t look to anyone in Westminster,” she said.

The right kind of change

In his article for the Sunday Telegraph, Starmer acknowledged that people often “recoil” when he talks about change in the NHS.

“They think Labour’s job is to merely defend public services. I have never believed in that. Labour’s job is to drive up standards, so that services don’t need defending” he writes.

While any discussion of NHS reform is bound to cause concern, it is clear something needs to change, as under the current system, we have seen waiting lists grow to the largest number on record.

While Covid is partly to blame for the backlog of care, the NHS was verging on a crisis before the pandemic began. A report commissioned by the Department for Health, stated: “We have essentially had 10 years of managed decline. This is not a Covid problem.”

While change is clearly needed, NHS staff want to be sure that it is the right change for the right reasons. They want to be involved in decision-making and most of all, they want to ensure that the NHS remains free at the point of use so that everyone can access care as and when they need it.

As Mr Banfield said: “Doctors are not the problem, they are the solution. You need us, as experts, to deal with the problems of the NHS. We are not averse to change, it is a complete fallacy that doctors want the health service to stay as it is. We are the first people to say that we want change in the health service, but please can we have it evidence based, please can you listen to frontline staff, and please can you invest properly in a health service we can be proud of.”