By Rose Tedeschi and Alex Rutherford
Health Secretary Wes Streeting has announced that ‘the NHS is broken’—and Labour doesn’t have a plan to change that anytime soon.
Waiting lists are at an all-time high, and the 8am rush for GP appointments has become a feature of everyday life. Meanwhile, emergency departments are full and patients are being treated in corridors, a state of affairs which Streeting has been clear isn’t going to change any time soon.
The NHS will not fund social care for any but those with the most complex needs. Most care is left to be paid for by councils, and more and more by patients themselves. Costs can be hundreds of thousands of pounds, forcing many to sell their homes. Staff shortages and low wages mean care is often substandard. The lack of care at home then prevents the NHS from discharging patients from hospitals, further adding to the overcrowding.
There is a serious staffing crisis across the NHS and social care. Staff turnover is high due to low wages and poor working conditions, which leads to increased pressure on remaining staff. Brexit caused an exodus of essential migrant labourers and the government’s ‘crack down’ on immigration is only exacerbating the problem. Around 19% of all NHS and social care workers are migrants.
Labour claims that it simply inherited the situation from the Tories, but that isn’t the whole story. While 13 years of Tory austerity certainly had a disastrous impact, it is not the underlying cause of the decline. Privatisation was baked into the NHS from the start by allowing GPs to be run as private partnerships. The organisation of hospitals into Trusts continued this trend, with each being run like a small business preventing effective centralised control.
Glorification of competition led to the introduction of the internal market under Thatcher, and privatisation was accelerated under Labour, with Gordon Brown’s Private Finance Initiatives (PFIs). These relieved pressures in the short term, but put dynamite in the foundations, diverting public funds into private companies and letting them milk profits by providing NHS services on the cheap. This undermined the NHS, leaving it ill-equipped to cope with austerity. Outsourcing has made providing healthcare both less efficient and more expensive, as profitable services are carved out and sold to the highest bidder. Taken together, these measures amount to a deliberate sabotage of a system which millions of workers rely on.
Labour’s so-called ‘plan’ consists of a commission led by Baroness Casey; the first stage to be completed by mid-2026, where critical issues will be identified and medium-term recommendations given. Why this delay is necessary considering that reports that have taken place over the last few years which already highlight the critical issues and recommend improvements is unclear. Phase two of the plan will not even report until 2028—a year before the next election is due to take place.
Fixing the crisis
The NHS is being transformed before our very eyes into a two-tier health service, with private insurance for some, and a second-rate service for everyone else. This is presented as the only option to save the service, but in fact it paves the way for further defunding and eventual dismantling, as wealthier voters go private and working class voters can’t accesss NHS services.
The scale of the challenges demands a new approach, renationalising the NHS, incentivising workers to choose careers in the health and social care services by offering improved conditions, subsidised training and better wages. But this would mean a showdown with powerful corporate interests which Labour is unwilling to countenance.
Health workers showed the way during the strike wave, when porters, paramedics, nurses and doctors of all grades took part in the greatest period of industrial action in NHS history. But these disputes were invariably sold short by the union tops, who recommended workers accept a paltry 5% deal, only a quarter of the original claim. Despite the best efforts of the rank-and-file group ‘NHS Workers Say No!’, which organised a successful campaign for nurses to reject the deal. When the Tories used the undemocratic anti-union laws to stop the strikes through the courts, the bureaucrats backed down.
This demonstrates the need for a rank-and-file organisation across the entire NHS which can take control of disputes and prevent future sellouts. Workers need to organise collectively, across all disciplines and pay grades to fight for what’s needed; a real pay rise linked to inflation, an end to privatisation, and a properly funded health and social care service paid for by taxing the rich.
