Interview of SHA chair on Socialist Telly.
Health and Social Services Secretary Wes Streeting launched the government’s “10 Year Health Plan” Fit for the future: 10 Year Health Plan for England on 3 July 2025. It is worth recapping how we got from the NHS as created in 1948 to the NHS as it is now. The change began in the 1980s under Prime Minister Margaret Thatcher with the introduction of the ‘internal market.’ After 1997 the government of Tony Blair compounded this change by building new hospitals that were owned privately and leased very expensively to the NHS. After 2010 the Tory-LibDem coalition and then the Tories alone introduced Acts in 2012 and 2022 that dramatically expanded the delivery of NHS services by privately owned companies. At the same time life expectancy has been falling, maternal mortality has been rising, and children’s health has deteriorated. SHA Chair Rathi Guhadasan explains.
To get to this point, the language now used by government and its appointees in the NHS is rather pernicious. What is meant is the opposite of what the public might think is meant. For example, expanding care in the community is very good for the patient but very expensive. What it would not normally be expected to mean is to do this on the cheap to replace hospital care. But that is what government means. Similarly, multi-disciplinary teams safeguard the patient from a single misguided clinician. What is not normally understood by the phrase is what in fact is happening – the substitution of less qualified staff in place of professional clinicians to save money. Rathi illustrates the deterioration of patient care caused by the actual meaning of terms meant to sound like improvements.
There are a number of consequences that flow from the outsourcing of NHS services to private providers and the pernicious meanings of terminology. Instead of referrals to other parts of a joined up service, increasingly the referrals are to privately owned providers that have nothing to do with each other. The service lacks continuity because it is all about wealthy outsiders with their own separate interests making money. As a consequence, the services are inevitably less accessible because they are more distant, and less well coordinated. These changes have tended to lead to widening inequality of patient outcomes. The roll out of patient advisors who patients are increasingly seen by instead of doctors, which is their right, is symbolic and symptomatic of all of the changes in the Ten Year Plan. Rathi is passionate on the subject, from personal experience.
Following this sorry recent history, the 10 Year Plan just promises more of the same. The three shifts – prevention, hospital-to-community, and the doctor in your pocket – are designed to enable private companies to profit, not to significantly improved health outcomes, indeed to worsen them. Improving housing and alleviating poverty would do far more to prevent ill-health than new-born screening, telling people to go for more walks and punishing them by withholding benefit if they don’t take a dangerous weight loss drug. Closing Accident and Emergency facilities and worsening population-hospital bed ratios is not mitigated by expanding privately provided community care, it is caused by it. A&E and community care should never be an ‘either-or.’
The patient waits for ever for an ambulance and then to get out of the ambulance, and then to get off the trolley, all because A&Es have been closed. Maternity services are essential, not optional, yet they are being closed because they are expensive. When it comes to cataracts and hip replacements, it’s the easy cases that end up on the private provider lists. The poor and sicker patients have to wait longer. And having taken away a lot of the surgery. the NHS units are told they are not doing enough surgery! They are under threat of closure, which will leave the difficult cases waiting even longer. The only answer is to reinstate the NHS; bring it all back in house!
In short, the 10 Year Health Plan is a plan for yet more wealthy profiteers to pick like vultures at the dying carcass of the National Health Service in the form that it was created by Nye Bevan in 1948 and run along the same lines until at least the 1980s.
See off the vultures and restore the NHS!