2024 was the busiest year on record for emergency departments and ambulance services in England. Care in corridors and car parks has become normal. One in eight beds are occupied by patients unable to go home without community or social support. Delays moving sick patients from emergency departments to a hospital bed, caused an estimated 14,000 avoidable deaths last year. A&E overcrowding means ambulances wait outside to hand over patients and miss 100,000 urgent callouts each month.

Despite its massive parliamentary majority, the Labour has dropped previous promises, sidestepped this immediate national crisis and instead announced partnership with the private sector to reduce non-emergency waiting lists by 2029. 

Why?

For Labour the waits for non-urgent (“elective”) appointments (6.3 million people waiting for 7.5m appointments) make bigger headlines. As part of their Elective Care Plan, Keir Starmer has chosen to invest £2.5 billion with “independent” companies to expand private capacity to an extra million NHS patients (currently at five million NHS-funded patients yearly), through Labour’s “Elective Recovery Partnership Agreement.” Though remaining “free at the point of use,” there’s no commitment for healthcare to be publicly provided. 

Paying the private sector to do NHS work rather than investing in the NHS is both a form of privatisation and a political choice. The small private sector (9,000 beds versus 140,000 in the NHS) will develop additional capacity at the expense of the NHS.

Witness cataract surgery, where cherry-picked work by private providers, paid for by the NHS, has reduced cataract waiting lists but left NHS eye departments deprived of staff and funding, and with sole responsibility for more complex care — resulting delays in treatment have meant patients going blind. 

Boosting the role of private sector

Labour has a threefold strategy for further entrenching the private sector: aligning NHS and private-sector digital systems, adding private booking options to the NHS app; giving long-term contracts to the private sector to expand capacity risk-free to see more NHS patients; and to forestall criticism that the private sector trains no staff, involving the sector in growing the elective workforce.

In reality there is only one pool of staff and the NHS does the training. It is dangerous to assume that quality training is even possible in small private hospitals (average 50 beds) dealing with a limited range of routine work for profit. These hospitals have poor out-of-hours medical cover, no intensive care facilities, are located in more affluent areas and select a less complex caseload. They transfer 6,600 patients annually to be rescued by NHS hospitals. 

The private sector is a competitor, not a partner

Labour goes further by inviting the private sector to join in the planning and commissioning of services by NHS integrated care boards. But far from being a natural “helper” of the NHS, the private sector is a hard-nosed competitor. How can the NHS benefit from this parasite?

Health Secretary Wes Streeting promises to repeat the NHS improvements made under Tony Blair and Gordon Brown. However, Office for National Statistics data shows that it was New Labour’s investment in NHS staff and NHS facilities that dramatically reduced waiting lists, not “independent” treatment centres or market reforms. 

How can Labour commit £2.5bn to the private sector but ignore the impact of local integrated care boards struggling to cover £8bn deficits with NHS “efficiency savings”? Most of the £10.6bn increase to the NHS budget for 2025-26 will be absorbed by salary and National Insurance rises, inflation and the £3.5bn allowed for rising costs caused by a growing and ageing population and new treatments.

Diverting public funding to grow private sector “spare capacity,” actively undermines the funding and staff available to the NHS and results in a worse service. Public money should not be used in this way to expand private profit-taking capacity. Return to any form of private finance initiative will also prove more expensive than direct investment by the government. 

Restore the public NHS

When the NHS was funded to succeed, evidence proved it offered healthcare of the best internationally. Labour must commit to building back publicly provided NHS capacity and to honour its manifesto pledges — including the rolling back of outsourcing and the implementation of the New Hospital Programme. The founding model of the NHS should be acknowledged as delivering the best comprehensive and universal care. 

An immediate solution is needed to the disgrace that is social care — this cannot wait for the 2028 report. The crisis in acute care must be recognised as a health emergency, with urgent funding to strengthen community teams, provide more hospital beds to reduce pressure on emergency departments, and address the huge and growing £13.8bn maintenance backlog. 

If the NHS fails, so too does the economy — 2.8 million people are currently out of the labour market due to ill health. Having invited Lord Darzi’s opinion, Labour should take his words as a call for the massive investment needed: “It is not a question of whether we can afford the NHS — rather, we cannot afford not to have the NHS.”

Join Keep Our NHS Public to call on Starmer to Invest in the NHS — NOT in the private sector — outside Parliament 12-2pm Wednesday February 26 after PMQs. Visit to keepournhspublic.com to find out more. 

John Puntis and Tony O’Sullivan are co-chairs of Keep Our NHS Public.