THE NHS trade union leaders have given a muted response to Monday’s Declaration of War on the NHS by the Labour government.
PM Starmer and Health Secretary Streeting stood in front of a group of paramedics in East London and announced that the National Health Service is to be transformed into a ‘Neighbourhood Health Service’, the purpose of which will be to keep people out of hospital.
Following last week’s threat to ‘jab the jobless’, along with the warning that obese people face being thrown off benefits, Starmer and Streeting launched a ‘public consultation’ on the future of the NHS on Monday.
They described a Big Brother-style dystopia with digitalised health data on ‘patient passports’ to be made available to the international drug cartels.
The first thing Streeting did the day after the General Election on 4th July, was to claim that ‘the NHS is broken’ and the two of them each repeated this mantra several times on Monday.
Starmer has brought in two relics of the Blair government to help him with his war on the NHS – Lord Darzi and Alan Milburn.
Darzi was the architect of a discredited plan to replace GP surgeries with ‘polyclinics’ and he is now resurrecting them under a new name.
GP-led primary care will cease to exist under the new Darzi plan.
No longer will patients have their own GP, but they will have to take their chance and get what they are given at a so-called ‘neighbourhood health centre’.
Milburn moved on from courting the privateers as Blair’s Health Secretary to working for Tory PM Cameron as his ‘Social Mobility Czar’.
Now he is back working for Starmer with the purpose of throwing people off benefits.
He published his Pathways to Work Commission Report in July 2024, which proposes to ‘personalise health’, and claims that the new government can ‘activate an untapped talent pool’ and ‘reduce the benefits bill by at least £8 billion a year’.
Throwing unemployed and disabled workers off benefits is to be at the heart of next Wednesday’s Budget, when the Milburn report will be activated.
But the underlying fundamental shift that is planned by Starmer and Streeting is the total privatisation of the NHS.
However, the NHS trade unions responded to their announcements as if they were good coin.
Unison head of health Helga Pile said: ‘The previous government mismanaged the NHS for years, leaving services in a perilous state and workers exhausted.
‘Staff will welcome the chance to have their views considered. But it’s hard for health workers to think about the future of the NHS, when they’re worried about their growing workload and making their wages go far enough.
‘The government must tackle urgent pay issues straight away and work with unions to negotiate the next wage rise due in April in good time.
‘That means fixing problems with the pay bands and stopping the lowest hourly rates from dropping below the minimum wage again.
‘An emphasis on neighbourhood health centres will reassure many patients but must be joined up with the government’s aim to replace the fragmented care sector with a new national service.
‘What’s needed for the healthcare system to work properly is a comprehensive workforce strategy that unites and invests in all staff equally.
‘That requires an end to hiving off some employees to private companies and ensuring all health workers benefit from nationally negotiated pay and conditions.’
The Royal College of Nursing said: ‘We want the nursing workforce crisis addressed, for patient safety to be protected, an end to corridor care and mental health support available for all nursing staff.
‘Nursing staff are ready to help deliver the modernisation our health service needs, but staff are overworked and chronically undervalued.’
RCN General Secretary and Chief Executive Professor Nicola Ranger said: ‘The last decade has been characterised by widespread staff shortages, collapsing nurse recruitment and worsening morale.
‘The next 10 years must promise to be brighter, but that will require new investment alongside any reforms.
‘A shift to community care and a preventative health model is going to need tens of thousands more nurses.’
BMA council chair Professor Philip Banfield said: ‘We will naturally be considering our response carefully and submitting it in due course – but it is vital that amid any changes, the voice of doctors and their colleagues is not lost, and that Mr Streeting sticks to his word that “the best ideas won’t come from politicians in Whitehall” but from staff.
‘Front and centre, we cannot be clearer: We need investment now, especially as we approach winter, and not wait for another review that concludes the obvious about the under-resourcing of public health and healthcare in the UK.
‘Several questions arise from the policies floated in today’s announcement.
‘There is no doubt that prevention is better than cure, and ensuring people can be seen earlier, outside of hospital, benefits the whole system – easing pressures and saving money.
‘But it’s very unclear how “neighbourhood health centres” would be run, by whom and how they would be paid for.
‘GP practices already provide invaluable continuity of care in people’s communities, proven to reduce poor health outcomes and hospital admissions, with family doctors working with a wide range of healthcare professionals.
‘It is not the model that is broken, but lack of investment to keep practices’ heads above water and help GPs and their teams meet patients’ needs that is holding them back.
‘The idea of a digital “patient passport” may sound convenient in principle, and doctors are as frustrated by IT systems that do not talk to each other as their patients are surprised by it.
‘But discussions and choices around patient data need to involve cast-iron safeguards and ensure they do not exclude those who are not digitally engaged or literate.
‘Likewise, we have to be realistic about the potential of things like wearable tech as a prevention tool, and who will benefit from this – and those who will be left behind.
‘In terms of technology, we cannot underemphasise the need to get the basics right first.
‘Millions of hours are wasted each year due to faulty and outdated computer systems – whether this is waiting half an hour to log on to a constantly crashing computer, or having to share one ancient PC that is wheeled around a ward.
‘An over-reliance on new tech risks pushing us from a two-tier health system to three-tier where the wealthiest use private healthcare, the tech-literate middle classes embrace a rapidly changing NHS, and the poorest continue to be disenfranchised and all but forgotten.’
- The BMA’s General Practitioners Committee for the UK (GPC UK) has voted in favour of stopping hiring physician associates (PAs) in general practice, and for existing roles to be phased out.
Their view was made clear at a meeting of GPC UK on 17th October, where an overwhelming majority of members voted in favour of the following motion:
‘This meeting believes that the role of physician associates in general practice is fundamentally unsafe and:
‘1. There should be no new appointments of physician associates in general practice
‘2. The role of physician associates in general practice should be phased out
‘3. The role of a physician associate is inadequately trained to manage undifferentiated patients, and there should be an immediate moratorium on such sessions.’
The motion comes as the Royal College of General Practitioners recently changed its position on PAs, voting to oppose a role for them in general practice.
The BMA believes that those in existing PA roles should be given opportunities to retrain into more suitable ancillary NHS roles.
Dr Katie Bramall-Stainer, chair of GPC UK at the BMA, said: ‘We are aware that this is a challenging and politically heightened issue.
‘At the heart of it is patient safety, which needs to be prioritised, alongside acknowledging the responsibilities of employing practices and welfare of existing employees.
‘It’s no secret that we desperately need more staff in general practice, but we need be sure that staff who see patients are suitably trained and competent to see them unsupervised.
‘Workload is inextricably linked to the recruitment and retention of the workforce, so additional roles should not generate more work for already-stretched GPs.
‘We’d like to see PAs being given opportunities to retrain and take up other roles in the NHS, but the bottom line is getting more GPs into the workforce.
‘We want to be able to give patients the care and services they need, when they need them, with the most appropriate clinician for their needs.
‘To do that, the government must urgently invest in practice staff such as GPs and general practice nurses.’
