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The latest information available, data for the end of January, show the overall UK National Health Service (“NHS”) waiting list had fallen slightly to 7.58 million.  In November 2023, BBC reported that the waiting list, an NHS backlog of 7.77 million, was almost double, nearly 3.5 million higher, than it was before the pandemic.  The drop in January is hardly newsworthy.

Labour’s Wes Streeting’s proposed solution to the NHS’ waiting list problems is to use private healthcare capacity. Streeting has received guidance from former Health Secretary Alan Milburn.  Both men were members of Tony Blair’s administration, which oversaw previously disastrous private finance initiatives that are still crippling the NHS.

In addition to its previous disastrous financial policies, the Labour Party is not addressing other political policies that caused the monstrous waiting lists to happen in the first place.

Policy watch: NHS waiting lists

By Prof. Carl Heneghan and Dr. Tom Jefferson

As the upcoming elections draw near, keeping a close eye on the political promises made regarding healthcare is crucial. 

This week, Wes Streeting, Labour’s Shadow Health Secretary, suggested that the NHS should consider using private healthcare capacity to fix the waiting list problems. 

Speaking to the Financial Times, Streeting said,  “I can simultaneously want to reduce [NHS] reliance on the private sector by making sure it has the staff, the equipment, and the technology it needs to treat patients on time, while recognising that there is currently some capacity in the private sector, and we should seek to use it.”

Streeting has received guidance from former Health Secretary Alan Milburn and ex-Number 10 adviser Paul Corrigan. Both were members of Tony Blair’s administration, which oversaw the disastrous private finance initiatives (“PFIs”) to fund infrastructure projects. 

PFIs locked NHS trusts in England into ongoing financial payments for which they bear the total cost. Between 2004 and 2021, the turnover of 99 NHS PFI companies was £28.4 billion, leading to pre-tax profits of £1.9 billion. These costs are crippling the NHS: The Guardian reports that trusts spent close to half a billion in interest charges for PFI contracts in 2021 – “equivalent to the salaries of 15,000 newly qualified nurses.”

Anyhow, enough of these crippling problems; what Trust the Evidence (“TTE”) is interested in are the political policies to prevent the monstrous waiting lists from happening in the first place.

TTE has already pointed out that by any measure, the waiting list figures show we have an emergency on our hands. 

Read more: Intractable waiting lists, Trust the Evidence, 11 July 2023

[Installed] Prime Minister Rishi Sunak said the “NHS waiting lists will fall, and people will get the care they need more quickly.” This was one of five promises he asked voters to judge him by. However, he recently admitted he had failed to fulfil the promise. There goes your vote, then. 

Yet NHS England also failed to meet its promise. In its 2022 post-covid elective recovery plan, hospitals were supposed to perform 21% more operations than before the pandemic. So, who is accountable for the mess the NHS is in?

It’s even more damning when you consider the Institute for Fiscal Studies (“IFS”) estimates that waiting will stay above pre-covid levels until 2030, irrespective of who is in power. 

Now, Wes thinks the private sector will tackle the shortfall. We’re concerned that part of his plan includes – yet more – new technologies and partnerships with cutting-edge private companies.   Streeting also considers the NHS needs to “put the foot down on the accelerator . . . when it comes to innovation” he considers the NHS is “too slow to disseminate initiatives that have proved effective.” TTE would be interested in knowing where the evidence for these effective initiatives is published. 

We think both parties’ manifestos should aim to end the disastrous PFIs and assign them to the bin. Given the low point was 2.32 million on the list, how will the parties prevent the drift to 4.5 million from ever happening again? Also, how will they ensure that lockdowns, which have added over 3 million to the list, never happen?

After the Brexit battle over sovereignty, are we about to sign the World Health Organisation (“WHO”) pandemic treaty and give away a big chunk of it to a body with a chequered history? Finally, when the system fails patients or political posturing destroys the promise of safe and effective care, we need to know who is responsible and accountable. 

TTE has no political leanings, but it is concerned that politicians, in their haste to adopt new technologies and restructure the system, often introduce wasteful and harmful policies. 

Increasingly, an ounce of prevention is worth a pound of cure: In the case of waiting, it’s worth 5 million less on the list. 

This post will not self-destruct or self-delete. It isn’t an experiment, won’t flip-flop, and isn’t commercially sensitive. It is not Teflon coated, nor will it do a bunk. You will not incur a fixed penalty notice if you choose not to read it, and you will not wait three years to read it.

About the Authors

Carl Heneghan is a professor of Evidence-based Medicine at the University of Oxford, Director of the Centre for Evidence-Based Medicine (“CEBM”) and NHS Urgent Care general practitioner who regularly appears in the media. Tom Jefferson is a clinical epidemiologist and a Senior Associate Tutor at the University of Oxford.  Together they publish articles on a Substack page titled ‘Trust the Evidence’.

Featured image: NHS waiting lists fall, although number of patients facing longest wait climbs, Knutsford Guardian, 14 March 2024