Wes Streeting has written an article for The Guardian on his vision for the NHS, which will come out today.
Cut out his self-defence and the padding, and two paragraphs appear to relate to his actual plan. They say:
Today, the prime minister will launch our 10-year plan for health, to radically reimagine healthcare. More care will be available on your doorstep and from your own home, with thousands more GPs. Services and resources will be moved out of hospitals and into the community. New neighbourhood health centres[?] will house doctors, nurses, physios, therapists, tests, scans and urgent care under one roof, built around patients' convenience.
AI technology will liberate frontline staff from the drudgery of admin, giving them time to care. Saving just 90 seconds of data entry and note-taking per appointment would be the equivalent of hiring an extra 2,000 GPs. For patients, tech will make booking appointments and managing your care as easy as doing your shopping online.
That rather weird question mark is, by the way, in the original text.
So, what is the vision? It is two-fold.
First, they will build health centres. Such centres were the epicentre of the vision of Alan Milburn when he was the health secretary under Blair, and they failed badly, with everyone eventually walking away from them with a sigh of relief. To work, they had to look like hospitals. They were, therefore, remote, big, duplicative, and a waste of money when we already had hospitals and GP surgeries which were much nearer people. Milburn is back, advising Streeting. He has obviously forgotten his past failure and is trying again.
And thereafter, everything is down to tech. Not patient care. Not tackling the causes of ill health. No regulation to prevent the addictions that are affecting people's well-being. No, it's all just down to tech. Speech recognition software, in fact, which has been available for a very long time, and gets a great deal wrong when linked to AI. That is it.
Oh, and there will be an app. Of course, there's always an app now.
If this is a vision, I am French, and I most definitely am not.
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My first question is yet again they fail to consider rural areas and much of Labour policy is very urban centric. I live 3 miles from a small but brilliant dispensing surgery and 10 miles from my nearest hospital. Public transport here is poor and we have a high elderly population. What we need is much better funded local GP services, not being required to travel long distances to a mega health centre.
Also many of us already use IT to book our appointments etc and whilst this could be improved I would rather GPs had time to deal with the complex problems now presented rather than see it as a way to skimp or getting the extra GPs desperately needed.
Spot on
And, meanwhile, they will let our hospital and GP surgery fall down
They won’t even employ all the graduate GOP trainees
I’m really lucky I can drive to the next village to this excellent practice, which is how the NHS used to be. The larger practice locally is on it’s knees with people waiting 3/4 weeks even if in pain and well meaning staff unable to deliver good care. The best way to keep people out of hospital and is quick access to a good GP, something that for many is no longer available.
They’ve lost the plot. This is farcical now.
They’re going to build new health centres but not repair and maintain existing crumbling hospitals. Which unfortunate group(s) is/are going to pay for those new builds?
Because they’ve got no money.
So who pays in cutback services? The children, the sick, the disabled, the elderly? All of them?
We know it won’t be the rich that LINO protects or spending on weapons and warmongering – so where’s the money coming from. We need to know.
This is like those dozens of hospitals Johnson and the Tories were going to build. How many of those have been completed?
Plenty of health centres in Belgium. They work well & take quite a bit of load off hospitals. That said, Belgium has (sort of) health insurance.
Our local one has radiology amongst other things. & there are local GPs surgeries as well (if I phones now I could get an appointment this morning or perhaps PM).
I have the impression that the NHS has been twiddled with for so long, by assorted politicos, that it is rudderless – no strategic direction, no tactics – nowt.
Did Streeting indicate how this would be paid for? & who will own & operate the health centres? Guess, private (USA) sector.
Streeting securing his financial future.
To use your argument about population density (regarding HS2 and Spain) Belgium is a very small country with an excellent public transport system. Health centre hubs may work there, but that does not mean they will work here.
I know from experience that health centres work perfectly well in Austria and Slovenia as well. And their population density is lower than England’s with the abundance of rural areas (some of them really difficult to reach). But – they’ve had them (a kind of) since the WW1 and more as they are today since the WW2. Then there are differences. Every girl over certain age and woman has a right to an assigned gynaecologist as well as a GP (so gynaecologists will be in these health centres), children are assigned paediatricians and not GPs (so paediatricians will be there). Dentists are much more connected to their variants of NHS, so dentists will be in these centres as well. Then there will be major specialists – radiologists, physiotherapists, psychiatrists, dermatologists etc, health visitor nurses will be stationed there, labs, ultrasounds etc will be there. There will be a doctor on duty during the night and on weekends as well and you are able to access a sort of urgent care for minor injuries and conditions which don’t require a proper A&E. But – they are still nothing like a proper hospital. The whole point of them is if you don’t require proper hospital treatment that you can be treated closer to home – as hospital can easily be 50 miles away. They do work very well in countries where they have them – but as England’s got a very different culture of health service it’s questionable whether they can and will work here. I was surprised when I came here that people went for basically everything to the a hospital.
You hit the Nail on the head: our system is not designed for them.
They will cause disruption and not integrate. And they will divert funds from essential hospital repairs and the employment of more GPs, which is possible now.
…and they will likely be run by private companies under contract to the NHS, like most of the already existing Community Diagnostic Centres (which if they are anything like my local one, provide a very limited and often poor service in comparison to in-house NHS provision). Since this plan is unlikely to result in much clinical or social benefit it has to be a wheeze primarily intended to extend and consolidate the privatisation of the NHS.
I found the answer to my question, about Johnson’s pledge to build 40 new hospitals, in the Times 21 January 2025:
“The new hospital programme we inherited was unfunded and undeliverable,” Streeting said.
“Not a single new hospital was built in the past five years, and there was no credible funding plan to build 40 in the next five years.”
When he became health secretary Streeting ordered a review of the plans as part of savings to fill a £22 billion budget shortfall, which ministers said they had identified in the public finances.
He told the Commons on Monday that the Conservative plan was “a work of fiction”, saying: “There were never 40 new schemes, and many of them were extensions or refurbishments. Put simply, they weren’t all new, some of them weren’t hospitals, and there weren’t 40 of them”.
Don’t hold your breath.
I’m sick to death of hearing how Ai will free up staff to provide a better quality of service. No it won’t, it will be used to replace people. I wish they ust stop with the bollocks and say it straight.
I remember there used to be any number of brass plates on the wall indicating GP’s Surgeries, usually with only a couple of Doctors.
Now its very convenient for me but I have what is probably the largest GP Practice in the country about half a mile away (Frome Medical Practice) with all the associated services under one roof
I suggest that there is a strong case for looking at how services are delivered – after all the GP model dates back to 1948 and the Dentists have never really been on board but it needs to be done with a proper spirit of enquiry and curiosity recognising that different areas have different needs.
This however doesnt sound like it
Interesting to note that a Private Hospital situated 10 miles away is now providing outpatient clinics in the NHS facility in Frome to make access even easier. At the same time the number of beds in the Frome Community Hospital is due to be reduced. And so the NHS dies, bit by bit.
Sad…
But for those of us on rural areas with poor public transport having to travel even further for basic primary healthcare is not a solution. And even in densely populated areas it’s much better to see a Dr you know before you are really ill. This seems to me a way to siphon off money to private providers who would run such services.
I agree the current GP model of practices run by partners needs reform, but not that we need to move away from GPs as the first point of contact. I am fortunate to have a really good surgery where I can get treatment when I need it with a Dr I know and trust. I’d like more not less people to have this.
If you can have a government police service why not a government dental service?
Yesterday you put up my comment about a hospital my Mum is in having 4 Business Managers and 4 Service Managers plus a Secretary in a single room. Your reply was about the complexity of running a hospital. That wasn’t really the point I was trying to make. IMO if you call yourself a Business Manager then you run the risk of adopting business ideas and worrying about the wrong things, but a hospital is not a business.
A business has to at least break even, but predominately make a profit on an ongoing basis or else it will cease to be. A hospital doesn’t generate income, doesn’t have sales (well that is not its core responsibility, but may have some marginal sources of income and sales). It is an organisation, and yes it needs managers, but adopting the title of Business Manager suggests entirely the wrong mindset.
This post illustrates business-like thinking from the top (Streeting, or rather those pulling his strings), being pushed down through the system.
I have to admit I did not see your point
And I am not sure I still do
I can be busy and go about my business in the home – wholly without intetnion of profit
Your are highlighting soemthing, I agree, but what would you call these people instead?
I agree there are certainly aspects of running a business that are unrelated to making a profit, but as I say, I think it is a mindset that is being pushed onto the NHS, illustrated by adopting a title of Business Manager.
The 4 of them are Business Manager, Division of Medicine. Why not Division Manager, or perhaps Operations Manager, or just Manager?
Noted
@Richard Kirby
Practice Manager or Operations Manager????
The above of are the used titles in many large US medical practices.
Commonly used in GP practices here, too
I suspect what Streeting is really doing is parcelling up parts of the NHS, or to be exact, patients within the NHS, ready for sale. Private providers don’t want complex care liabilities or emergency care; they want easy-to-treat but long-term sick. They want people who can be put on tablets and called in for a consultation every six months. They want diabetics, asthmatics, and the obese. They want a customer for life. All Streeting is doing is rounding them up providing them.
The BIGGEST money in the USA is in Orthopedics followed by Cardiology.
Orthopods are “parts changers” and Cardios are basically plumbers specializing in Roto-Rooter work with some remove and replace part work.
That’s genuinely surprising to me. Is it the profit margins involved? The predictability and routine of the work? Orthopedics is an area of medicine that can be hard to get treated on the NHS, with people left in long-term pain or on lengthy waiting lists. Cardio is treated preventively past a certain age with medication, I think, although I have not reached that age yet. I’m still in the age bracket where the thing most likely to kill me is myself, a statistic that isn’t given much thought in either country’s health system.
@Tom B.
“The predictability and routine of the work?”
EXACTLY!
Orthopedic and Cardiovascular surgeons are really not involved in metabolic diseases or metabolic aliments so every patient is basically the same. Profit margins are high and patients are basically healthy unlike oncology, pulmonary or hematology.
Assemble a top-notch crackerjack team and you can run a well oiled production line from initial consultation to surgery to rehab to final discharge with patients and associated family members very happy with the results and long-term outcomes.
Many GP practices are being bought by private equity. It will be interesting to see statistics of how many and the rate of acquisition. I had a chat about this quite recently with my GP, senior partner in the practice now approaching retirement age. He explained that as young GPs and aspiring GPs are loaded with massive student debt, they cannot afford to buy into practices, as was the case in earlier generations. Hence the field is far more open to PE. Another side effect of student loans (perhaps a feature rather than a bug?). In the US, where health insurance reigns and all the horror stores related to billing practices, young doctors pretty much have to follow the money due to horrendous student debts there, that anyone on the medicare, medicaid programs are shunned as these programs pay far less well than via private insurers. Where the US goes, we surely follow thanks to the same uniparty government. I would not trust Streeting an inch, to say the least.
Medicare patients are NOT shunned. Medicare patients are actively pursued. Medicare is a national program.
Medicaid patients are a whole different story as this program varies state to state.
I based my statement on a recent post on nakedcapitalism by an internal medicine doctor who regularly posts about the american healthcare system. He may well be wrong, but he does seem to know what he is talking about from inside the US healthcare system.
The tell tale sign is that the new health centres will be ‘hubs’. Hubs are so on trend.
Correct…
A health hub has been opened up in a shopping centre in Grimsby. Go and do your shopping, in whatever shops aren’t boarded up, and get your minor medical issues taken care of. It really sums up this countries current state somehow. Blood pressure taken, then go next door to Gregg’s.
🙂
I would also add that none of this ‘tech’ will be cheap. A feature of the expense of running the NHS has been the rising cost of equipment. Overall it’s the perfect answer for a timeframe you won’t be answerable for. Very Labour.
And, of course, the vast bulk of the public funding that will be applied to this pointless exercise will sluice into private pockets, much of out, no doubt, redirected from public NHS services, staffing and infrastructure.
And the shiny white elephant health centres will be staffed by poaching desperately needed staff from the NHS, because the private sector doesn’t invest in people, it invests in profit.
And then the mainstream media will post vacuous un-researched articles about the failings of the NHS system, but not about the root causes of oligarchic greed and political ambition and stupidity that create the failures.
And, eventually, when the statistics demonstrate conclusively that the British public has been duped again, the angry electorate will go to the polls and vote for a different-coloured branch of the single transferrable neoliberal party and the circus will start all over again, while the nation’s health continues to deteriorate and the corporate winner CEOs quaff Dom Perignon on their misery-funded ketches in the warm shelter of the bays they bought with public pain.
Let’s hope they don’t use Private Public Initiatives (PFIs) to fund these health centres.
PFI was an absolute disaster, with much of the money going to private investors rather than the people who need healthcare.
“Private Finance Initiative: hospitals will bring taxpayers 60 years of pain” (2011) The Telegraph
https://www.telegraph.co.uk/news/politics/8279974/Private-Finance-Initiative-hospitals-will-bring-taxpayers-60-years-of-pain.html
The Government wants to “develop a business case for the use of public private partnerships (PPPs) for neighbourhood health centres”.
Even the Tories thought PFIs were bad value.
Source: https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future/fit-for-the-future-10-year-health-plan-for-england-executive-summary
Oh, f**k
More privatisation
Streeting even described the NHS as being akin to a shopping experience today
AI is being mentioned because a lot of these AI companies are wanting to expand into healthcare. It’s a constant stream of usage (until people are no longer needed) and makes them look good. The NHS is a big opportunity to train AI on an entire advanced western population. Our health data is going to be sold off, and you cannot trust Americans (or any other sovereign country really) with our data on that scale.
Our government and its structure is wholly unfit to provide good outcomes to the population, and thus everything it touches is unlikely to either.
According to Starmer the NHS has to “reform or die”. So Streeting and co announce a bunch of unfunded “reform” requirements that the NHS will be unable to meet so it must of course “die”.. And it will all be the fault of the NHS itself.. How very Labour/ Starmerish. Nothing to do with him + Streeting and their very good links to the private healthcare sector.
You can tell that Health and the NHS is important just be reading through the comments here.
IT or Tech has been held up as a transformation route for years. Often more activities are either put on staff or patients all while apparently providing huge productivity gains. The latter is normally not taken as real gains eg more appointments or operations but as a reduction in head count.
I suspect Streeting 10 year “strategy” is a dressed up cost reduction exercise. Driven by HMT to put health services on a sustainable footing! Similar to helping our disabled by removing the PIP payments.
Labour believe passionately in reducing expenditure on public services. They are like the Tories but they like to pretend they care too.
They lie.
We know they are lying
They know we know they are lying
Yet they continue to lie.
Wes Streeting has not got a plan.
No targets.
No success measures.
No accountability.
No funding.
Just a brochure. That’s it.