Keir Starmer’s NHS plan: what are the key elements and can it succeed?
In Monday’s big NHS speech, Keir Starmer promised that by spring 2029, 92% of patients waiting for planned care in England would be treated again within 18 weeks, as intended – but only six in ten are that actually.
“This elective reform plan will deliver on our promise to reduce backlogs,” the Prime Minister promised, as he outlined initiatives to deliver on a promise that is a key part of his policy. plan change.
Here we describe the key elements of the plan and assess their chances of success.
Expanding the role of community diagnostic centers
A network of CDCs throughout England was first announced in October 2021, to help the NHS improve waiting times following the massive disruption to care caused by Covid-19. They aim to provide faster access to X-rays and CT and MRI scans, and are located in convenient locations such as shopping centres, improving earlier diagnosis of diseases and reducing pressure on hospitals.
The innovative element of Starmer’s plan is that the approximately 170 CDCs will open 12 hours a day, seven days a week “where possible” to increase the number of tests carried out. But even if that happens, “it falls into the category of useful but not groundbreaking in terms of making a significant dent in NHS waiting lists,” says Siva Anandaciva, chief analyst at the King’s Fund think tank.
Only 10% of CT and MRI examinations are performed in CDCs, even though they have been around for several years. Health Service Journal November reported.
More operations are being performed in surgical centers
These have also been around for several years and over 100 have been opened. These specialized facilities typically perform common surgeries such as cataract removals and hip replacements. Under the elective reform plan, 14 new hospitals will open in June and three others will be expanded, allowing for more surgeries and earlier treatment.
Do they work? The proof suggests they do. Hubs enable the NHS trusts that host them to carry out 22% more operations than if they had none. That’s mainly because, because the hubs are separated from the rest of the hospital’s operations and have their own beds and staff, routine operations there are less likely to be canceled due to a shortage of beds.
However, the NHS’s staff shortages could make it difficult for CDCs and surgical centers to combine to handle the additional 500,000 appointments per year that the new plan aims for, Anandaciva says.
“Where should the staff come from? The NHS still has around 100,000 vacancies. The government has talked a lot about their ambitions for these two types of facilities, but not much about who exactly will staff them,” he says.
Using the private sector to treat more NHS patients
Under the new plan, private companies will give NHS patients around 1 million extra outpatient appointments, diagnostic tests and operations a year, on top of the 5 million they already do, the Independent Healthcare Providers Network says. That 20% increase in activity could mean they receive a further £2.5 billion more than the £12.3 billion they already receive from the NHS and Department of Health and Social Care.
The NHS in England has used private healthcare providers to treat patients since Tony Blair’s Labor government pioneered that approach in the 2000 NHS scheme. Governments have since increased the NHS’s reliance on for-profit operators who treat NHS patients, paid from the service’s budget. – “that has been tried again and again,” says Anandaciva.
The fact that the NHS is busier now than it was in 2000 means that it is likely that patients who want to exercise their choice of location will “face a choice between a long wait in hospital A and a long wait in hospital B. I’m sceptical that it will make a big difference to how long people wait.”
All hospitals must treat 65% of patients on the waiting list within 18 weeks
Under the plan, all NHS trusts would have to treat at least 65% of patients referred to the waiting list for treatment within 18 weeks by the end of March 2026. Only 59% are now seen within that time frame.
The 6% performance improvement needed in a short time has been achieved before, between August 2007 and March 2008, says Sarah Arnold, senior policy lead at the King’s Fund. But, she adds, the NHS was in better shape then than it is now.
In 2023-2024, only a third of trusts improved the proportion of patients they treated within 18 weeks. Although just over half have done so by 2024-2025, “the scale of the challenge (in meeting the new 65% target) is clearly enormous”, although its mere existence could help to minds of trust bosses, and the absence of strikes by NHS staff make it easier to deliver, Arnold adds.
NHS experts are skeptical that the plan will deliver the promised massive transformation in waiting times. “It would be a heroic achievement to reach the 92% target in that time,” said Thea Stein, CEO of health think tank Nuffield Trust.
Starmer spoke of introducing “radical reforms” but in fact much of the plan involves expanding on approaches already deployed by previous Conservative governments for the same purpose, such as using private hospitals, she adds.
Anandaciva agrees. “The government would be very lucky if it delivers on the 92% promise by the end of this parliament. I wouldn’t bet on them doing that. It is a good plan, but it is more of a plan for gradual improvement by next year rather than a clear roadmap on how the goals will be achieved by 2029.”