Starmer wants a 'dramatic reimagining' of the NHS. What does that mean for you?

In 2018, Elizabeth Pfiester was diagnosed with thyroid cancer. But she feels lucky.

“I feel sort of relieved that it happened when it did, which is a weird feeling,” Pfiester says. “I brought it to my GP, who was like, ‘I’m referring you urgently.’ And I was seen very quickly, got the biopsy quickly. All in all, I was very, very impressed… I just don’t think it would be like that now.”

Today, a damning independent investigation led by academic surgeon and peer Lord Darzi has highlighted sweeping failures in Britain’s ailing public health service – including “unacceptable” wait-times for NHS cancer consultations.  

The 62-day target for referral to first treatment has not been met since 2015, while more than 30% of patients are waiting longer than 31 days for radical radiotherapy. The UK has some of the highest cancer mortality rates in Europe.

“It’s terrifying,” Pfiester, who now lives with multiple autoimmune conditions after surviving cancer, says. “These are people’s lives.”

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Lord Darzi’s new report paints a stark picture of an NHS in “critical condition”. Cancer waits are listed among a litany of failures: decrepit infrastructure, avoidable deaths, staff shortages, and lengthy wait times.

The “awful state” of A&E – where nearly a tenth of patients wait 12 hours or more – is leading to 14,000 more deaths a year. Meanwhile, the number of appointments and procedures has stagnated because “patients no longer flow through hospitals as they should.”

When patients do manage to secure treatment, the facilities are barely fit for purpose: parts of the NHS are “operating in decrepit portacabins”, the report suggests, while mental health patients are being housed in “Victorian-era cells infested with vermin”.

“The social contract between the NHS and the people” has been broken, the report concludes.  So, how do we fix it?

Speaking this morning, prime minister Keir Starmer said that the service must “reform or die”.

“The NHS is at a fork in the road, and we have a choice about how it should meet these rising demands,” he said. “Raise taxes on working people to meet the ever-higher costs of an ageing population – or reform to secure its future.”

What will Labour’s reform of the NHS look like?

Any further funding will be contingent on dramatic changes, Starmer said, adding “we have to fix the plumbing before we turn on the taps”.

The government’s 10 year plan for the NHS – which will be published next spring – includes three “big shifts” in approach.

These include using more technology to create a “digital NHS”, shifting more care out of hospitals and into communities, and moving from treating sickness to focusing on prevention.

These sound like positive aspirations, but it is less clear what the detail will entail, said Diarmaid McDonald, director at patient advocacy organisation Just Treatment.

“A shift to increasing the focus on prevention, that makes sense. A shift to moving more care out of hospitals and into the community, that makes sense. Investment in improving the digitisation of the NHS, yes, that makes some sense,” he told the Big Issue.

“But if those things happen without proper public interest analysis done to balance that private sector profit-driven motive, or if it happens with very adequate resources to fund these reforms, we’re going to make the situation worse.”

According to the report released today, underfunding is a clear cause of the NHS’s decline.

“The 2010s were the most austere decade since the NHS was founded, with spending growing at around 1% in real terms,” the report warns – well short of the 3% minimum recommended by independent health organisations.

The government previously announced some reforms that entail more funding – for example, promising 40,000 more appointments each week. Authorities will achieve this by paying staff overtime rates to do extra shifts out of hours, on evenings and weekends. More funding detail will be clear in the autumn budget.

But any new money will be tethered to reforms – reforms we won’t know the shape of until the spring.

“The big question now is what happens next,” says Thea Stein, chief executive of the Nuffield Trust.

“The improvements we all hope for – and that patients desperately need – will take time, commitment and major financial, practical and system-wide support. There will be no quick fixes.”

Will the government privatise parts of the health service?

Starmer promised that reform will “not mean abandoning those founding ideals of a public service, publicly funded, free at the point of use”.

This is what sets the UK apart from countries like the US. An American by birth, Pfiester will “never forget” the first time she picked up a prescription from a British pharmacy.

“I didn’t have to wrangle with insurance, I didn’t have to jump through a bunch of hoops like I did in the States, and I was able to walk out of that pharmacy without paying anything,” she recalls. “I was just so grateful.”

Pfiester – who has lived with type 1 diabetes since the age of four – moved to the UK to study in 2011. She was “blown away” by the quality of UK treatment.

“In the US, it’s a health lottery. If you don’t have insurance, it’s terrifying,” she explains. “Privatisation is not the answer, I’ve seen it first hand.”

But despite Starmer’s promises, campaigners have expressed concerns that the ‘dramatic reimagining’ of the service announced today will constitute a “privatisation by stealth”.

Health secretary Wes Streeting previously vowed to use “spare capacity in the private sector” to free up waiting lists.

McDonald described this process as a “vicious circle”, because public health trusts have to pay private providers to take on patients to make up for under-investment – thereby expending more resources.

“This idea that there’s lots of excess spare capacity in the private sector is a bit of a red herring,” he said. “The more that we invest and shift resources to private sector healthcare, the more we’re actually draining money and draining staff trained up in a very, very expensive way by the NHS.”

Previous Big Issue reporting showed that the NHS in England spent more than £1.4bn of public money on private mental health beds between 2019 and 2024. The number of NHS mental health beds in England fell by nearly three quarters, from 67,100 to 18,400, between 1988 and 2019.

The Darzi investigation provides the right diagnosis, said Chris Thomas, head of the Institute for Public Policy Research (IPPR)’s commission on health and prosperity. But it must not be used as a cover to undercut its original funding model.  

“Lord Darzi is right that the NHS has been beaten by a pandemic, austerity and misguided reform,” he said. “But he is also right that the NHS’ model is not fundamentally broken – we must not be distracted by rabbit holes like social insurance systems or changed funding models.”

Additionally, McDonald said we should be careful about “tech-utopian” and “biopharmaceutical” solutions that suggest we can fix the health service without more investment. For example, the government has announced plans for drugs such as Ozempic to play a pivotal role in the shift to preventative healthcare..

“There are paid lobbyists for private companies constantly trying to convince the Department of Health, the NHS and central government that their shiny new tool will solve all the NHS’s problems… we need to be wary of that,” he said.

“There is nothing more important than being able to pick up the phone and dial 999 and get help when you need it, whenever we’re most vulnerable. Arguing that this is the kind of area where we need to penny pinch just seems completely wrong-headed.”

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