THE publication of Wes Streeting’s 10 Year Plan for Health in England removes any doubts that Health Secretary is dead-set to hammer the final nails into the coffin of the NHS.

Rather than support a service geared to meeting the clinical needs of the population, the NHS is to be repurposed to serve the interests of private healthcare companies, big tech and financiers.

Soon after the election Streeting announced the three key “reforms” intended for the NHS: from hospital to community; from analogue to digital; from sickness to prevention. A year later in July 2025 the plan was published.

It represents a chaotic rehash of ideas peddled by the Tories, but more importantly it continues the 40-year plot to privatise the NHS “by stealth.” The difference is that this plan outlines an intensified, deeper and more comprehensive attack.

All over the plan are the fingerprints of the Tony Blair Institute (TBI) which has published several papers favouring “disruptive delivery” in the NHS. The plan intends to “reinvent” and “entirely reimagine how the NHS does care.”

This is the priority, not solving the myriad of problems currently and urgently besetting the NHS: staff shortages, bed shortages, corridor care the lottery of social care, to name a few. The plan proudly announces that it intends to do nothing about them: “Our strategy is not ‘fix the roof, and then begin reform’; it is only through reform that we can restore standards.”

The emphasis on reform itself will batter the NHS. As the head of health at the OECD commented in 2012: “The UK is one of the best performers in the world. But outcomes are not what you expect because there is a big reform every five years … No country reforms its health service as frequently as the UK.” This current round could be fatal.

The plan is 171 pages of management-speak and IT jargon, boundless optimism bias and honeyed words about “patient choice.” From this morass this article picks out the likely implications of the most significant “reforms.”

From hospital to community — neighbourhood health centres

Streeting’s flagship reform is to create 200 to 300 neighbourhood care centres across England. These might be smaller ones of 50,000 patients or larger ones or multi-neighbourhood providers will be 250,000 — that is roughly the size of a small London borough, and serving a population similar to an average general hospital.

Neighbourhood health centres (NHCs) will be a new tier in the NHS that will centralise a wide range of services, many of which are currently provided by a range of organisations — the NHS, private and voluntary sectors and local authorities. These include GPs, nurses, mental health specialists and many others.

The aim is for NHCs to undertake “the majority of outpatient care,” including, diagnostics, post-operative care and rehabilitation and could also offer services, like debt advice or smoking cessation.

All this will be housed in a single building, to enable them to provide patients with a “one-stop shop.” Obviously, new buildings will be required — the finance for these to be provided by a rehashed version of PFI.

Inevitably, these services will be those that are less risky, more routine, and therefore easier to deliver in high volume. In other words, just the sort of things from which private medicine can make an easy profit.

Not surprisingly, many of these services have been outsourced already. Funding would move with those services, leaving NHS hospitals to carry out more complex and higher risk care with less funding.

This is the true meaning of “integration” — centralising the provision of those services that healthcare companies find attractive in a single (privately provided) location, thereby creating the opportunity for one big, centralised, “integrated” and juicy contract for the private sector to buy into.

The policy of creating effectively a new tier of the health service on a minimum budget, and in quick time, is wildly ambitious. Reality is beginning to hit as government officials have “struggled to agree the details” — the first PFI contracts were supposed to be in place this year but now none is likely before 2027-28.

Streeting’s flagship policy might collapse under the weight of its own contradictions, but if it goes through it leaves both primary and secondary care in turmoil, GPs roles and skills sidelined, hospitals left scrabbling for funds and a second-class public service enshrined.

Privatisation and deskilling

This is not the only way that Streeting will degrade and deskill the NHS. Adding to the extensive privatisation of the NHS that exists the plan reasserts pressure for outsourcing, dictating that every level of the NHS bureaucracy must foster a new “ecosystem of providers.”

“We will not let spare capacity go to waste on ideological grounds,” the plan declares, justifying more NHS-funded provision in private hospitals. Yet privatisation does not extend capacity, it replaces it: where a profitable area such as cataract surgery has been cherry-picked away from NHS hospitals the full range of NHS eye services is “undermined.” And of course funds leech out of the NHS in profit.

For medical professionals the plan draws a very dubious distinction between training “to task” and training “to role,” arguing that: “For too long, we have trained ‘to role,’ often requiring individuals to complete years of training, when many tasks can be carried out with good supervision.”

This dismissal of a thorough grounding in medical science which doctors must currently have is to be accompanied by an overhaul of education and training curricula.

Already “Physician Associates” with just two years’ training are being used to fill rotas and see undiagnosed patients, while taking training places that qualified doctors need to progress. A similar process is afoot in nursing, and hence a full-scale dilution of skills is being proposed.

The plan specifically states that the NHS workforce will be smaller by 2035. It will also be overall less skilled – again creating a second class service.

Scaffolding for an Americanised healthcare system

Under the rubric of  “a patient-controlled NHS, that provides real choice, real control and real convenience for patients” the plan intends an extension of Personal Health Budgets (PHBs).

These currently cover about 180,000 people with disabilities who are assigned a pot of money and can choose how it gets spent, for instance on equipment or therapies. The Plan wants a million people on a PHB by 2030 and to offer it to everyone by 2035. PHBs will acclimatise the population to pre-set limits to healthcare, as a health insurance policy does in fact.

Meanwhile a new role for hospitals indicates further moves towards the US model of Health Maintenance Organisations (HMOs).

The plan proposes that all hospitals become Foundation Trusts and that “the best” of these become “Integrated Health Organisations” (IHOs) and allowed to hold the healthcare budget for a local population, the first to be up and running by 2027.

Like the existing Integrated Care Boards IHOs will have a strategic planning function for a given population size and determine the type and level of healthcare it will provide.

US HMOs are run by private healthcare companies, but unlike “fee for service” based policies, they have a fixed income based on premiums paid by a given population. They retain any surplus from this budget as profit, so incentivising withholding of care and the use of cheaper providers.

Similarly the distinguishing feature of Foundation Trusts is their relative autonomy from central government, including being now compelled to retain surpluses, creating the incentive to withhold care.

The elements of a US insurance system have been in development for some time but these two elements – PHBs and the new role for Foundation Trusts — makes the end game still clearer.

Although the NHS system will continue to be entirely funded by taxpayers and “free at the point of use,” the administrative changes mirror the US HMOs and presage still further private takeovers.

Conclusion

These “reforms” together represent the latest, largest and deadliest corporate cuckoo’s egg to be planted in the NHS nest. If put into practice the plan will intensify the privatisation of the NHS beyond anything the Tories could have dreamt of: Streeting’s private donors will be well rewarded.

The NHS still provides an invaluable level of service to ordinary people. The labour movement must mobilise to end privatisation.