Labour’s Health Secretary Wes Streeting has made a series of high-profile interventions exposing the reality of the Starmer government’s “10 Year Health Plan for England”.

Claiming to want to save a National Health Service (NHS) in “critical condition” and “standing at an existential brink”, Labour intends to ramp up privatisation by stealth and other measures that will end in the death of the state-run service.

Launched in July, the 10 Year Plan claimed it would make the NHS in England “Fit for the future” under conditions in which Streeting was denouncing resident doctors (formerly junior doctors) for demanding a pay increase after being underfunded for years.

The document dressed up Labour’s real plan for cuts, massive productivity increases and ramped-up privatisation behind a swarm of buzzwords. Its core components include a “new care model” centred on community rather than hospital settings, and the creation of a “Neighbourhood Health Service, designed around you.”

The NHS would be shifted from “From analogue to digital”, so that “patients will have a ‘doctor in their pocket’ in the form of the NHS App, while staff will be liberated from a burden of bureaucracy and administration.”

The abolition of “bureaucracy” runs like a red thread throughout the document. What this means is the loss of thousands of administration workers whose jobs are in fact critical to the running of the NHS. “NHS England, the headquarters of the NHS,” will be combined “with the Department of Health and Social Care (DHSC), reducing central headcount by 50%.”

Labour’s plan envisages an even smaller workforce in 10 years than that mapped out by the last Conservative government. It boasts that by 2035 “there will be fewer staff than projected in the 2023 Long Term Workforce Plan”,

The overall strategy would be based on “Productivity and a new financial foundation”.

It states, “The era of the NHS’s answer always being ‘more money, never reform’ is over. It will be replaced with a new value-based approach focused on getting better outcomes for the money we spend.” This would “restore financial discipline by ending the practice of providing additional funding to cover deficits,” i.e., letting the service bleed to death.

The main task was to “urgently resolve the NHS’s productivity crisis,” to make the workforce work harder for less. “For the next 3 years we have set the NHS a target to deliver a 2% year-on-year productivity gain.”

What is meant by a new financial foundation is to “develop a business case for the use of public private partnerships (PPPs) for neighbourhood health centres, ahead of a final decision at the autumn budget.”

Streeting is therefore preparing to burden the NHS with yet more vast debts, while handing over additional tens of billions to the private sector through a de facto return of the disastrous Private Finance Initiative (PFI) scheme, imposed to devastating effect by the last Labour government of Tony Blair and Gordon Brown before it was voted out of office in 2010.

Earlier this month the Financial Times reported, “The government has sounded out private finance investors about backing up to 200 neighbourhood health centres.” It noted, “Investors would win long-term contracts to design, build and manage local NHS centres with the aim of having one in every community by 2035 and the most deprived areas targeted first…” The plan would again see the public sector “provide the land while private companies deliver the facilities and services on contracts of between 25 and 30 years.”

It adds, “People familiar with the matter said at least two ‘market testing sessions’ were held over the summer by the health department, which is being advised by management consultancy Deloitte and law firm Addleshaw Goddard and working with the new National Infrastructure and Service Transformation Authority.”

The Guardian revealed Wednesday that Deloitte and Addleshaw Goddard are receiving contracts worth £3 million each, as they work out the finer points of the privatisation. This month Streeting announced the location of the first 43 centres to be set up under the PFI operation.

The 1997-2018 PFI deals left a staggering debt legacy of £80 billion for just £13 billion of actual investment. Most of this debt (more than £40 billion) won’t be finally paid off by NHS Trusts until the end of the 2040s.

On Monday, the Department of Health and Social Care revealed that productivity in hospital trusts in England in 2024-25 had increased by 2.7 percent. This is above the target of 2 percent growth in productivity each year envisaged in the 10 Year Plan, aimed at cutting NHS costs by £17 billion by 2028-29.

In response, Streeting took to the Times to pen an op-ed declaring that the figures demonstrated the need for a “relentless focus on productivity” to overcome an inefficiency “doom loop” as “reforming the NHS is one of the most important economic missions of this government”.

Streeting took the opportunity to declare that productivity increases were central to “balancing the books” and under the 10 Year Plan, “The NHS will no longer receive emergency top-ups to plug deficits. The outdated system of paying trusts the same regardless of how many patients they see is being dismantled.” He threatened, “Pay is being linked to performance, poor care will no longer be rewarded, while excellence will be.”

Streeting’s “reform” rhetoric is code for the worst attack on the NHS and its workforce since it was founded 77 years ago as the jewel in the crown of the post-war welfare state. In declaring that the NHS will receive no new money, no matter what emergency—with just a few months to go before the annual NHS winter crisis—Labour has declared war on its more than 1.4 million strong workforce and a service on which most British workers exclusively depend.

The NHS has already been deprived of hundreds of billions of pounds by successive governments. According to research by the British Medical Association (BMA), the NHS would have received an additional £423 billion if the historical average growth in spending had continued since 2009/10.

To enforce productivity increases and further inroads by the profiteers, Streeting is reliant on the trade union bureaucracy. The 10 Year Plan states that the government will “continue to work with trade unions and employers to maintain, update and reform employment contracts and start a big conversation on significant contractual changes that provide modern incentives and rewards for high quality and productive care.”

The health care unions ensured that strikes in the NHS and those in the private sector were largely extinguished as they backed Starmer’s Labour government coming to power.

Following five days of strikes by resident doctors in England over the summer—in pursuit of pay restoration that the sellout deal that the BMA signed with the incoming government denied them—Streeting has declared that no new money will be offered. Last week he called on the BMA leadership to end the dispute, declaring, “I need partners, not adversaries.”

The BMA remains in talks with the Health Ministry and has called no further industrial action despite holding a six-month mandate for further industrial action until January 2026.

The fight to defend the NHS cannot be left to the unions, which have betrayed countless struggles of their members. Neither can it be left to what remains of the “left” within the Labour Party or those gathered around Jeremy Corbyn and Zarah Sultana in Your Party.

These forces cannot defend the NHS because they refuse to challenge the capitalist system and call only for the mildest reforms—as the ruling elite is demanding the destruction of every social gain of the working class to fund a vast military rearmament. As leader of the Labour Party, Corbyn opposed the development of a mass strike movement within the NHS against the Tories, consistently calling for the unions and management to negotiate deals preventing a genuine fightback.

What is required is a unified fight by all NHS grades—doctors and nurses, ambulance workers, hospital support staff including porters and caterers, and admin workers—who are kept isolated from one another by the various health unions.

Linking the many sections of health workers together requires the building of a network of rank-and-files committees democratically controlled by workers themselves. These committees will win a powerful response from millions of workers and their families who rely on the NHS.

NHS FightBack, an initiative by the Socialist Equality Party, calls on health workers to contact us to discuss the building of a rank-and-file committee in your workplace.