In June, I used my column to shine a light on something I’d been working on as Shadow Health Minister: the Government’s reforms to NHS referrals.
I wrote about how I’ve been using my clinical experience to make a definitive impact. Be it for our area or on things that affect the whole nation, such as this. I thought you may be interested in this update, as it’s been a few months since the changes came into place…
This Government wants to tell a positive story about the NHS.
Just before Wes Streeting resigned as Health Secretary in hopes of challenging Keir Starmer for leadership of the Labour Party, he claimed: “our plan for the NHS is working”.
But when you look past the headlines, you see a manipulation of the numbers and patients are left asking questions about their access to care. From spikes in people being removed from waiting lists to bumper payouts to hospitals to cut the lists, there is rightly a concern about what is actually happening. Is the system simply being played?
One such example is the new mandatory Single Point of Access for most GP referrals to a hospital, which also includes a service called Advice and Guidance. The aim is for specialists to give advice to GPs without patients needing a face-to-face appointment.
For years, GPs have been able to refer patients directly to specialists when clinically appropriate. Alongside that, Advice and Guidance has existed as a voluntary system to support decision-making. Used properly, it helps avoid unnecessary hospital visits and gets patients the right care.
This scheme has been used for more than 10 years; it’s nothing new. But the Government's changes went much further.
Advice and Guidance was set to become a mandatory gateway, combined with a mandatory Single Point of Access, with a clear drive to divert patients away from specialist care. A paper published by the Government said it aimed to “redirect 25% of referrals”, or 1 in 4 patients who the GP feels need to see a hospital specialist.
That is not reform. It’s rationing.
When Conservatives raised those concerns publicly and in Parliament, the response from Ministers was swift and dismissive. My warnings were branded “total nonsense”. Despite quoting Government papers, I was told it was “misinformation”.
The then-Health Minister, Stephen Kinnock, described me as an "opportunist Tory" peddling "conspiracy theories".
But these changes are not just flawed; they have been dangerous.
The Health Services Safety Investigations Body (HSSIB) has now linked Labour’s referral policy and implementation to patient deaths. It cites patient harms and delays to care, including delays to cancer diagnoses.
The HSSIB - which Labour is planning to strip of its independence - has called for an urgent review into the entire system, saying “harm had arisen as a result of delayed or missed diagnoses”.
A coroner's report into the death of a patient with a history of epilepsy found the patient experienced multiple delays of more than one month after seeking help for repeated seizures.
The investigation found cases where two patients were both diagnosed with cancer more than 6 months after their initial referral. In one case, the cancer “was more advanced than when it was originally suspected”.
GPs report submitting several repeat referrals for patients and described responses to some requests as “obstructive” or too generic.
In yet another report, a survey published earlier this week, 7 in 10 physicians said they received requests they believed were “inappropriate” for the Advice and Guidance route, “including some that require urgent clinical intervention”. The survey also found that many specialists didn't have allocated time or the training on how to deliver Advice and Guidance.
This echoes the findings in the HSSIB's rapid review.
Making the system mandatory does not make it run smoother; it overloads it.
We all want the system to work better, and implementing reforms is part of that. But when clinicians and patients spoke about the damage this would cause, the Government should have listened.
Instead, Ministers cast concerns aside as if they were simply political attacks, without any attempt to answer legitimate questions.
Patients do not care about political spin; they care about whether they receive treatment and the quality of their care.
It’s time these concerns are taken seriously. The Government, the new Health Secretary and the NHS must listen to the safety watchdog and review this ill-thought-out, poorly implemented policy immediately before more patients come to harm.
The question is, will they?
