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As Liberal Democrats, we believe in universal access, clinical autonomy, local accountability, and innovation that serves the patient rather than the platform. Labour’s 10-year plan for the health service threatens each of these foundations. It shifts decision-making power from clinicians to digital triage apps, replaces continuity of care with walk-in hubs, and centralises England’s patient data under the control of Palantir, a US surveillance firm with no democratic oversight. The plan anticipates fewer staff, conditions access on risk scores and outcomes, and introduces no new safeguards on how patient data is routed, monetised, or reused. This is not modernisation. It is a quiet, systemic repurposing of the NHS, and the public deserves to understand the full implications.

Digital Gatekeeping

At the centre of Labour’s digital vision for the NHS is a radical shift in how patients access care. By 2028, the NHS App will become the universal entry point to NHS care in England (Labour 2025: 10). This includes triage, appointment booking, and condition management, all of which are presently core functions of local practices and NHS staff. The plan outlines a “My NHS GP” feature to route all access digitally (Labour 2025: 11, 31).

Yet placing digital triage at the heart of NHS access introduces serious and well-documented clinical risks. AI symptom checkers show error rates of 20–40% depending on symptom complexity, often under-triaging serious cases or giving false reassurance (Fraser et al. 2022; BMJ 2020). They lack clinical context, are not accountable, and disproportionately fail older adults, patients with cognitive or language barriers, and those with multimorbidity (King’s Fund 2022).

Institutionalised Staffing Shortages

These risks can, of course, be mediated through medically professional oversight, a practice common on the continent, where digitalization is introduced to augment, rather than replace, medical professionals. However, rather than follow European best practice, Labour’s plan appears to institutionalise staff shortages as necessary to the functioning of the new digital NHS. By forecasting that ‘fewer staff than projected’ will be needed by 2035 due to anticipated efficiencies from automation, AI scribes, and redesigned roles (Labour 2025: 74), the plan builds systemic understaffing into the future model of care.

Cutting roles on the assumption of seamless substitution rarely works in complex systems like healthcare. Evidence from NHS digital implementation reviews shows that automation and role redesign frequently fail to deliver efficiency in practice due to clinical interdependencies and the unpredictable nature of care pathways (King’s Fund 2021; Health Foundation 2020). Rather than reducing labour, substitution redistributes pressure, deepens burnout, and increases the likelihood of unsafe gaps in safety-net care (GMC 2022; BMJ 2022). Digital tools can assist, but they cannot replace the presence, judgement, or adaptability of a trained clinical team operating under pressure (WHO and OECD 2020).

The End of Outpatients

As is to be expected from radical reductions in workforce expectations, Labour’s plan includes a restructuring of service delivery. By 2035, outpatient departments in England will be eliminated and replaced by “Neighbourhood Health Centres” responsible for diagnostics, monitoring, and follow-up (Labour 2025: 35). These are framed as flexible and multi-skilled, but there is no provision for clinical continuity, responsibility, or long-term therapeutic relationships.

However, removing that continuity risks far more than administrative confusion. Patients without a consistent clinical anchor are more likely to fall through gaps, face delays in diagnosis, and suffer from contradictory advice (King’s Fund 2018; Royal College of General Practitioners 2020). Complex or chronic cases (the very patients who use outpatient services most) depend on long-term therapeutic relationships (National Voices 2022). Labour’s plan dismantles that structure without offering an alternative, making the system more efficient for providers but more opaque and fragile for patients.

Disenfranchisement Risks