You say you don’t want the Government to privatise the NHS?

Image of a post showing an N4S Not for Sale sticker on it.
N4S” by secretlondon123 is licensed under CC BY-SA 2.0

Headlines so often set the agenda for debate. Alarms that our beloved NHS may be privatised may arouse incredulity or campaigning energy. Even these warnings are too late.

Privatisation would not, surely, deprive us of the healthcare we need? Other such services have gone down that path before, without the ravens leaving the Tower. What is the problem? Does privatisation matter?

The health service belongs to and is free to us all. The very fact of public ownership makes it directly accountable to us, its users. Take the assets into private hands and at a stroke, priorities change, from delivery to dividends. Once control passes to investors, these can decide on pricing, location, frequency, quality and scope of services.

Examples of why to be fearful lie in the railways, now so chaotic that even Conservative administrations have had recourse to re-nationalisation, [though long after their chosen investors have scuttled off with their astounding profits]; and with water, now so under-invested in private hands that long-clean seashores and rivers are daily polluted with untreated human waste, with government backing.

The example too of social care is cautionary. By placing responsibility for service provision in the private sector to avoid both accountability and public investment, whilst starving funding of Local Authorities, successive governments have left this vital sector fragmented, lowly paid and unable to meet demand.

Surely, though, no hedge fund or sovereign wealth fund is big enough or foolish enough to acquire an organisation with over 1 million employees, running a nationwide service of huge sophistication and complexity and responding to uncontrollable circumstances? Would enough of the public be willing to buy stakes in something they already own? Perhaps not, but to think in these ways, which may have been the models before, is to place too narrow a definition on “privatisation”.

‘Hip replacements and cataract treatment are already open season for private providers’

What if the NHS were left so starved of resources [skilled staff; funds in keeping with demand] that it could no longer cope and had to be rescued by additional capacity being contracted from private providers?  What if parts of the service were to be served no longer by NHS-owned provision but by operators either under contract, or by the NHS ceasing to supply? Would not such scenarios constitute partial privatisation?

Foundation Trusts already operate independent of ministerial control, allowed to sub-contract to private sector companies for added capacity. Clinical Commissioning Groups (CCGs) have been allowed to exclude from their obligations a wide range of medical interventions such as hip replacements and cataract treatment, leaving these as open season for private providers.

Surely no minister of our government would deliberately allow such cherry-picking of ripe business opportunities? Or would they? Quite apart from the disgraceful and blatant corruption associated with Covid-19, US insurance company Centene already owns some 70 GP practices, with over ½ million registered patients. UK private sector providers like Spire and Nuffield own hospitals nationwide, which are available as extra capacity when required. The Priory Group is already the largest supplier of mental health services to the NHS, with over 2500 beds; hundreds of “NHS Dentists” are in reality private businesses working under NHS aegis; and a representative of Virgin Health has a seat on the Board of one of the new Integrated Care Systems. Are these not examples of privatisation? And if the answer is “Yes”, how can the government deny that it is privatising the NHS?

The arrival of Covid-19 brought new impetus to this Tory-led trend. The urgent demands of the pandemic allowed the government to acquire powers which enabled it to contract supplies and services without even the norms of competitive tendering.  At the same time, the NHS was put under unprecedented pressures, which were mitigated by making use of private sector capacity.  

It is clear from international comparisons that, despite ministerial protestations about £billions of investment, our healthcare budget and thus capacity are already woefully low, with consequences for patients. In recent days there have been reports of a major teaching hospital “ceasing to function as a hospital”  as A&E attendance grew to record levels, with ambulances queuing to deliver patients who were waiting days for admission: and of patients dying in ambulances as response times lengthen. The Conservatives’ miserly approach to healthcare perpetuates the need for additional capacity, which they prefer to come from the private sector, not public funds.

Once a service on which people depend becomes available only via private sector providers, there is a barrier neither to price hiking by exclusive suppliers nor to the principle of free delivery disappearing.

You don’t want the government to privatise the NHS?

This government already is.

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