Why not... privatise the NHS

Nurse and hospital patient

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A look at eye-catching policy ideas that are often talked about but never seem to feature in UK general election campaigns.

The background

The NHS was created by the post-war Labour government in 1948. For the first time, hospitals, doctors, nurses, pharmacists, dentists and opticians were brought together under one organisation to provide services free to the public at the point of delivery.

The central principle - that health services will be available to all and financed entirely from taxation - has been an article of faith in British politics ever since. David Cameron is the latest in a long succession of prime ministers to vow that the NHS is "safe" in his hands and would not be "privatised".

But privatisation is a slippery concept. Some see it in the opening up of NHS services to more private competition. Others argue that the word "privatisation" would only apply if Britain dismantled the NHS altogether and adopted a US-style private health insurance system instead - and that the NHS's status as "sacred cow" is blocking constructive debate about its future.

Thomas Cawston: The case for privatisation

Competition is a "bogey" word in the NHS.

Yet this hostility to competition and private providers is a uniquely British obsession.

Diverse providers of healthcare are common throughout Europe.

Thomas Cawston
  • Thomas Cawston, research director, Reform
  • Masters in South Asian History at the University of Oxford and a BA in History and Politics at the University of Exeter
  • Reform is a non-party public services think tank
  • Corporate backers include outsourcing companies such as Serco, Capita and GE

In Germany for example a third of hospitals are run by charities, a third by for-profit companies and a third by government. Sweden has invited private providers to provide GP clinics and hospital services. By contrast only 3% of the NHS budget is spent by private providers in England.

The reason for competition is that can drive real improvements in care.

To take one current example, patients with chronic back pain in Bedfordshire will soon enjoy a much better service. The local NHS has asked different organisations to suggest the best way to deliver all musculo-skeletal healthcare services for the next five years.

All qualified providers, including NHS hospitals, GP practices and private companies, are invited to submit bids to provide a world class service at the greatest value for money.

The winning bidder will be the one that gets the different parts of the NHS to work together successfully so that patients are treated as quickly as possible. The competition will deliver new thinking and NHS patients will benefit.

Competition also puts patients at the heart of the NHS.

Poll after poll shows patients value their right to choose which hospital to go to and what treatment they receive. Yet without competition patients would have to "like it or lump it" and choice remains the privilege of the rich who can afford to buy their way out of the system.

Opponents of competition argue that it will fragment NHS services.

In fact, those services are already fragmented, which is one cause of the current crisis in A&E admissions.

The Bedfordshire initiative shows that competition can join up NHS services, to the great benefit of patients.

Oliver Huitson: The case against privatisation

It is not clear where the evidence base for competitive, privatised health provision comes from.

This is perhaps why the Conservatives and the private health industry, including the "think tanks" they fund, rely on a handful of soundbites. Respectable economic theory and the evidence from real-life healthcare both disprove their case - competitive markets fit healthcare exceedingly poorly.

Oliver Huitson
  • Oliver Huitson, co-editor of OurNHS website
  • Author of 2012 report, How the BBC betrayed the NHS
  • OurNHS is a three-year project dedicated to "reinstating a genuine National Health Service in England"
  • The site is hosted by openDemocracy
  • It is funded by businessman and philanthropist Henry Tinsley and the Andrew Wainwright Reform Trust

When markets are introduced into healthcare provision, providers chase income, costs soar, health outcomes suffer, fraud increases, and the system of universal care coverage collapses.

The public need only look at what's happening to out-of-hours care already - a stream of scandals, capped by an A&E crisis. Blaming this on NHS "fragmentation" is quite extraordinary. The privatised service, with less qualified staff to cut costs, has seen an increase of 50% in the rate of calls referred to A&E since 2010.

Sweden put "competition at the heart" of their NHS. "Choice" grew in affluent urban areas where privately-owned clinics pushing unnecessary care now abound. Of the 196 new clinics that opened in Sweden, all privately-owned, 195 were in wealthy areas.

The newly privatised Dutch system showed similar problems. The GP organisation tried to address it by asking newly qualified GPs to take positions in rural practices. For this "interference with the market" the national competition regulator fined the GP association 7.7m Euros!

Competition puts revenue, not patients, at the centre of care. It's a legal requirement for firms to maximise shareholder value - not patient wellbeing. This is why the public consistently oppose privatisation; it converts a public health service to a "fantastic business", in Cameron's words.

"Choice" is often a fantasy, as commissioners, patients and charities will soon learn; a warm buzzword used to mask the fact the NHS is being changed to a profit-led market without the public's consent.


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  • rate this

    Comment number 1223.


  • rate this

    Comment number 1222.

    1219. Sally the c
    ' I'll take the good Dr's word, "

    Haha you're talking about Dr ron ( bigot) Paul, Americas joke politician, now thankfully a retired dinosaur. Of course , you share with him a futile philosophy, a total disregard for facts and the truth as as well as an inability to make a coherent point. perhaps you should carry on his lifes work of issuing offensive newsletters. laughable!

  • rate this

    Comment number 1221.

    Healthcare in the UK is the biggest money making machine this country has. The number of dentists, doctors, opticians et al that sit on thousands of pounds of cash is scandalous, this is where the money goes. The NHS is already privatised in part

  • rate this

    Comment number 1220.

    Sally - 2/10 for history. The growth in the 1820s in industry was largely funded by recycled bad debt from the collapsed property boom during the Napoleonic wars - see Byron 'The Age of Bronze' Canny Quakers loaned money where it would generate real growth, and men like Edward Pease became immensely rich. The Markets produced their usual cycles of boom and bust - 1825, 1846, etc - nothing useful.

  • rate this

    Comment number 1219.

    You're free to be wrong. But, I'll take the good Dr's word, since he actually practiced medicine during that period, in the US and overseas. Your revisionist history tonight is alarming, ignoring the benefits from the Industrial Revolution @1211 for one. I don't know what your qualifications are, but even an amateur historian would not make such an error.

  • rate this

    Comment number 1218.

    1215 Sally

    That was post the second world war, when America had a massive boom and was receiving large payments on War Loan from an impoverished island off Europe. I notice he says HAD, and poor people such as Henrietta Lacks would not agree about its quality. Eugenics was practised long after it vanished from Germany and it was very much a two tier system. Don't get sick in America!

  • rate this

    Comment number 1217.

    Crying "Without an NHS, no one will get healthcare", is like saying:
    "Without slavery, no one will pick the cotton".

    We didn't need the government institution of slavery to pick cotton, just like we don't need the government institution of an NHS to provide healthcare.

    The NHS is an inefficient dinosaur. The 5th largest employer in the world, in a country with 0.91% of the world's population.

  • rate this

    Comment number 1216.

    Perhaps Thomas Cawston would like to branch out and found a new "think-tank" on the lines of "Deform"...perhaps one extolling the virtues of smoking tobacco, funded by non-partisan cigarette makers, who only have the well-being of their customers at heart above any profit motive. It is wonderful how graduates in history are so well informed in disciplines where they have no expertise.

  • rate this

    Comment number 1215.

    "We forget that for decades the United States HAD a health care system that was the envy of the world. We had the finest doctors and hospitals, patients received high-quality, affordable medical care, and thousands of privately funded charities provided health services for the poor... People had insurance for serious health problems but paid cash for routine doctor visits."
    ~Dr Ron Paul M.D.

  • rate this

    Comment number 1214.

    Yeah, lets give it to the private sector they are known for their compassion and caring approach.

  • rate this

    Comment number 1213.

    Because a civilised society says healthcare should be free for all, because private is about profit and health care should be about the common good and because we don't want to go the way of the US...
    And what planet have you been on BBC? The Coalition have wrecked the NHS & YOU have not said a word.

  • rate this

    Comment number 1212.

    We need market freedom in healthcare, not a monopoly.

    "The time has come to rise up against these parasitic tyrants in our society."~Ron Paul

    “A society that puts equality before freedom will get neither. A society that puts freedom before equality will get a high degree of both...

    Underlying most arguments against the free market is a lack of belief in freedom itself.”
    ~Milton Friedman

  • rate this

    Comment number 1211.

    In the 1820s it was recycled bad debt from a failed property boom. In the 1930s, after the Great Crash, and a change in taxation, property prices collapsed, and small builders built suburbia, with the aid of the government sponsored District line. We didn't need to go to war in 1939, but Germany was bankrupt, and America was still deep in Depression in 1941 - both welcomed the war!

  • rate this

    Comment number 1210.

    Hey, give the Industrial Revolution, not the state, did that.

    "La Liberté guidant le peuple"

  • rate this

    Comment number 1209.

    1207.Sally the contrarian

    Good work. Fail though.. go to bed. ta ra x

  • rate this

    Comment number 1208.

    Or conversely, we can invest money in real businesses such as manufacturing, rather than playing the markets using money borrowed against inflated property values. These will generate the taxes to pay for the NHS, as well as providing real jobs. Exactly as we did in the 1820s - of course you won't have the first idea how to do that, none of you ever having had a productive job!

  • rate this

    Comment number 1207.

    What a terrible plan. You'd throw people onto the streets, simply for owning a home. That's your civilisation? And why? To fund an unrelated insolvent Healthcare Ponzi scheme. Only a Collectivist would be so envious, so cold, so selfish.

  • rate this

    Comment number 1206.

    @ Sally still no reply? I declare victory.
    I feel like it was an unfair fight though, since you don't know the difference between 'of' and 'have'.. amazing.

    Should a functional person with 80 IQ, who works 45 hours a week, takes care of his health very well, but earns very very little be entitled to the same Healthcare as a millionaire smoking, alcoholic?

    Yes or No sally..end of discussion

  • rate this

    Comment number 1205.

    Interesting that Mr Cawston only uses the word profit once in his piece and yet his 'think tank' is backed by the very companies who stand to profit by his proposed changes.
    The competition will deliver new thinking'. Why? 'Competition puts patients at the heart of the NHS'.How? More likely to lead to the situations in 1193. The later implication about rich and choice.....dream on sonny.

  • rate this

    Comment number 1204.

    Wow, another comment for me from you, you are obsesses with Sally.

    How was your dinner, did you pay for it? Well, that'd be a 1st, surprised you didn't send the bill to our unborn kids like you do for the NHS.

    Your socialism requires you to live in envy, my liberty doesn't. That's why I'm happy for my neighbours' success, while you conspire to steal it.

    "LOL" :)))))


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