Opinion polls suggest that the National Health Service is one area where Labour comfortably out-performs the other parties, and it is clear that it will form a key plank in their General Election campaign.
One of Labour’s charges is that the Coalition is “privatising” the NHS. This charge is highly questionable in itself, but it is also disingenuous, since as the process of creating public/private partnerships has a long history in the health service, much of it in the years 1997-2010! The bar chart above, shown on successive editions of Newsnight recently, shows the extent of “outsourcing” (or “contracting out”) in the National Health Service over the last eight years. Is outsourcing “privatisation”? I would argue not.
The physical assets of the NHS are still owned by the state. This is more than semantics. In privatisations (like the most recent one of the Royal Mail), assets are sold. This is not the case with outsourcing. The justification for any involvement of the private sector in the NHS has to be that the contractor will provide a more efficient and cost-effective service than if that activity was managed by direct public sector employees. There should be no presumption that private provision is good or public employee provision bad (or vice versa) – this is because this is self-evidently true.
The judgment calls relate to where the line is drawn. For example, a hospital needs heat and power, and the former is generally provided by a boiler house on site. The operation of this boiler house and all its connected facilities throughout the hospital is of course crucial to the welfare of patients and staff. There is no inherent reason why this service should not be contracted out to third party providers in the private sector who commit to provide a service against standards agreed as part of the tender against which they bid and were appointed.
Hospitals and all the other publicly-owned facilities are part of an overall public/private partnership across our healthcare system. Take the making up and issuing of prescriptions. Our doctors prescribe medication for us, and gives us prescriptions. The next step is vital. We must get from the dispensary exactly what the doctor has prescribed – there is zero room for error. Vitally important, you might say – and therefore an area which should be under tight public service control. But of course it isn’t, and never has been. This work is carried out on behalf of the NHS by private sector pharmacies against standards laid down by the NHS – and there is competition between them which is in the consumer interest.
If we edge away from ideology – whether it is that of the free-market ideologue of the Right (who would literally privatise healthcare) or that of the neo-Marxist of the Left (who would allow no private sector involvement at all) – this takes us towards the citizen. As citizens or patients, we are surely unlikely to be bothered by ideology one way or the other. The citizen wants professional and reliable healthcare – and in some cases to be able to make a choice between competing offers – but is unlikely to be bothered about whether the provider is an NHS employee, from an agency or from a private company so long as the care is good.
But if contracting out does take place, it must be well done! An example of how not to do it was Hinchingbrooke Hospital where the shambles teaches us that care is needed to make sure that operational standards are met by all providers, whether public or private. The unions in the health service are totally opposed to the involvement of the private sector because, essentially, every outsourcing contract is likely to be awarded to a supplier who may have non-unionised employees.
The botched experiment of Hinchingbrooke weakened the case for public/private partnerships badly and the unions, and Labour, understandably jumped on this. But, equally, the scandal of Stafford hospital showed that unionised NHS staff can make venal and fatal errors as well. There is no alternative to improving efficiencies if the NHS is to be affordable, but equally there is a need for standards to be set and performance monitored across the health service, whosever the provider is. Private and public sector activities of a similar nature can provide performance benchmarks to one another which can surely only be helpful.
The 2010 Conservative Manifesto was not a charter for privatisation and the commitment that “… we will never change the idea…that healthcare is free at the point of use” has not been broken. Labour point to the fact that some senior Conservatives are in favour, as Jeremy Hunt put it in 2007, of “… in effect denationalising healthcare in Britain”. But this was not Party policy. The manifesto did propose changes to the NHS, and no doubt the Tories would say those changes have been successful and Labour would argue that they have not.
However, as the bar chart shows, there has been no dramatic increase in “outsourcing” and the charge of privatisation being one of the major causes of poor performance, so frequently being made, cannot be sustained.
In their manifesto for the upcoming election, the Conservatives will need to refute the charge that they have been party to the “selling off” of the Health Service and that they plan more. Ninety-four per cent of healthcare is currently provided by NHS employees, and that needs to be emphasised. The drive to create efficiencies and cost reductions can in part be helped by outsourcing providing there is no reduction in service standards or care. To quantify, in the manifesto, the planned extent of this over a Parliament, and explain why it is necessary, would be a sensible thing to do – whilst recommitting to the principle of a publicly-owned, free at point of use Health Service.