David Hare is the Chief Executive of NHS Partners Network.
The notion that the NHS is being privatised is as old as the NHS itself (70 years old recently, in fact). However, as Stephen Dorrell, the former Health Secretary, said recently, the NHS’ “best kept secret” is that it has always been a public/private partnership.
So if we’ve always had non-statutory organisations providing NHS care, why does the claim that the NHS is being “privatised” still persist?
There has never been any attempt to “sell off” the NHS as was done with, for example, British Gas, and no health system in the western world is delivered purely by the public sector, including France (a country no stranger to socialism), whose health service has a significant private sector component.
GPs, pharmacies and NHS dentists have always been privately-run organisations and independent sector organisations including charities, social enterprises as well as for-profit providers have been delivering high quality, universal and free at the point of use care for NHS patients for decades.
Currently around 7.7 per cent of the NHS budget is spent with private providers (more than 20 per cent if you include GPs, NHS dentists and charities) who deliver a wide range of NHS services. It could be an NHS patient choosing to get their hip replacement in a private hospital (paid at NHS prices); a private organisation running an NHS hospital’s diagnostics department using the latest scanning technology, or a private provider winning a bid to run community services by investing in the latest digital kit. All things which are absolutely compatible with a universal, publicly-funded service, free at the point of delivery.
For many on the Left, this is an ideological issue, but the crux of the matter is simply that we need to ensure that the £120 billion-plus budget for the NHS is spent in the most effective way possible. Having an internal market, as introduced by Ken Clarke in 1990, isn’t a back-door way of introducing an American-style private insurance system, but about ensuring that both patients and commissioners have choices. Patients can choose their provider of healthcare and the money follows their choice. Commissioners can choose between different providers, making sure that there are real penalties for underperformance (you can lose a contract) and real incentives to innovate (you can win a contract). And taxpayers can be confident that their hard-earned money is being well stewarded by organisations accountable for the health of their local population.
None of this should be contentious. Indeed, Theresa May herself quoted Tony Blair earlier this year when she said: “If an old age pensioner who used to wait two years for her cataract operation now gets it on the NHS in an independent treatment centre, in three months, free at the point of use, that is not damaging the NHS: it is fulfilling its purpose.”
However, too often any semblance of reform to the NHS is immediately decried as a conspiracy to privatise it, leading to politicians of all persuasions becoming increasingly nervous about publicly making a clear and reasoned argument for the use of the private sector in the NHS or, worse, engaging in an arms race over who has made least use of private sector provision. This is all in spite of the fact that the public is consistently reporting as being entirely relaxed about who provides their care – what matters tis that it is high quality and free at the point of use.
As the NHS ambitiously embarks on developing its ten year plan this summer, it’s vital that we take the public’s lead on this and bring in ideas and innovations from all sectors on how to deliver accessible, highest quality care – not simply obsess about who is providing it. Otherwise this will represent yet another missed opportunity with patients the ones being forced to bear the brunt in an unresponsive ‘like-it-or-lump-it’ service