Why it’s dishonest to claim that the NHS isn’t being privatised

To hold ideological support for the privatisation is one thing, but to pretend it isn't happening is a far more insidious lie.

To hold ideological support for the privatisation is one thing, but to pretend it isn’t happening is a far more insidious lie

Last week on BBC Question Time, the panellists were met with yet another question about NHS privatisation.

The Times columnist Camilla Cavendish attacked the ‘misleading’ use of the word ‘privatisation’ and immediately asserted that such a trend simply ‘isn’t happening’.

Nigel Farage similarly condemned the ‘entirely false debate’ on the issue, concluding that ‘the word privatisation is bandied about without really meaning anything’.

And, to an extent, Farage is right. A fundamental lack of understanding and transparency has surrounded the government’s changes to the NHS.

The incomprehensible and jargon-filled Health and Social Care Act was presented in a way that few people could engage with.

And when concerns were raised – as they were by the overwhelming majority of doctors,nurses and patients’ groups – they were ignored.

Even the timing of the announcements (who is really following political affairs just two days after Christmas?) seemed to suggest that the government was determined for their ‘reforms’ not to be scrutinised by the public.

Yet, almost three years since the legislation was passed, discussion about the NHS is still dominated by the same ungrounded mudslinging. On one side are fears about ‘creeping privatisation’, which are crudely dismissed as nonsense by the government.

Meanwhile, the prime minister has resorted to defending his actions using emotive anecdotes about family illness.

What these debates are desperately lacking are details of the reforms themselves, the effect they are having and the views of those best placed to debate them: patients and medical professionals.

So, how did the Health and Social Care Act change the NHS? Perhaps the most contentious issue was the decision to encourage competitive tendering and introduce the concept of ‘Any Qualified Provider’.

This allows NHS services to be replaced by healthcare provision from private companies and charities, based on open competition. Furthermore, the Act stated that clinical commissioning groups had an explicit duty to ‘not engage in anti-competitive behaviour’, highlighting the pressure for local commissioning groups to outsource health services.

Only this week, figures showed that since the reforms, a third of NHS contracts have been awarded to private sector providers. These contracts attracted interest from companies such as Serco and Virgin, with some worth over a billion pounds.

In fact, the government’s reforms so clearly represent a form of privatisation that an attempt to reinstate public sector healthcare provision by reversing the Act would likely result in a legal battle with competition lawyers.

And it’s not just NHS contracts where privatisation has taken place – the government’s changes encouraged NHS hospitals to open their doors to patients who have paid to receive healthcare privately.

Before the reforms, up to two per cent of a hospital’s income could be generated in this way. The coalition government raised this cap to 49 per cent. As predicted by campaigners, hospitals are exploiting the change to generate extra income in the face of a funding crisis.

Earlier this year it was revealed that some hospitals had seen up to 40 per cent increases in income from private patients.

When NHS hospitals are encouraged by government policy to offer almost half of their services to private patients, I think it’s fair to use the word ‘privatisation’.

If this is contentious, then what proportion of hospital beds must be filled with private patients before journalists such as Camilla Cavendish concede that the NHS is indeed being gradually privatised?

The irony in the current government’s attitude towards the NHS is striking. Consider the pre-election promise that guaranteed ‘no top-down reorganisation’, followed a year later with the largest piece of health legislation since the NHS was founded.

Or the irony of introducing reform supposedly designed to empower doctors in decision-making, while ignoring the medical profession’s almost unanimous opposition to the changes.

But the most insidious lie is the idea that privatisation isn’t taking place, at a time when NHS contracts are being offered to private companies and hospitals encouraged to welcome fee-paying patients to a greater extent than ever before.

Whether the involvement of the private sector in healthcare should be resisted or welcomed is a different question. But it’s clear that the government’s changes to the NHS cannot be re-branded as anything other than privatisation.

Only when both sides drop their emotive rhetoric, and instead start scrutinising legislation, will this be realised.

George Gillet is a medical student and blogger. Read his blog here, and follow him on Twitter

35 Responses to “Why it’s dishonest to claim that the NHS isn’t being privatised”

  1. YL

    Most people would agree we shouldn’t move to the American fully privatised non-universal system, but a debate should be had about whether a state-run, tax-funded NHS or a Continental social insurance system is better.

    Western Europe’s social insurance systems mostly have better outcomes and lower waiting times – but they are more expensive as a % of GDP, are more bureaucratic, have higher charges, and leave a small proportion of the population uninsured.

    2013 report on European health outcomes: http://www.healthpowerhouse.com/files/ehci-2013/ehci-2013-report.pdf

  2. Dave Stewart

    They also cost a darn site more per capita than the NHS does. The NHS is considered if not the most cost effective healthcare system than damn close to it in the world. If governments of all colours funded the NHS to the same tune as other european countries spend on healthcare then it would do a darn site better.

    It seems to me that the government (not just this one) is starving the NHS of funds forcing it into crisis so they can claim it doesn’t work a privatize it. Which is more or less exactly what happened to British rail

  3. Anthony

    “Listening to some of the opposition to the Conservative reforms one could be mistaken in thinking that Labour now rejects out of hand the use of private companies in the NHS. That is not what our recent history is, nor is it what our future policy should be. As a party we need to recognise that in some health care situations private provision can increase efficiency and bring benefits to patients quicker than would otherwise be possible. Private provision of services does not mean a privatised health service As a collective voice we need to reject the open market currently proposed, but accept that a limited use of private provision can improve the level of service to patients.”


    By continuing on using the same attacks on the Tories that the left used on Labour throughout the 2000s we are going to kneecap future Labour health policy to the detriment of the NHS for the short term gain of shouting “privatisation” and deliberately fear mongering for electoral advantage.

    The parallels with Nick Clegg’s anti-tuition fee policy pre-2010 is not hard to spot. We will look like idiots at best, and liars at worst.

  4. madasafish

    I suppose “starving it of funds” is giving it more money every year (which is what has actually happened).

    A rising population plus a growing elderly population is toxic for NHS demand.

    Add in an economy with low tax revenues and it is unsutainable.

    Either taxes rise – a lot , or demand is curtailed through rationing or we reduce the demand by making people healthier .

    I would not want to be any politician making the choices – all are toxic.

    I cannot see any private enterprise wanting to take over the NHS in its entirety: many patients have little or no money so are totally dependent ion state funding.

  5. DrPlokta

    It’s pretty simple to tell when the NHS is being privatised. It’s privatised if it no longer offers medical care to all, free at the point of delivery. How that care is delivered doesn’t matter, as long as it’s the government footing the bill and not the patient — it’s all run for private profit anyway, and always has been, since salaries paid to employees are private profit just as much as fees paid to private companies are. Dental care, optical care and prescriptions have been partially privatised for a long time, but I’m not aware of any further moves towards charging patients for NHS care.

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