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

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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.

  6. treborc1

    God this site has been taken over by Tories and New labour .

    Sadly the NHS which New labour tried to take down the privatisation route has changed people views I cannot for the life of me get an NHS dentist for example and now get use to not going, if I get toothache pay the emergency dentist who takes it out even if it can be saved.

    People in the main who are middle class who earn above the £38,000 would be willing to pay insurance UNUM Provident I’m sure will be happy.

    My hospital was up for closure in 2007 we marched through town with about 1000 people with Unions banners flying, last year we marched to say it and 80 people marched .

    Pe4ople are now getting sick of the use of the NHS by all parties we all know Blair and Brown were willing to allow the yanks to take a shares so are the EU so for me the fight is over what happen happens I’m sure that MP’s and Minister will have BUPA paid for them.

  7. Robbie

    Come on, you can’t sincerely think that paying employees wages is the same as peoples I’ll health generating company profits? Yes optical care, dental care and prescriptions have been partially private (meaning the NHS is no longer free at the point of care) but the costs for these have been steadily rising and qualifying to get them free has been increasingly difficult. Braces are a new thing that you now pay for, they were free when I got them but my sisters braces were £1500!

  8. Robbie

    These are not the only options. We learnt about the NHS in my course (Podiatry) and whole sections are dedicated to overseeing private contracts and making them fairer. Getting rid of these parts would save money! Not to mention that healthier happier societies generally require less health care. The year of the financial crisis (2008) so an increase in spending as people lost money and therefore become unhappy, stressed, and more likely to drink, smoke, eat badly etc…

  9. John Devine

    The extra money going into the NHS every year is what is needed to pay for the PFI hospitals. It does not reach the ‘frontline’ of healthcare. Somewhere in the region of 118 PFIs at some £5 to 6 M per month each adds up to a lot of front line staff having to be cut from the budget !

  10. Paul Lawrence Hayes

    It’s not just NHS privatisation. [At least] the appalling austerity and ‘welfare reform’ policies have been facilitated largely by deceit too. The UK is in a very dark place now. It’s a democracy, Jim, but not as we knew it.

  11. madasafish

    Well we all know who signed all these PFI contracts… the same Party floundering in the “economic competence” polling…

  12. DrPlokta

    Yes, profits are profits whether it’s an individual profiting by selling their labour or a company profiting by selling their products and services. I don’t care what organisational structure the entities delivering NHS care have, whether they’re salaried employees, freelancers or companies, I just care that they’re delivering the best service at the lowest price.

  13. David Davies

    2 weeks ago, Simon Stevens declared that 94p in every £1 spent is retained within the NHS. He is either an idiot, or a liar. Yet another asset funded over decades by tax-paying plebs will be gifted to the tax-dodging fraudsters who wrecked the economy. Marginal costing will be used to undercut NHS providers, and NHS will cease to be before very much longer.

    No one acknowledges TTIP, which will finish the job. EVERY prospective MP should be forced to declare whether they have a personal financial interest in the NHS, in their manifestos.

  14. Leon Wolfeson

    That you’re not aware of the charges for some things – not widespread yet, but spreading…

    And we have a crisis in dentistry where there’s a shortage of dentists and people are loading extra work onto them by only seeking care when they have bad dental problems rather than having routine checkups!

    (If I hadn’t had my problem with a wisdom tooth caught in a routine checkup, for example, I’d have used even more NHS dentistry time than I did ><)

  15. Leon Wolfeson

    One, they absolutely cost more.

    Two, system’s like France’s have an issue with poorer people not seeking care until they are seriously ill. And they don’t have the same issue of a tide of poverty growing as we do, which would make the system far, far less than economical.

    Three, in a system with mandatory yearly payments, you’d end up with millions of people chosing between food and possibly being prosecuted (and not having healthcare access).

  16. Guest

    Er… Preventative care does NOT cut costs. It improves quality of life, but no surprise you consider that toxic as well.

  17. Guest

    You mean them all, compared to pre-1990’s? Right.

  18. John Devine

    It would seem that all the major parties are content for things to go on as they are. Only the Green Party, Welsh and Scotish Nationalists are prepared to fight to return the NHS to public ownership.

  19. John Devine

    Spot on, David.

  20. Nico

    94% Means everything but 6% which is the same figure the government uses to state “only” 6% of services have been privatised (so far). This is their way of avoiding recognising that a third of services ***recently contracted for*** have gone to profit-seeking entities.

    Speaking of TTIP, Stevens was spokesman for a US board of private healthcare companies that supports TTIP so they can get into European healthcare.

  21. Nico

    There is an online tool in preparation which will make it easy to click and see an MP’s interests.

  22. Nico

    Well, they won’t deliver the best services if they’re in it for the money. They make their money *specifically* by using as little of the budget as possible for services and wages so they can keep this ‘surplus’ as profit. It’s oil and water.

  23. DrPlokta

    Why do you think that private companies such as Tesco, Amazon and First Direct can deliver good services to their customers, if they’re keeping all they can as profit? Do you think a non-profit-making government-run supermarket chain would be better and cheaper than Tesco? If not, then what’s the difference?

  24. blarg1987

    The thing your miss off is lack of transparency, Tesco is in trouble for cooking its books with the auditors help, and shareholders could not easily access this information.

    Amazon has been using tax schemes to reduce its tax liability but this information only came out form the media and was not easy for the every day joe to find.

    Government run places have the problem that everybody wants to know where every penny is spent, private companies just have to declare if they are turning over a profit.

  25. blarg1987

    You do realise it was the Conservative party who were in power in the early 90’s who started PFI, and when in opposition, did not claim it was a waste of taxpayers money.

    I do not agree with New Labour, but the conservatives would have also done the same.

  26. Leon Wolfeson

    And problems with squeezing suppliers?


  27. DrPlokta

    I want the NHS to be squeezing its suppliers until they hurt, thank you very much, so that it spends as little taxpayers’ money as possible. Saying that private companies are better at squeezing their suppliers is an argument in favour of having private companies delivering NHS services.

  28. Leon Wolfeson

    Oh right, so driving suppliers out of business, getting shoddy equipment, etc.

    Nope, you are just arguing for bad value.

    There’s a reason things like supermarkets demanding yearly payments from suppliers is so widely derided, too.

  29. marje arnold

    not yet you havent – but wait untill this lot gets in again and you will see increasingly health services privatised and with that will come the fees just a s they did with dental and eye care. we all know what happens when privatisation take place – costs rise year on year just as they did with energy and transport etc. they will also cherry pick the services they wish to run, leaving the costly services to be funded by the state. if you think that this is not the aim of the tory government your are very much mistaken.

  30. marje arnold

    i`m glad you pointed that out.

  31. marje arnold

    i would also point out that a large proportion of the front bench tories have huge shares in the private companies which are stealing the NHS out from undre our noses

  32. DrPlokta

    Have you seen Tesco running short of products or getting shoddy products because it’s squeezing its suppliers? It clearly works for Tesco, despite complaints from their suppliers; why should it be different for the NHS?

  33. Leon Wolfeson

    Works? Oh yea, the shoddy crap there which got me to change to another supermarket.

    As you ignore the fact it’s not a market where we can chose provider (and healthcare isn’t a market anyway, realistically), plus again there’s single providers for many things.

  34. marje arnold

    i agree with the above comment. we all know that the aim is to fully privatise and the NHS will be left with most expensive options because the private companies will cherry pick the services they want. regarding TTIP. people in europe are marching in protest about this thorny issue. why arent we . we are so apathetic that we are sleepwalking into this disgusting issue.

  35. Anthony Kilcoyne

    In Dentistry we widely recognise the Government Spin regarding NHS status, when already it’s neither N or H or S free to all regardless of income equally etc.

    In short, we call it The Big Lie from HMG and their Civil Servant agents, to the public.

    Many practices (especially small local ones) are being forced to close or go Private to continue to be able to spend the TIME to deliver high quality bespoke dental care AND prevention – indeed Prevention treatments are the most economic and healthy option.

    Shame the NHS mandarins don’t recognise that as the No.1 medical reason for any Primary school child to be hospitalised, is rotten teeth !!!

    Yes that’s not some poor deprived Country statistic, but England in 2015 🙁

    But hey it’s free to the patient so that’s OK, don’t make a fuss, right ???

    Err no, clearly not, but it just reflects CONTINUED centralised neglect, waste and flaws IMHO.

    I can’t believe the Journalists are giving Politicians a ‘free ride’ on such aweful Dentistry issues – if Politicians and their Civil Servants get away with it there, what awaits the rest of the NHS ???

    Yours deeply concerned,

    Dr. Tony Kilcoyne
    Dentist and Specialist in Prosthodontics.

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