4 Oct 2019 01:26pm

Debate: is healthcare privatisation the only option?

We ask a panel of experts whether privatisation is the only possible future for healthcare

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Caption: Image: Getty Images

Deborah Harrington

Public Matters

“We should not accept increasing corporate influence in England’s NHS. Though arguments against public service are made on the basis of public cost versus private sector efficiency, they do not hold water. Spending on the NHS when it was a public service (pre 1990), was significantly less than most international comparisons. It provided local, comprehensive, universal care without proof of eligibility, regardless of contributions. Public funding also allowed it to aim for equity of care. That isn’t matched anywhere else. Whatever the rhetoric, poorer patients always get less or are even excluded by privatisation, topup payments or insurance.

“Politicians may claim a ‘love’ for the NHS, yet under their policies GP and hospital facilities are sold to create private profit streams.

“The results for all to see are reductions in treatments available on the NHS, facilities closing down, and certain groups such as homeless people being denied access to treatment at all. If we care more about healthcare than we do about corporate profit then a rapid reinstatement of our unique, publicly funded, publicly owned and publicly provided NHS is long overdue.”

Dr Ahmeen Kamlana

GP and activist, on Twitter

“The NHS is like a loyal friend that’s supported us from day one. This government is exploiting the NHS by allowing private companies to profit from our illness. It’s our turn to show that we care. #NHSTakeBack”

Rachel Tansey

In The Creeping Privatisation of Healthcare for Corporate Europe Observatory

“Squeezing profits for shareholders out of health services risks deteriorating working conditions, which negatively impacts on safety and quality of care.”

Stuart Singer

Partner at RBP, a firm of specialist medical accountants

“There’s good reason why the topic of privatisation of the NHS is so controversial. Privatisation sounds the death knell for Bevan’s vision of free healthcare for all at the point of delivery, based on need, not on wealth.

“The increasing demands of an ageing population and the financial restraints responsible for squeezing the health service of the necessary investment have inevitably resulted in an institution that has begun to buckle. But this is no excuse for betraying the founding principles of a free NHS.

“To my mind it’s impossible to apply business methods and the profit motive to the provision of healthcare. Put yourself in the shoes of any doctor tasked with explaining to their patient that they’re unable to operate because it’s not cost-effective!

“To hamper devoted professionals with the economic restraints of targets and quotas flies in the face of their Hippocratic Oath to do no harm.”

Hidden Figures: Private Care In The NHS

By the British Medical Authority

“The English health service is heading towards a projected £30bn funding gap in 2020/21; the government has committed £10bn to help mitigate the situation, although the BMA has argued that, in real terms, and factoring in the cuts to other services, the figure is closer to £4.5bn. Within this climate, one of the few areas where funding is increasing is independent sector providers of NHS care.”

Dr Shriti Pattani

Clinical director, NHS Trust, GP, and chair of NHS Health at Work Network

“My priority has always been that the NHS remains true to its principles: free at the point of consumption; accessible to all citizens; and providing high quality care. Through moderate use of the private sector these tenets can be advanced, yet over-involvement could lead to compromising these fundamentals.

“The NHS is more strained than ever before, compounded by crises in recruitment and retention of clinical staff. The current level of private sector involvement has benefits, notably the reduction in NHS waiting lists and more competitive costs for treatments. Nonetheless, total privatisation is not the solution.

“Instead, we should opt for a blended approach, whereby the private sector supports a selfsufficient NHS, but crucially, does not replace it.”

Matt Hancock

UK secretary of state for health and social care, on Twitter

“NEWS: We’re committing to: £850m for 20 hospital upgrades – £1bn to tackle the maintenance backlog across NHS – A new strategic hospital building programme.”

Peter Hartland

CEO of St Luke’s Hospice, Sheffield

“It seems pretty clear that a hybrid of public and private organisations working in partnership is the only practical route for the sustained development of healthcare services in the UK.

“Why? Because in the UK, public healthcare is a political football and the main metric is ‘to do more and better’. But unless demand can be capped – and there appears to be little political appetite to do this – then there is no commercial model that can cope with such an unlimited expectation built on a finite contractual relationship.

“The service delivery aspects of healthcare in the UK seem likely to remain a growing part of the public sector – a giant machine of many moving parts, running on lots of different operating systems and too many variable inputs.

“That’s where the private sector comes in – innovating, moving nimbly, offering changes to bring commonality, applying new technology. It works best where the private sector helps to shape and refine, rather than rip everything up and start again.”

Dr John Lister

Co-chair, Keep Our NHS Public; editor, Health Campaigns Together

“Privatisation of healthcare is not the future, it is the past: the idea that healthcare should be a privately traded service accessible only to those able to pay was discarded in Britain 71 years ago with the formation of a National Health Service.

“There is no genuine ‘partnership’ between public and private providers. Public provision is undermined and made less efficient by contracting out selected support services to unreliable, failure-prone private companies whose profits come at the expense of poorer quality care, and who walk away if profits are insufficient. Competition and ‘markets’ in healthcare are costly and wasteful.

“Our government has chosen to impose a real terms funding freeze while population increases, forcing providers into deficit. This does not mean public provision is unaffordable: a new government, with different priorities, could tax corporations, pass new laws, reverse privatisation... and rebuild our NHS.”

Michael Butcher

Director of Blackadder Corporation Limited

"At present, we have a nearly fully privatised social care system. This privatised social care model can lead to (some would argue, is leading to) a system of wealth creation for landlords, with care being seen solely as an activity to generate rent for distant and disinterested property companies. Such companies can prioritise investor returns, not care outcomes. The recent failings of Four Seasons are testament to the risks of such an approach.

"Were the healthcare system to be privatised, I believe we would quickly see a similar OpCo/PropCo structure emerge that would see healthcare funds deliver rent for landlords and so exit out of the care environment. Such a model removes care from the centre of the ‘healthcare’ system, as financial reports refer to types of care as rent-generative or not.

"I believe a more sustainable, inward investment focused model of care is demanded. Where landlords commit to inwardly invest in equipment, fixtures and fittings and property capex. Where wage growth is celebrated more than investor returns. Where care outcomes are as important as cashflow. This is achievable under a privatised model of healthcare; it¹s just a financially regulated one."