The covert privatisation of the NHS

Nobody voted for this. Politicians still talk of the NHS as a unique national treasure whilst their actions serve to undermine the very institution they so lavishly praise.

As in so many other areas it is those with no spare cash who will miss out – and health inequality will worsen.

When the NHS was created private health care was not eliminated it has always been there but a new report from think tank the Centre for Health and the Public Interest charts the recent increase in private provision.

Its findings cover England where the process is more advanced but the trend exists here too and we can expect the development of similar trends as the system creaks and buckles under the weight of demand.

A significant recent factor has been the massive increase in patients opting for private care as a result of the sharp growth in waiting lists caused by the pandemic.

A striking feature of this has been the increase of people without private health care who are choosing to pay for their own operations to speed treatment.

Between 2019 and 2022 those paying for their own hip operations has grown by 193%.

And in the first eight months of 2021 private hospitals carried out 56% of all hip and knee operations, compared with 40% prior to the pandemic.

It is worth reminding ourselves that this in turn means that medical consultants  are increasingly treating people privately, potentially at the expense of NHS patients.

 All this is happening in a country with a publicly funded universal healthcare system based on need rather than ability to pay and it has been enabled and encouraged by government.

Investment in private health in the UK is growing - £2 billion was invested in acute healthcare in England between 2014 and 2019 double that invested in capital expenditure on the NHS.

Please note that the private sector does not contribute at all to the training of the 17,500 medical consultants who deliver care in its settings whose training is paid for by taxpayers. 

Yet between 2013 and 2018 the NHS in England spent £5.6 billion on the private healthcare sector.

The process of privatisation by stealth was kick-started under the Blair and Brown governments with the setting up of Independent Sector Treatment Centres to reduce health service waiting lists. These were privately owned but publicly funded and stimulated the growth of large private healthcare providers in England. They were offered very attractive incentives to build and run the centres, including paying them on average 11.5% more than equivalent cost of an operation provided by the NHS, and ISTCs were guaranteed payments irrespective of whether they undertook the contracted number of procedures for the NHS. As a result 35 of these new centres sprang up.

The private sector received two further boosts. The first took place as a result of the Choose and Book initiative in England, whereby patients were allowed to choose whether the treatment took place under the NHS, or privately at public cost.

Naturally many chose the private option because of the lengthening NHS waiting lists between 2010 and 2018 there was a 156% growth in NHS funded care in private hospitals compared to just 19% growth in NHS elective care. Between 2013/14 and 2018/19 an additional £5.6 billion of NHS budget for England went to the private sector.

Another development in England – the creation of NHS Foundation Trusts – hospitals which were explicitly encouraged by the government to generate more of their income from outside of the NHS created opportunities to private companies to partner with the NHS and use national resources to boost profits.

HCA Healthcare, an American company has done this to great effect. An example is the Christie Clinic in Manchester, a joint venture with the NHS Trust, which generates £48 million a year in revenue from private cancer patients and whose profits are shared between HCA, the Trust and with the NHS consultants who also have shares in the company.

Most of the companies profiting from the NHS are owned overseas and they are delighted with an arrangement which gives them access to NHS doctors without having to contribute to the cost of their training. Perversely they are able to cash in on the growing pressure on the NHS, which is exacerbated by doctors freelancing for private companies, through the growth in numbers of those so fed up with waiting that they are prepared to pay for themselves. Often the staff involved are those who might have been able to do the NHS work in a reasonable timeframe  if they were not too busy topping up their pay by freelancing.

However recession will soon bite, limiting the ability of people to fund their own care and the ability of the private sector to meet growing demand is limited. At the moment most medical consultants are employed by the NHS and are contractually obliged to commit most of their time to treating patients in NHS hospitals. There are also shortages across many of the consultant specialties.

The UK has a shortage of staff across the health sector, meaning there is just one limited pool for the private and public sector to recruit from.

But this is more of a danger to public services than any protection from creeping, covert privatisation because growth in private care for those with the ability to pay can only come at the expense of those who cannot afford to do so.

And if the NHS becomes a residual fall-back for the poor it will inevitably end up offering a poor service. Richer people will not look kindly on the prospect of paying more in tax for services they no longer fund.

So in England health is at a crossroads. At stake is the very future of the NHS which is fast slipping out of public ownership into the hands of overseas profiteers.

And as more and more have to wait longer and longer for operations, often in pain, so too will more and more choose to pay for themselves.

And as they do so the case for universal care becomes weaker, consensus breaks down and those with insurance packages and the ones with spare cash will not want to subsidies the rest of us.

The hijacking of revered public services has not happened to anything like the same extent in Northern Ireland.

But with an even deeper crisis, longer waiting lists, no additional funds and the prospect of no government it is hard to see how further privatisation of this precious national resource can be prevented.