Why the NHS must be public
We all need access to good healthcare, and the NHS promises to provide that to everyone. The NHS is one of the best healthcare systems in the world – and unlike many others, remains free at the point of delivery. It is also one of Britain’s most recognisable and popular publicly owned institutions – looking after, on average, 1 million people every 36 hours. However, our NHS is currently facing its biggest threat since it began. Behind the scenes privatisation is likely to damage the quality of service it provides whilst also costing the public more.
What you need to know
The Health and Social Care Act 2012 was the most controversial set of reforms in NHS history - greatly expanding the role that private companies play in delivering health services. Instead of a publicly funded and publicly owned NHS in England, the Act created a competitive market for health services where the government pays for, but does not provide healthcare.
- According to a recent YouGov survey, 84% of us want public ownership of the NHS.
- In 2015, private firms won 40% of all contracts put out to tender by Clinical Commissioning Groups (CCGs).
- A report produced by the Commonwealth Fund in 2014 described the NHS as the best healthcare system in the world - as well as the second-cheapest of those analysed.
- In the same report, the private insurance-based US system ranked last on indicators of efficiency, equity, and cost.
- The UK spent around 8.9% of GDP on healthcare in 2012, whereas the US spent 16.2%, based on OECD research.
- An internal ‘market’ has been created in the NHS which costs us at least an extra £4.5 billion a year – money that could be put towards frontline patient care.
- Administration costs have risen from 5% of the NHS budget in 1979 to over 14% in 2010.
- In NHS Scotland, which has opted to reject competition and markets, satisfaction with the NHS has increased by 20% since 2005 - for the UK as a whole, satisfaction has fallen 10% from its 2010 peak.
How is the NHS being privatised?
Commissioners now have the option to bring in private companies to compete for contracts with the NHS. Clinical Commissioning Groups (CCGs) are responsible for buying in NHS services for patients in England and may commission services from ‘any qualified provider’ - including private companies. This means that private firms providing services for the NHS will often operate under the NHS logo, so it is difficult to know whether your treatment is being provided by a for-profit company.
The Health and Social Care Act also removed the Secretary of State’s legal obligation to provide comprehensive healthcare for everyone - meaning that decisions about what services a particular hospital will offer or be able to charge for are made by local commissioning groups. These groups can withdraw or charge patients for particular NHS services, which could mean the end of free services for all.
Private Finance Initiative loans have been used to fund hospitals, which means a transfer of money from the NHS into private hands. This unaffordable policy led to a reduction of 73,000 beds (almost a third) between 1992-3 and 2009-10. Find out more about PFI at The People vs PFI.
Cuts to funding also threaten the NHS, and can make it easier for it to be privatised. Under the current chief executive, Simon Stevens, £22 billion of imposed cuts – alongside the £20 billion instigated by his predecessor David Nicholson - have damaged the quality of NHS services. The NHS is already facing recording waiting times - in January, the number of patients waiting at least 4 hours on a trolley to be admitted reached 51,545 compared to 13,162 in 2011. Cuts such as these, which undermine the credibility of a publicly owned NHS, can be used to support the case for privatisation.
Why is privatisation failing?
Countries with higher proportions of private healthcare providers tend to spend more on healthcare. The costs of regulating and administering the ‘market’ created are huge. Conservative estimates made by the Centre for Health and Public Interest put the annual cost of the internal market at £4.5 billion, with NHS campaigners putting the figure as high as £10 billion - money that could be directed towards frontline patient care. Administration costs have risen from 5% of the NHS budget in 1979 to over 14% in 2010.
Whilst the UK spent around 8.9% of GDP on healthcare in 2012, the US, with its insurance-based system, spent 16.2%, based on OECD research. In a 2014 survey, 65% of CCG leaders said that they had incurred extra costs related to commissioning NHS services.
A comparative study of the healthcare systems of the world's richest 15 countries has shown that where there is competition, privatisation or marketisation in a health system, health equity worsens. There is some evidence that it increases hospitalisation rates and mortality.
Introducing competitive markets in healthcare does not improve quality or efficiency. Evidence shows that contracting out NHS services - cleaning, facilities management, GP 'out of hours' services, treatment centres, clinical services, shared services and IT - has often damaged the quality of patient care.
Privatisation can also reduce accountability. Serco was forced to pull out of a contract to provide out-of-hours GP services in Cornwall after it emerged that the company had been falsifying data and operating a ‘bullying culture and management style which inhibited whistleblowers from being open in the patients’ interest’.
Examples of privatisation going wrong
- Hinchingbrooke, the first privately run NHS hospital, was sold to for-profit firm Circle in 2010 on a 10-year contract worth £1 billion. Despite this, Circle withdrew in 2015 claiming the deal was "no longer [financially] viable under current terms". Savings projected in Circle’s initial bid were unachievable - the deficit for the first nine months of 2014 to 2015 alone came to £7.5 million, well above the level it was contractually committed to cover. As a result, the public will have to pick up the rest of the bill. Hospital services had also been criticised for inadequate hygiene standards and patient neglect by the Care Quality Commission.
This April, a £63.5 million 4 year contract was awarded to the for-profit firm Coperforma, replacing the NHS’s South East Coast ambulance service as the provider of non-emergency patient transport services. After hundreds of patients - including people with cancer and kidney failure - have repeatedly missed important appointments for treatment, the NHS has launched an investigation into the service.
Why a public NHS is best
A report produced by the Commonwealth Fund described the NHS as the best healthcare system in the world, scoring highest on quality, access and efficiency. It is also the second-cheapest of the healthcare systems analysed. Not suprisingly, the private US system ranked last on indicators of efficiency, equity, and cost.
NHS Scotland has opted to reject the competition and markets that have been introduced in England, embracing cooperation. Satisfaction with the NHS there has increased by 20% since 2005, whereas for the UK as a whole, satisfaction has fallen 10% from its 2010 peak.
What can you do to stand up for your NHS?
- Find out more about the NHS Reinstatement Bill campaign.
- Join the campaigns: Keep Our NHS Public and 38 degrees.
- Support Doctors for the NHS.
- Find out which NHS services have been sold off in your area.
- Read about how campaigners in Gloucestershire stopped privatisation of their community hospitals and health services.
- Download the essential campaign guide from False Economy: 10 tips to save the NHS from privatisation, or download this guide from Unison on how NHS workers can resist privatisation.
Photo used under Creative Commons licensing, thanks to Salim Fadhley https://www.flickr.com/photos/salimfadhley/
Tue 12 Jul 2016. Source: www.theguardian.comJeremy Hunt eyes part-privatisation of NHS staffing bank
Thu 09 Jun 2016. Source: www.ft.com
Tue 24 May 2016. Source: www.theguardian.com
Thu 12 May 2016. Source: www.hsj.co.uk
Tue 12 Apr 2016. Source: www.theguardian.com