Plurality in healthcare provision is integral to patient choice
It is difficult to explain this peculiar ritual to somebody who does not live here, but conspiracy theories about ‘secret plans’ to privatise the NHS are part of the cult around the health service. The Americans have their Area 51, we have NHS Privatisation Paranoia. It is hard to tell when this started, but it must have been a while ago. Take this quote:
‘Labour’s summary of the ideas […] says they “clear the way for a massive shift of resources from the NHS to private companies”. […] [P]rivate companies (Labour says) are to be enabled to asset-strip the NHS. The NHS must pay full price to the private sector, which will be allowed to pillage NHS resources.’
It could easily be from any of today’s newspaper, but it is in fact from 1983. The NHS has been ‘privatised’ so many times that one wonders how it can still be around.
To be fair, it is true that nowadays, the dividing line between the NHS and private healthcare is less like the Berlin Wall, and more like the US-Mexican border: still fiercely guarded but not impermeable. Primary Care Trusts (PCTs) now spend about 8 per cent of their secondary care budget on healthcare services delivered by independent sector providers, up from just 4 per cent in the mid-2000s. Add in other voluntary and local authority providers, and non-NHS actors account for a ‘market’ share of 12 per cent. This is still a very low proportion compared to European social insurance systems: in France, a country one can suspect of many things but not of rampant market fundamentalism, the private sector accounts for a third of all hospital beds. However, given where the British system is coming from, it is quite a change, which could yet go further. As it should. The NHS has benefited from a dose of competition, so why not increase the dose?
It is important to note that nobody is ‘forcing’ for-profit healthcare on an unwilling public. Private sector providers can only gain a foothold if patients voluntarily choose them over NHS providers, or if PCTs choose them when awarding contracts. The only way to purge the NHS of private sector presence would be to abolish patient choice, and to undermine the autonomy of local commissioners. The NHS would once again have to become the top-down service of old. That sounds a lot less appealing than ‘saving our NHS’, but those are the options we are facing.
This article was originally published by The House Magazine.
 The Times: ‘Partnership with private sector would help NHS, circular claims’, 1 June 1983.