Who’s the extremist? The coalition’s healthcare plans are modest and moderate

A foreign visitor recently asked me what I thought about the government’s plans to ‘privatise the NHS’. Somewhat irritated, I assured him that no such plans existed, nor anything remotely similar. But my visitor insisted they did: on the way from the airport, he had read about it in a newspaper.

It is difficult to explain this peculiar political ritual to somebody who has not lived here for a long time. Whenever an organisational reform of the NHS is being proposed, especially if it is a rather complex one, then it is only a matter of time before somebody claims swathes of the NHS are being ‘put up for sale’, if not immediately then at least as a long-term aim. Others then repeat the claim, fortifying it with some scare story of Scrooge McDuck taking over your local hospital to squeeze profits out of it. From then on, the debate might as well be replaced by an automatic buzzword generator fed with soundbites like ‘turning healthcare into a commodity’, ‘marketisation of our health’ and ‘sacrificing NHS principles on the altar of free market ideology’.

This article is not about whether market-based healthcare would be desirable or not, because this is not what the coalition’s plans are about either. The change is merely that the commissioning of specialist and in-patient healthcare services will be performed by GP-led consortia instead of Primary Care Trusts (PCTs). These consortia could conceivably purchase services from private providers, and there is also a possibility of private providers taking over failing NHS hospitals. At least that was the idea. The bill is presently being revised (i.e. watered down), and the mentioned elements could well be the first ones to go.

But let’s suppose the bill would lead to a considerable extension of private healthcare provision. Would this mean the Americanisation of British healthcare?

No. It would merely make Britain a bit more similar to its European neighbours, as far as healthcare provision is concerned. Some combination of private and public provision is the standard practice throughout most of Europe. The table below shows that in the hospital sector, private providers account for about a third or more of the total. Unfortunately, there is no recent figure for Britain, the latest ones being from the early 1990s. However, these figures show that private hospital care was almost non-existent then, and there is no reason to believe that the figure has skyrocketed in the meantime.


Private in-patient

hospital beds as

% of all beds











(Source: World Health Organizationdatabase)

Of course, the fact that most others are approaching healthcare this way does not make it right. Maybe the rest of Europe has got it wrong; maybe they should learn from Britain and not vice versa. But one cannot reasonably portray the coalition’s plans as ‘extremist’. From a European perspective, the British model of healthcare provision is an atypical one. So the extremists are the defenders of the status quo.

Dr Kristian Niemietz is the IEA's Head of Political Economy. Kristian studied Economics at the Humboldt Universität zu Berlin and the Universidad de Salamanca, graduating in 2007 as Diplom-Volkswirt (≈MSc in Economics). During his studies, he interned at the Central Bank of Bolivia (2004), the National Statistics Office of Paraguay (2005), and at the IEA (2006). He also studied Political Economy at King's College London, graduating in 2013 with a PhD. Kristian previously worked as a Research Fellow at the Berlin-based Institute for Free Enterprise (IUF), and taught Economics at King's College London. He is the author of the books "Socialism: The Failed Idea That Never Dies" (2019), "Universal Healthcare Without The NHS" (2016), "Redefining The Poverty Debate" (2012) and "A New Understanding of Poverty" (2011).