NHS privatisation fears? Grow up

Published in The Guardian (December 21, 2012)

Nearly one in five patients having hip replacements and hernia repairs are handled by private companies, thanks to reforms introduced by the last Labour government. Every week, 60 patients have gall bladders removed by private operators. Silently and stealthily, hundreds of profit-driven health providers have made incursions into our sacred National Health Service in the past decade.

The genie is well and truly out of the bottle. Yet anyone looking for a pantomime villain only has to mention “privatisation of the NHS” to get an audience booing and hissing. Labour politicians, whose party unleashed this revolution, curse competition for cheap applause. Medical union leaders, their members earning good incomes as private contractors, proclaim the end of their world. Now the Guardian joins the chorus of disapproval, running a hostile series on private providers.

For those who care only about ensuring the NHS survives and thrives, such blinkered conservatism is highly depressing. It panders to the nostalgic worship of a monolithic institution that never existed except in the mind of its devotees – in which doctors are all saints, and profits the dirty work of the devil.

The reality is rather more complex, which is why this view is so damaging at such a critical time for our health service. The NHS is slowly starting to turn from the centralised institution founded by Aneurin Bevan, designed to fight infant mortality and infectious diseases in big hospitals, to a community-orientated one that can cope with complex conditions thrown up by an ageing society and rising levels of disability.

At the same time astonishing scientific advances are increasing not only life expectancy but also the costs of healthcare. Budgets remain static in real terms, but health inflation and rising demand means we are staring over a financial abyss. Britain simply cannot afford to continue this ridiculous and outdated debate over the role of private medicine. The only thing that matters is what works in the most efficient and effective manner to ensure the best possible care that is free at point of delivery.

So deep is this bizarre prejudice against profits in the health world that one Downing Street study found taxpayers would prefer to pay nearly 50% more for services provided by the state than for identical services offered by private outfits. Yet most GPs have always been private contractors and increasingly, given a choice, patients are choosing private centres for treatment.

This stance seems strange when viewed from abroad. Forget the smokescreen of the US, since no one is demanding we import their system. Look instead at Germany, with more profit-driven hospitals than publicly run ones. Or Spain, where private firms provide huge chunks of healthcare in some regions. Even in Sweden, for so long the left’s nirvana, market-led reforms have transformed health services.

Competition works in health, just as it works elsewhere. This is why the introduction of personal budgets is so potentially transformative for long-term patients, especially those with complex needs. One study found hospitals in areas with more choice had lower death levels. Another last year found it was associated with faster falls in 30-day mortality rates after heart attacks. A third found higher quality of care when GP surgeries were closer together.

Of course some private provision is poor, substandard and sometimes cruel; think only of those people with learning difficulties bullied so badly at the Winterbourne View care home. So are some state services, as Labour MP Ann Clwyd discovered with the dreadful lack of compassion shown to her dying husband. Remember the biggest health scandal in recent years occurred in two NHS hospitals in mid-Staffordshire, where hundreds of elderly patients died in the most hideous circumstances.

Britain needs to grow up when it comes to the NHS. We must raise standards, ensuring elderly and disabled patients are not repeatedly failed as they are at present, at a time of rigid austerity. The key issues are ones of management, regulation and harnessing of technology, not who provides the consequent care and treatment. The truth is that those protesting so loudly over “privatisation” are harming the institution they seek to protect.

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