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Privatisation of the NHS: what does the future hold?

As the number of NHS patients waiting for tests, surgery and routine treatment in England hits a record high of 5.5 million could this lead to a  ‘corporate takeover’ of the NHS?

When the government announced plans to reform health and social care in July of this year, it raised concerns from some commentators that the new legislation would be a means of ‘dismantling’ the NHS and opening the door to more private providers.

Privatisation of the NHS has been a thorny debate for decades and the pandemic prompted fears that the Government’s Covid-19 response would accelerate the use of private outsourcing throughout the health system.

Last year, the British Medical Association wrote: “Rather than finding a moment of clarity in this crisis to reinvest in a publicly provided health service and build for a better future, the government has doubled down on its failures, choosing to throw huge amounts of money at scores of private firms.”

Now, new research this week has revealed that one in five patients has paid for private health treatment because they couldn’t get the treatment they needed from the NHS.

The survey of 4,000 people from the charity Engage Britain also found that 25% of those surveyed said waiting times had harmed their mental health and 28% felt they had to fight for treatment.

As the number of NHS patients waiting for tests, surgery and routine treatment in England hits a record high of 5.5 million, could this lead to a ‘corporate takeover’ of the NHS?

What is privatisation of the NHS?

The World Health Organization defines privatisation as “non-government bodies become increasingly involved in the financing or provision of health care services.”

Since the Health and Social Care Act of 2012 (HSC Act), Clinical Commissioning Groups have been required to put health services out to competitive tender, allowing the NHS to become increasingly open to the involvement of private sector providers.

A report from the Guardian found that more than £96 billion of health service funding has gone to non-NHS providers of care over the past decade, including private firms such as Virgin Care.

Yet the King’s Fund says it is too difficult to determine how much the NHS spends each year on the private sector. This is because central bodies do not hold detailed information on individual contracts with service providers, especially where these contracts may cover small amounts of activity and spending. Information on private sector spending is available from the annual accounts of the Department of Health and Social Care but also requires judgement and interpretation.

But it added that if spending on primary care services ‐ including GPs, pharmacy, optical and dental services ‐ is included, some have estimated that approximately 25% of NHS spending goes on the private sector.

It concluded that “overall, there is no evidence of a significant increase in spending on private providers or widespread privatisation of services in recent years.”

Will the Health and Social Care Bill accelerate privatisation?

In a recent blog post, the Nuffield Trust said there was nothing in the Bill that would change the NHS from being a publicly funded service, free at the point of use except for existing charges for services like dentistry.

Authors Mark Dayan and Helen Buckingham, said that for the past six years, private provision has remained at a stable level. Many of the changes in the NHS over this period were accused of increasing privatisation at the time, but this did not happen.

They added that the Bill would completely change the procurement rules used in the NHS that govern how the health service locally buys care for people. The new rules would allow contracts to be rolled over where the existing provider is doing a good job and allow the local NHS to decide whether it wants to use competition as long as it acts transparently in the interests of patients.

“This change seems unlikely to sharply increase private provision,’ they said. “An increase in private provision would require lots of contracts to be taken away from existing NHS providers and given to someone else, but this is probably less likely under the new system.”

The King’s Fund confirmed that although the Bill proposes to reduce the role of competition and increase the flexibility around procurement rules, this does not necessarily have particular implications for the involvement of the private sector in delivering clinical care in the NHS.

A more important point highlighted by both think tanks was that the Bill would give the Secretary of State sweeping powers both to intervene earlier in decisions about changes to local services and to direct NHS England.

This creates scope for greater political interference in the day-to-day decision-making of the NHS and also a health service where decisions are taken to suit party politics rather than patients.

Will patients wait for treatment?

A recent report from Policy Exchange found that out of the current waiting list, more than 4.2 million (80%) are awaiting a decision on treatment.

The report, A Wait on Your Mind? warns that 90,000 cases of cancer are usually detected in patients on non-cancer pathways, meaning that there are likely to be hundreds of undiagnosed cancer patients sitting on a routine referral within each NHS hospital in England.

Robert Ede, Head of Health and Social Care Policy and the lead author of the report, warned that millions are being “left in limbo”, with no idea how long it will be until they are treated.

“Operational transparency must improve,” he added. “Current clinical prioritisation and waiting times are hidden from patients. Few are informed about their likely wait time, how this compares to their rights as set out in the NHS constitution, or how new prioritisation methodologies is being applied to their case.

“The ‘consumer’ of the service is being left in limbo, with limited support whilst they wait. There is evidence that the existing approach is also cementing health inequalities.”

With millions of people waiting for treatment on the NHS, the number of people considering paying for healthcare has gone up 20-25%, according to David Hare, the chief executive of the Independent Healthcare Providers Network.

Engage Britain said that one woman who they surveyed said her health need became so great she re-mortgaged her home to pay for treatment.

Director Julian McCrae added: “The NHS unites so many of us with a feeling of pride. But the fact is millions are also being let down every day by our health and care services. It’s vital that future changes address the daily challenges that so many in Britain are facing. Only answers rooted in real experiences can deliver health and care that works for us all.”

Will the new Health and Social Care Levy help reduce the backlog?

A new Health and Social Care Levy was announced last week by the government, which is a new UK-wide tax being introduced to help pay for the NHS and social care in England.

It is expected to bring an investment of £36 billion in the health and care system over the next three years.

The majority of money raised over the next three years will go to the NHS to help it recover from the pandemic and the care backlog that has built up with more funding promised to social care after that.

The government calls it the biggest catch-up programme in the NHS’s history. It says the new funding could deliver the equivalent of around nine million more checks, scans and procedures.

NHS England’s national medical director Professor Stephen Powis said: “NHS staff have worked tirelessly over the pandemic, caring for 450,000 patients with the virus in hospital, which has inevitably had a knock-on effect on less urgent care and created a backlog, but staff are also now pulling out all the stops to recover services and help more people as they come forward for care.

“During June and July, the NHS delivered millions more tests, checks, treatments and operations than we did last summer, while the health service is also currently treating more than ten times the number of patients with Covid in hospital compared to this time last year.”

Yet Richard Murray, Chief Executive of The King’s Fund, said although the three-year funding settlement represents very significant investment in the NHS, it is important to be realistic about how quickly the service can clear the waiting list.

He added: “While we have yet to see the finer detail of the settlement, putting this funding to best use will critically depend on developing a plan to address chronic workforce shortages. Public expectations will rise with their taxes and the government must be honest about how long it will take to recruit and train enough staff to provide the tangible improvements to NHS care the public will expect.”

Only time will tell if those that can afford it will continue choosing to pay for their own care and the impact this will have on waiting lists and any future health inequality.

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