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Britain is privatising the Natioanl Health Services
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Britain
is privatising the Natioanl Health Services
NHS privatisation: Why the fuss?
Nick Triggle Health correspondent
20 February 2015
http://www.bbc.com/news/health-31435842
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The words
privatisation and NHS together are enough to start a fight in an empty room.
But what exactly do we mean by it? And why does the issue make many so angry?
London's
Cromwell Hospital, run by Bupa, does a good trade in NHS patients at its gamma
knife radiosurgery centre. About a third of the patients with brain tumours
seen there are sent by the NHS, costing the health service nearly £7,300 a go.
But even the
most ardent critics of privatisation in England (it tends to be a debate which
is focused there) accept this.
Why? Because
the NHS only has a handful of such units as it hasn't been considered
economically viable to open more. So when demand requires the NHS pays for them
to be seen privately.
Dr Louise
Irvine, of the National Health Action Party, which was set up 2012 to campaign
against privatisation, says: "It's is a good example of how the private
sector can help. It's not financially worth it for the NHS to have lots of
these facilities so paying for them is the best way.'
Emotions
So what is it
that stirs the emotions then? It can be summed up in three words: profit,
fragmentation and destabilisation.
Every year
thousands of NHS patients are treated by the private sector for routine
treatments, such as knee and hip operations. This is not because NHS hospitals
cannot treat the patients, but because both the last Labour government and the
coalition have encouraged private firms to get involved as a way to reduce
waiting times and to offer patients choice.
Private firms
have also been invited in to run whole services or entire centres - as in the
case of Cambridgeshire's Hinchingbrooke Hospital until Circle
pulled out recently.
Dr Irvine says:
"The problem is that private companies cherry-pick what they want to do.
They naturally do the easy stuff, leaving the NHS with the more complicated
elements that are more expensive. That can cause real problems."
The
privatisation debate in numbers
§
§
Last year the NHS in England spent £6.5bn on getting the private
sector to see and treat patients.
§
That is the equivalent of 6.1% of the NHS budget.
§
Critics argue the bureaucracy to run a market system can add
billions more to that bill.
§
As a proportion of the NHS budget that is up from 2.8% in
2006-7.
§
Another £3bn was spent last year on getting other providers,
including local authorities and charities, to deliver NHS care.
§
Another £7.5bn was spent on GP services.
§
The average earnings of GP partners is £102,000 - a figure that
has been falling in real terms in recent years.
§
The average pay for GPs who are employed by partners is £56,400.
She cites
another Bupa contract - one to run musculoskeletal services in Sussex which
was cancelled amid
concerns about its effect on the local hospital's finances - as an
example of this.
Charities
But, by that
token, you could argue that the charities that run hospice, drug and alcohol
treatment or cancer services could fall into that category. After all, they
tend to be run by the profit-making arms of their organisations, but have a
long history of working side-by-side NHS providers.
Dr Irvine
accepts the point, saying with some services changing hands all the time this
too can lead to destabilisation and fragmentation of care. But she also says
some services, such as the hospice sector, have played an invaluable role in
helping the NHS improve care.
And what about
GPs? They have what is effectively self-employed status. Partners who own the
practices take profit from the business once overheads and the salaries of
staff, including more junior GPs on the payroll, are deducted.
These GP
businesses can be pretty big. Once of the most successful in recent years has
been the Hurley Group in London. It runs 13 GP practices and employs more than
200 staff. One of the partners is Dr Clare Gerada, a former president of the
Royal College of GPs and an outspoken critic of this government's approach to
the NHS.
She is adamant GPs
are not private though. "We are essentially the state, but with different
contractual arrangements. The state decides where I can open, what I can do. In
practice a GP is virtually completely reliant on the NHS for income."
She says when
considering privatisation of the NHS, it is important to look at the wider
context.
"What
makes the NHS unique is not that it is free at the point of need - many other
health systems are - but that it is planned on the basis of need.
"We have
to have unprofitable services as well as those that can make people money. Once
you get other providers involved it is about who can shout the loudest for
their service. Once that planning goes and the risk is other areas of
healthcare lose out."
But even if you
accept that GPs are in the NHS, what about dentists, opticians and pharmacists?
All are partly paid for by the NHS and partly by individual user contributions
- and as a result are delivered by individuals and organisations that sit
outside the traditional health service family.
"It is
really quite a difficult one to define - and the arguments don't always run
along a consistent line," says Richard Murray, director of policy at the
King's Fund. "For some it is about profit, for others it's about what
control the state has. You can go on and on."
How much is the
government really privatising the NHS?
The pros and cons of privatising the NHS
Feb 9, 2017
'Winter of
discontent' raises questions about sustainability of health service
The NHS's
winter of discontent shows no signs of abating, with new figures revealing that
January's A&E waiting times were the worst since current targets were
introduced in 2004.
More than
60,000 people waited between four and 12 hours in A&E departments for a
bed, while 780 were made to wait more than 12 hours, according to statistics
compiled by the healthcare regulator NHS Improvement and leaked to the BBC.
SEE RELATED
‘No party is
telling the truth about crisis facing NHS’
The NHS aims to
see and deal with 95 per cent of A&E patients within four hours, but in
January it fell short of that target, with only 82 per cent of patients
admitted or discharged in under four hours.
The Department
of Health dismissed the leaked figures as "unverified".
"It is irresponsible
to publish unverified data and does a disservice to all NHS staff working
tirelessly to provide care around the clock," a spokesman said.
However, Health
Secretary Jeremy Hunt "recently suggested the four-hour target may have to
be scrapped and could potentially be replaced by another measure", the BBC
reports.
Public
confidence in the NHS appears to be taking a knock amid recent reports that the
service has reached "breaking point". A poll conducted for Sky News indicates that 64 per cent of people think the NHS is
getting worse, and most of those – 57 per cent – believe the situation will
continue to deteriorate.
More than two-thirds
of those surveyed said that they would support increasing income tax by one per
cent if the money was used to support the cash-strapped health service.
Meanwhile, the
prospect of privatising aspects of the health services continues to be
controversial. News that an NHS practice in Bournemouth is offering patients
the chance to pay to "jump the queue" has sparked fears that opening
the door to a "two-tier system" could make NHS patients
"second-class citizens", says The Guardian.
It may be a
politically touchy topic, but would privatisation of the NHS offer any
benefits? Here are some of the pros and cons:
CONS
Eroding NHS
principles:
Critics fear
that an increased use of private companies will erode the key foundations on
which the NHS was established in 1948, in particular the principle of free
health services at the point of delivery.
Fragmented
services:
Dozens of medical practitioners have warned that an increase in
privatisation could result in the fragmentation of health services to the
detriment of patients.
Less
transparency:
Accountability
suffers when private involvement increases, claims Unite. Commercial confidentiality makes it impossible to scrutinise
public spending, while negotiating complicated contracts creates another layer
of bureaucracy, says the union.
Postcode
lottery:
Critics fear
that with different organisations offering different services, people will receive
varying standards of care across the country. A Labour inquiry, led by MP Debbie Abrahams, found that
"where there is competition, privatisation or marketisation in a health
system, health equity worsens".
Prioritising
profit:
Private
companies, run for shareholders, will inevitably put profit margins before
patients, say critics. They claim this bias is a recipe for overcharging, over-treatment
and corner-cutting on safety, with private companies "cherry picking"
the most profitable treatments. Abrahams' inquiry said there was also
"some evidence" that privatisation impedes quality, including
increasing hospitalisation rates and mortality.
PROS
Protecting free
services:
One argument
behind the increase in competition is that it gives clinical commissioning
groups the opportunity to find better-value contracts – which will actually
protect the key principle of free services at the point of delivery. Ministers
behind the 2012 Act said competition would only be used if it is in the best
interests of patients, and private companies would not be given any advantages.
Quality not
dependent on profit:
An analysis by
independent health charity The King's Fund concluded that for-profit, non-profit
and NHS providers can provide high-quality care, and equally all sectors can
fail to do so. "Whether a provider (public or private) makes a
surplus/profit from its trading with the NHS does not automatically mean that
quality of care is compromised," it said.
NHS needs help:
Partial
privatisation is seen by some as a pragmatic alternative to improve the NHS.
With the population increasing and people living longer, public spending on
healthcare is likely to come under even more strain in the future.
Better patient
choice:
Thomas Cawston,
research director for Reform, claims
competition puts patients at the heart of the NHS by giving them more choice.
Patients will not know how much a service costs when they choose it as they
will not be paying for it, so their decision will be based on quality not
price, encouraging all services to offer the best care.
NHS already
fragmented:
The NHS has
always been made up of hundreds of thousands of different organisations and
individuals, many of them from the independent sector, say the Conservatives. The party says the Health and Social Care
Act actually creates a new duty to promote integration. Others point out that
private sector operators are widely used in social care, pharmacy, dentistry
and optical care.
How does the UK
compare worldwide?
Britain's
healthcare system often comes under fire, but last year it was named the best
in the world. In a study of 11 high-income nations carried
out by the Commonwealth Fund, a private American foundation, the NHS was deemed
the second cheapest and the best performing overall. It ranked first for
access, safety, coordinated care, patient-centred care and efficiency –
although it came in third for timeliness of care, beaten by Switzerland and the
Netherlands. It also ranked among the lowest for "healthy lives",
which took into account life expectancy, infant mortality and deaths that might
have been prevented by medical care.
At the other
end of the scale, the United States, where healthcare facilities are largely
operated by private sector businesses, was deemed the most expensive and was
ranked last in the study. Around 37 per cent of people in the US said they
would avoid seeking medical help because of cost, while patients in the UK and
Sweden, which also has a tax-payer funded system, were the least likely to
report having these cost-related access concerns. Just four per cent of people
in the UK said they were put off seeking medical care because of cost.
How much is the
government really privatising the NHS?
Figures show privatisation to be less of the explosion that Owen
Smith warns about and more a gradual, inexorable rise in the outsourcing of
services
Denis Campbell Health
policy editor
Monday 15 August 2016 13.46 BST
Figures show that the amount of Department of Health
funding that has gone to ‘independent sector providers’ has increased from
£4.1bn in 2009-10 to £8.7bn in 2015-16. Photograph: Anthony Devlin/PA
The myriad different bodies that make up the NHS in England and their opaqueness,
especially in terms of contracts to provide services, makes mapping the true
extent of the privatisation of public healthcare difficult.
The available evidence bears out Owen Smith’s
claim that NHS privatisation is increasing, but it is less of the “explosion” that the
Labour leadership hopeful warns about and more of a gradual but inexorable,
rise in the proportion of the NHS budget going to firms such as Virgin Care,
Care UK and Bupa. It is also noteworthy that the private sector has been making
ever bigger inroads into several key areas of NHS care, notably general
practice, community services and mental health care.
Department of Health (DH) figures show that the amount of its
funding that has gone to “independent sector providers” more than doubled from
£4.1bn in 2009-10, Labour’s last year in power, to £8.7bn in 2015-16.
Slow-release privatisation has also seen the percentage of the
DH budget finding its way into private hands rising from 4% in 2009-10 to 8% in
the last financial year.
A few privatisation contracts involve huge sums. Several GP-led
NHS clinical commissioning groups (CCGs) in Staffordshire caused controversy in
2014-15 when they sought to hand 10-year contracts for cancer and end-of-life
care worth £1.2bn to a private provider, though those plans have been held up
after NHS England became involved. Most contracts are smaller, sometimes for a
few million pounds.
In January,however, Richard Branson’s Virgin Care group – which
has won a growing number of NHS contracts – was awarded a £126m contract to
provide a range of health services at hospitals in north Kent, including home
visits and community hospital care. It is unclear what the impact of that
tendering decision will be on the failed NHS bidder, Kent Community Health NHS
Foundation Trust, which has lost a key source of income.
Similarly, there are serious concerns about the effect on
Southport and Ormskirk NHS Trust now that West Lancashire CCG has opted to
outsource a range of urgent care services, such as GP out-of-hours services and
walk-in centres. Having rejected its local acute trust’s bid, the CCG remains
in talks with United Healthcare and Virgin Care about the contract.
“This group of people [the CCG] are taking decisions which are
destabilising the future of our local hospital and could lead to NHS services
being privatised,” the local Labour MP Rosie Cooper said recently. Local
residents were disgusted, she added. In its response, the CCG said: “This
re-procurement of local community health services is standard practice for
CCGs. This process is subject to national procurement legislation which
requires the CCGs to enable both NGS and independent [private] providers to
compete.”
Will this creeping privatisation continue? Almost certainly. The
NHS’s financial squeeze, coupled with private firms’ ability to undercut NHS
providers, plus the obligation imposed on CCGs by the coalition’s shakeup of
the NHS in 2012, together mean that more and more CCGs are likely to feel
obliged to outsource more and more contracts, despite concerns about the
quality of service that may ensue.
Concern about the quality of NHS-funded inpatient care for
mental health problems in Priory hospitals is merely the latest reminder that
private providers do not always meet the highest standards.
Concern about NHS privatisation has grown since the
Conservatives won last year’s general election. Some in the healthcare
profession, such as Dr Kailash Chand, who until recently was the vice-chair of the
British Medical Association, see growing outsourcing as part of an
unacknowledged Tory plan to deliberately run down the NHS and pave the way for
the replacement of its unique funding model with a new setup in which private
health insurers and private medical care are central.
Last month the then health minister George Freeman called for an
end to the “apartheid” between the NHS and private sector. “In my party, we
have to end the apartheid that suggests the private sector does all the
innovation and entrepreneurship and the public sector just treats people … The
NHS is the great engine of innovation that can drive that partnership,” he said
in a speech to the Reform thinktank. There also needed to be “a debate about
how we fund health and care in the 21st century”, he added.
Freeman has since acquired a position of much greater
significance under Theresa May, as chair of her policy board.
• This article was amended on 16 August 2016 to clarify
details of the contract won by Richard Branson’s Virgin Care group to provide
health services in north Kent; it did not include walk-in centres.
