Boris Johnson’s government denies any attempt to privatise the NHS - but the Health and Care bill carries risks (Photos: Getty)
The government and its supporters deny that there has been or ever will be any privatisation of the NHS. In their response to the NHS petition, they said: “The government has been steadfast in its commitment to the guiding principles of the NHS which mean the NHS is not and never will be for sale to the private sector.”
That sounds quite definitive, so it is worth asking whether or not it is actually true. In fact there are at least four distinct ways of privatising the NHS, only one of which has not happened: the squeeze-out; the throw-out; the contract-out; and the big sell-off.
Squeezing out is when the capacity of the NHS is reduced to well below demand. This can easily be achieved by sustained underfunding. The result is that the NHS develops a large backlog of cases which it simply does not have the capacity to process more quickly.
At the moment, the UK has record waiting lists of over 5.5 million people. And for many of these people, while their conditions may not be life-threatening, they can be extremely painful and life-constraining.
An example is a hip replacement, where last year, for the first time, more replacements were carried out privately than within the NHS. The price of a hip or knee replacement ranges between £8,000 and £15,000 depending on the provider and location. Those patients wealthy enough to afford to go private were squeezed out into using private sector provision.
More directly, the government can simply remove certain treatments from NHS coverage.
When the NHS was founded and until 1989, opticians’ services were covered for everyone. Now most people pay for their own glasses and contact lenses.
As well as optical care, this has already happened with prescriptions, over-the-counter medicines and certain minor surgical procedures. Most of us have been thrown out to the private sector.
Even when we can still get a service free from the NHS, the service may be provided privately. Many ambulance services are now private, the blood transfusion service, even dialling 111 will connect you to a private sector employee.
From the point of view of patients, this may be less serious than a squeeze-out or a throw-out, but it could result in one of these if the provider finds the service insufficiently profitable. And from the point of view of taxpayers, it could easily be far more expensive as we have seen with the recent PPE and Test and Trace scandals.
It would be possible to have everything the NHS does delivered by the private sector but still claim (as the government does) that “the NHS is not and never will be for sale to the private sector.”
The NHS would be reduced to a brand, sitting on top of a network of private sector providers.
The Big Sell-Off
The extreme case of the big sell-off would be for the government to turn the NHS into a limited company and then auction it in a single large transaction. This has not happened and is unlikely to happen. Presumably, it is the big sell-off that the government is referring to when it makes its claim.
Even with sell-offs, however, there have been sales of GP practices to US healthcare corporations, so sell-off by parts is clearly on the agenda.
When Centene bought AT medics, around 500,000 people found that their local GP services were about to be delivered by a private US Healthcare corporation.
GPs have never been employees of the NHS: traditionally, GP practices are run either by a single GP or a number of GP Practice Partners. Most GPs have taken the Hippocratic oath and their priorities are guided by that.
Directors of a US or UK corporation, by contrast, have a fiduciary duty to their shareholders. So the sale of GP practices is more than just a change of ownership, it is a change of focus, from patient-focussed to shareholder-focussed.
A sell-off by parts would not be without consequences for UK patients and taxpayers.
Some people do not deny the examples above but claim that, overall, the NHS is not being privatised by any of these means. The facts say otherwise.
It remains true that the majority both of funding and delivery is by the state, but the direction of travel is clear.
The new Health and Care Bill will make it easier to transform the NHS into something much more like the US healthcare system – which is responsible for two thirds of American personal bankruptcies – while the government will continue to claim that the NHS is not and never will be for sale.
Mark E Thomas is the founder of 99% and author of 99%: Mass Impoverishment and How We Can End It. He has spent most of his career in business; for many years he ran the Strategy practice at PA Consulting Group. He is a Visiting Professor at IE Business School and has a degree in Mathematics from Cambridge University.
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