This week, Andy Burnham called for a halt to NHS privatisation until after the election. (http://www.independent.co.uk/news/uk/politics/stop-nhs-privatisation-until-after-the-election-says-shadow-health-secretary-andy-burnham-9633982.html). This led to the usual 2-pronged retort from critics of the NHS:
1. Privatisation isn't happening.
2. So what if it is? As long as treatment is free and effective, who cares who provides it?
Both responses are wrong. Here's why:
PRIVATISATION IS HAPPENING
- The World Health Organisation's definition of 'privatisation' is: “A process in which non-governmental actors become increasingly involved in the financing and/or provision of healthcare services”. This is undoubtedly happening.
- The Government admits that £6 billion of NHS money is already being paid out to private companies to run NHS service, up by 1.3% since 2010. The Department of Health's annual accounts for 2013-14 showed that £10bn-worth of NHS business went to private and other providers, including Virgin Care and Care UK. That’s still only a small amount of NHS spending, but it's rising by about £1bn every year. ( http://t.co/TW0QUNtmVm)
- The NHS Support Federation says £13bn of NHS contracts are out to tender ( http://www.nhsforsale.info/privatisation-list/contract-alert/contract-alert-report-april-april.html) and this includes: a) the biggest privatisation deal in NHS history involving patient care - a £1.2bn deal to sell off cancer care in Staffordshire.The Staffordshire deal is significant not only because it is so huge but also because it's about providing services for a whole area rather than a particular service. b) a £800m five-year contract out to tender for elderly care in Cambridge. c) The largest contract notice, worth up to £5 billion, being advertised by NHS England for the provision of commissioning support services, which could allow private firms a further share of the administration and purchasing market in the NHS.
- According to research by Bain Consultancy for the FT, £5.8bn of NHS work is currently being advertised to the private sector and the number of live tenders – advertised contracts not yet awarded – is up 14 per cent on the same period last year when deals with a value of £5.1bn were advertised. (http://www.ft.com/cms/s/0/
acbd7be4-165c-11e4-8210- 00144feabdc0.html?siteedition= uk#axzz38xAFMoLo)
- An experienced health commissioner wrote recently explaining why the full impact of the government's legislation has yet to be felt: "I can explain the workings of the clinical commissioning groups. We will begin to see radical changes to where the NHS budget is spent only once CCGs have rewritten the documentation for invitations to tender. The first wave of contracts will be let next April; then I expect the volume to increase in subsequent years. Therefore Oliver Letwin is perfectly correct, if he indeed said that the NHS will no longer exist in five years." (http://www.theguardian.com/
PRIVATISATION IS BAD FOR YOUR HEALTH
- It costs so much more to run a marketised system, necessary for privatisation, because of the administrative and legal costs involved in contracting health services. Money ends up in the pockets of lawyers and accountants and is taken away from frontline care. Admin costs in the NHS have risen from around 5% to 15% since the introduction of the market and are heading towards a US-style 3o% if we continue along the privatisation path.
- It reduces quality of care because private companies are looking solely to make money. When 60% of the costs of healthcare is on staff salaries, the only way to make money is to cut staff, and then the quality of care goes down. The privatised US health care system has been ranked the worst in the world by international experts.
- It leads to fragmentation – most of the gains in cancer, stroke and heart attack care in this country in the last decade or two have come from collaborative work; you can’t have collaboration if you’re all supposed to be competing with each other.
- Private companies cherry pick the easy and profitable areas of healthcare, leaving the NHS to deal with the expensive and complicated cases, but without the income to do so. The NHS currently subsidises a comprehensive range of costly services with the easier, more profitable treatments. As these are picked off by private providers, hospitals can find themselves in financial deficit and under threat of closure.
- If NHS hospitals are in financial difficulties they will either have to cut back staff and close services, and/or increase their private income by treating more private patients, taking advantage of the Health and Social Care Act which allows them to make half their income this way. They may even have to consider closing and/or merging with other Trusts. This actually reduces choices for local people as they lose local services, and a two-tier system is created, whereby those with health insurance can get access to NHS beds quicker than those without.
- Private companies can undercut the NHS to win a contract but when they realise it's not profitable, they ditch the contract, leaving the NHS to pick up the pieces. The NHS would never abandon its patients in this way.
- NHS staff may transfer from NHS hospitals to private hospitals (which don’t train their own staff). This will take vital expertise out of the NHS and create yet more pressure, especially in professional groups where there are already national shortages.
- Private contractors hide behind the NHS logo and also hide their organisation behind ‘commercial confidentiality’ which prevent patients getting the true picture. The chair of the House of Commons public accounts committee, Margaret Hodge, says that even she can’t break through their wall of secrecy.
- Privatisation means that public funds are used to pay for private sector provision of NHS services. This means taxpayers’ money is going directly into the profits of multi-national private companies and their shareholders. It is diverted away from direct patient care, and also diverted outside of our economy. Many of these companies are also registered in offshore tax havens.