The Guardian view on NHS privatisation: the £9.2bn question

The gap between what the government is saying about the NHS and what is actually happening is growing. When the health secretary, Matt Hancock, declared in January that there would be “no privatisation on my watch”, he was not announcing a change in policy but a continuation. Andrew Lansley’s 2012 reorganisation is recognised by Theresa May’s government as a failure, and ministers support NHS England’s goal of abolishing the compulsory tendering that it ushered in.

Whether a government led by Boris Johnson sticks by this policy remains to be seen. But even it does, the willingness to rein in profit-seeking companies by restricting competition is far from the whole story. Analysis of recent figures reveals a 14% rise in the amount of money going to profit-making companies over the past four years, up to a record £9.2bn in 2018-19 (a rise of more than £1bn from the £8.1bn spent on private healthcare in 2014-15). In some sectors the proportion of private spending is many times the overall average of 7.3%, with 44% of all spending on child and adolescent mental health going to private providers, and 30% of mental health budgets overall. In the controversial area of “locked ward rehabilitation”, where people are held as psychiatric inpatients, sometimes against their will and for years at a time, the private sector has held a share of the market as high as 97%.

These extraordinary figures should be far more widely known, and opponents of NHS privatisation are rightly angry. While the government insists that the overall share of NHS budgets being handed to private companies is steady, this is disingenuous when set against the outsize role they now play in some areas. There is no sense in which a £415m annual increase in the value of private contracts is consistent with Mr Hancock’s “no privatisation” promise.

Systematically starved of funds during a decade of austerity, NHS trusts have been forced to outsource. But even more concerning than this overall picture is the detail of where private companies have chosen to expand. Where their role in diagnostic testing and routine operations such as hip replacements was conceived as a way to reduce waiting times, the delivery of highly complex mental health services is a different matter. If it is generally undesirable to introduce a money-making motive into a health setting, as most people believe it is, it is nowhere less appropriate than in an environment where trust, professional judgments and staff-patient relationships underpin good outcomes.

Evidence that private providers are failing in their duty of care to vulnerable young people is mounting. In April, Priory Healthcare was fined £300,000 after pleading guilty to criminal charges related to the death of Amy El-Keria. Another of the company’s hospitals is set to close after being rated inadequate. While poor practice is not limited to private providers, on accountability and transparency measures they fall far short. Recent research highlights the potential for conflicts of interest, with Virgin Care among providers to have an ownership structure that is opaque.

All these issues require ministers’ attention, but parliament too must step up. The Lansley reforms must be undone not by stealth, because politicians are stuck on Brexit, but with Commons votes. Privatisation of health services urgently requires scrutiny. At a time of significant concern about young people’s wellbeing, a public debate about whether companies should make money by looking after the most vulnerable among them would be a good place to start.