I’m a doctor who gave up working clinically to advocate for NHS staff and patients, and I’m incredibly concerned about NHS privatisation. Governments have allowed forms of privatisation to infiltrate the NHS for three decades (for example, building hospitals using private finance initiatives (PFIs), incurring enormous debt in the process).
However, despite widespread concern about NHS privatisation, it is often perceived as only a threat, not a reality. EveryDoctor, the organisation I run, is now lifting the lid on the extent of current privatisation.
We have created a map displaying the NHS services run by “non-NHS providers”, each one marked with a digital pin. This was a difficult task, because there is no single list comprising these providers. We’ve built it piecemeal from various websites, along with testimony from our network of supporters. There are 2,531 pins on the map so far.
Some of these services are run by not-for-profit organisations, but many are private companies. They apply to run health service contracts on behalf of the NHS, and if they win the contract, they take public funds to run a service.
Some people don’t see outsourced NHS services as a problem; even if the provider is a private company. We’ve certainly had push back from many MPs claiming that NHS privatisation isn’t happening, presumably because they determine that “privatisation” only encompasses care which is paid for by the patient at the point of use.
However, outsourcing NHS services to private companies is allowing privatisation to infiltrate the very fabric of the NHS. This matters. The priority of any private company is profit generation – where does this fit in when delivering a public healthcare service?
Aside from the potential profit to be made from outsourced NHS care, there is the practical consideration of infrastructure disruption. Any change to NHS services requires detailed logistical planning. Many non-NHS providers take on short-term contracts of service delivery, and the associated administrative overhauls can be deeply frustrating for clinicians who are trying to focus on their patients.
In a soft, immeasurable way, these overhauls impact patient care through staffing changes. They can interfere with long-term caring relationships between NHS staff and their patients. Caring relationships are difficult to quantify, and receive little attention when we consider the metrics of public healthcare delivery, but are incredibly important. Many NHS GPs, for example, will have known multiple generations of the same family for many years, and this acquired knowledge enriches the healthcare they can deliver to their patients. Disrupting this healthcare architecture can have profound consequences.
There is growing concern about the impact of outsourced care on patients’ health outcomes. The Lancet recently published an observational study of NHS privatisation. They found that an annual increase of one percentage point of outsourcing to the private for-profit sector corresponded with an annual increase in treatable mortality of 0.38 per cent. This is a stark finding, and the government should be paying close attention to such studies.
We suspect that outsourcing of NHS services is about to accelerate. The government has just implemented the Health and Care Act, which Sajid Javid described in April 2022 as “the most significant change to the healthcare system in a decade”. Last year, the government said that it would “dispose of unnecessary bureaucracy that has held the health service back”.
Reading between the lines, many NHS campaigners fear that the Health and Care Act will enable accelerated NHS outsourcing and privatisation, and further disruption of existing services. We’re extremely fearful for patients and what will come next for the NHS.
What, then, is the answer? I speak to hundreds of NHS staff and members of the public about the NHS every day. There appears to be a widening disconnect between the political ideals and trajectory of this government’s plans for the NHS, and the desires of the public.
The inefficiencies of the NHS will not, to my mind, be solved by increasing fragmentation and privatisation of an already underfunded, under-resourced service. Instead, we need hopeful, transformative thinking, returning to the original vision of the NHS and reimagining it for the 21st century.
Society has changed. Healthcare needs have changed. But our desire for care and careful attention when we are sick has not changed. A patient deserves to be at the very centre of decision-making within public healthcare. No NHS provider should be balancing the competing demands of making money, and delivering patient care. Profit-making must therefore be eliminated from the delivery of NHS services, to allow patients’ needs to sit at the centre of decision-making.
Political leaders will be working on their manifestos for the next general election soon. Watch closely. Our patients don’t deserve another leader pushing a privatisation agenda, or an apologist for existing privatisation and outsourcing. We need a leader who is brave enough to eliminate NHS outsourcing altogether, and put patients at the very top of their agenda. We are all patients, after all. And we all deserve better.
Dr Julia Patterson is the chief executive of EveryDoctor