160,000 people have called on the government to end the market driven NHS, but firms dispute that this shows that the public are rejecting private sector involvement.

A consultation set up by NHS England to invite views about plans to re-shape the NHS has received their biggest ever response from the public. A key part of the listening exercise surrounded plans to remove the rules that currently force the NHS to compete with the private sector and charities for contracts.

Testing the popularity of outsourcing the campaign group 38 degrees asked 170,000 of their members whether “local health services should typically be run by the NHS, not private companies”, an overwhelming 97 per cent agreed or strongly agreed in an online survey.

The group have published their survey ahead of the official consultation response from NHS England.

Countering the survey findings, David Hare, the CEO of the Independent Healthcare Providers Network said in comments to the HSJ, that they were out of step with other polling “credible research organisations such as ComRes and Ipsos MORI has shown time and time again that a representative sample of the public are entirely comfortable with independent organisations delivering NHS care”.

Newest evidence

However, an analysis of the most recent polls reveals that the public are becoming far cooler about the idea of firms delivering NHS care. Ipsos Mori found in their 2017 public poll that there has been an increase in the number of people who prefer to use NHS services – 55%, up from 39% in the 2014 British social attitudes survey.

Opting for the NHS over private providers is an even more telling choice by the public given the pressures on NHS. For the first-time satisfaction rates are falling, but the public’s belief in the core principles of the NHS is holding fast.

Nine out of ten still back an NHS that is free at the point of access and provides a comprehensive service to everyone.

There are also signs that voters are more likely to back nationalization policies over those that give the private sector more control. YouGov poll found that only 10% of the public believe the NHS should be privatized and run by private companies, with 83% saying it should be nationalized and “run in the public sector”

Feeling the impact

It is true that, at one stage polls seemed to show a small majority of the public to be indifferent about how NHS care was delivered – as long as it was free at the point of use.

However, a succession of spectacular outsourcing failures has crumpled public confidence. Firms that haven’t made profits have frequently dropped contracts, leaving the NHS to resurrect service provision. Recently Virgin announced it is to walk away early from its £270m contract to provide services to frail older people in Staffordshire.

Back in 2014 Serco abandoned all its NHS work after profit margins were squeezed and accusations that it fiddled performance figures and left GP services in Cornwall dangerously understaffed.

A year later Circle gave up running an entire NHS hospital in Cambridgeshire after the health watchdog produced a damning report on its failings.

More recently the collapse of Carillion and the repeated problems with Capita and G4S contracts have made them household names and piled reputational damage on to the outsourcing project.

The public view of private companies is becoming more nuanced. The panama papers and other tax scandals explain why nine out of ten people believe tax avoidance by large companies is morally wrong.

However extensive cuts and restricted spending on public services have pushed more commissioners towards the private sector. However, the shock of this long period of austerity has also now shifted opinions on these key national policies.

Only one-fifth now think that there is a real need to cut spending on public services to pay off the national debt and most people would pay extra tax to see spending on the NHS rise.

Campaigns move governments

In the months after the Health and Social Care Act 2012 was passed the government confidently launched successive new ways to involve private firms, but now, seven years on it seems that most privatisation projects in the NHS are toxic to the public.

In the past few months a plan to privatise PET scanning in Oxford has resulted in a vigorous local campaign, pulling in MPs and councillors to back the opposition. NHS England has already attempted one climb down, but the local objectors are yet to be convinced.

In fact, after announcing that it is trying to persuade the government to scrap the section 75 rules that enforce competition, it is the credibility of NHS England that is on the line. They must convince a battle hardy constituency of NHS campaigners that they are genuinely steering the NHS away from markets and the privateers. However, the emergence of new privatisation projects, like that in Oxford are raising real doubts.

We Own it and Keep Our NHS Public have worked together to encourage the public to answer NHS England’s consultation. They encouraged supporters to send NHS leader’s a letter that reads “I’m really pleased that you’re calling on the government to abolish section 75 of the NHS Act….But I want you to go further. I want an NHS which is publicly provided, publicly funded, and publicly accountable.”

Campaign groups suspect that the NHS integration project will still provide opportunities for private companies to expand their control. They cite the NHS contract for Integrated Care Providers as evidence, as it gives private companies the chance to take on the lead budget holding role. Even if this is unlikely, say campaigners the new local partnerships of providers also lack accountability and proper governance.

In the last two years petitions against privatisation have collected millions of signatures and a provoked a handful of judicial reviews. The public have become steely and active in their opposition. After being taken to the high court there is no doubt that NHS leaders are more realistic about the public mood.

NHS England are also clear in their view that competition and market rules are dysfunctional, working against their new integration plan for the NHS. The public want them to go further, to banish an era of private sector incursions and you can bet that campaigning won’t stop until they do.


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director of the NHS Support Federation

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