(adapted from an article for Labour Outlook)
Wes Streeting has been winding up health workers, campaigners and Labour activists once again, with more loose talk about turning to the private sector rather than investing in expanded NHS services to reduce waiting lists.
It follows his promise last November to “hold the door wide open” for “those entrepreneurs that are coming up with cutting-edge treatments and technologies to know that when they come up with a great idea that can deliver better outcomes for patients and better value for taxpayers’ money”.
Rishi Sunak of course has been saying exactly the same thing, and his Elective Recovery Taskforce has been trying to bully NHS bosses into making more use of private providers.
To make matters worse, Streeting’s latest statements were made in an article for the Sun newspaper. In line with the prevailing right wing bias of Sun reporting, Streeting went on to imply – without a shred of evidence – that the “middle class lefties” who disagree with his focus on the private sector are themselves jumping NHS queues and paying privately. He says:
“Middle-class lefties cry ‘betrayal’. The real betrayal is the two-tier system that sees people like them treated faster — while working families like mine are left waiting for longer.”
The Sun’s generally lower-income (but often ill-informed readership) might not be aware that Mr Streeting is on a Parliamentary salary which starts at £91,346 plus expenses. It might make them question whether he is really part of a “working family” like theirs: and it’s far from clear Sun readers are at all wanting to privatise more NHS services.
That’s because in real life objections to using the private sector to solve capacity and other problems in the NHS are by no means limited to the “middle class” or to “lefties”. They have been raised by sensible NHS managers, medical Royal Colleges, Trust bosses and far from radical think tanks.
Streeting’s glib remarks and readiness to accept cash from private sector sponsors also jar with Labour’s potential supporters in Scotland. The National newspaper highlighted “Wes Streeting takes £175k from donors linked to private health firms,” following an earlier report headlined “Anger meets Labour pledge to bring private healthcare into NHS”.
The reports quote Labour’s rivals for votes in Scotland, with SNP, Green and Alba Party spokespeople all gleefully exploiting Streeting’s words and similar statements from Keir Starmer. Streeting may feel he has balanced his comments with his insistence that the NHS would only be privatised “over my dead body,” but these comments are not grabbing any headlines: it’s the talk of private providers that makes the impact with both right wing and left wing news media.
Making such statements is not only electorally unwise, the policy itself is seriously wrong and ignores decades of grim experience of outsourcing in the NHS. Indeed there are good reasons for anyone to question the extent to which a private sector which has failed so lamentably and profited so shamelessly after taking over other public services could behave any better or deliver better results in health care.
It can’t, it hasn’t and it won’t.
Back in 2015 the notorious private company Circle proved that the private sector could not run even the smallest of NHS general hospitals when it walked away just three years into a ten-year contract to manage Hinchingbrooke Hospital, leaving a total shambles.
There have also been private sector fiascos running patient transport services, decades of failures of private contractors to clean or deliver other non clinical support services to the NHS, and the expensive New Labour experiments with using private hospitals and “Independent Sector Treatment Centres” to treat NHS funded patients 20 years ago, which is now almost entirely a bad memory.
Streeting is misinformed or deluded, not in believing there is “spare capacity” in the private sector (which has failed to win the surge of customers it expected as the waiting list has soared) but in believing this capacity can be tapped into without detriment to other NHS services.
There are sound practical reasons why the private sector is not the best or even a viable way to tackle capacity problems in the NHS.
Every pound spent on NHS patients’ treatment in a private hospital or clinic is a pound that could have been invested in expanding and improving NHS. Diverting the revenue, and the simplest routine caseload in this way means the resources are never there to expand core NHS provision, and builds permanent dependence on private sector.
But the private sector is tiny, with just 8,000 acute beds, unevenly spread around the country, in hospitals with an average of just over 40 beds: only a few have any provision of intensive care that is needed after more serious operations.
That’s why they only offer a limited range of specialisms, and only accept the least serious and most simple cases. It’s also why when these operations go wrong the private hospitals dispatch patients with complications to NHS hospitals for emergency treatment.
But even in the best case scenario using private hospitals for straightforward cases leaves the NHS with all of the more complex elective caseload as well as all the emergency admissions. And while the claim is that the private sector only gets paid at the NHS tariff prices, the NHS-treated patients are more likely to need longer in beds and cost more.
The private hospitals also have relatively few full time staff – surgeons and nursing staff come in to do specific sessions and operations, but the rest of the time are employed by the NHS. So the more NHS patients they treat, the more NHS-trained staff private hospitals need to employ, from a limited pool of professional staff.
That’s why increasing the numbers of patients treated in private hospitals and clinics leaves the NHS with less cash, fewer staff … and can therefore mean longer waits for patients with greatest needs.
Nor does use of private hospitals necessarily increase numbers of operations: in the case of hip replacements, for example the increased share carried out in private hospitals ran alongside a decline in NHS provision – leaving numbers almost unchanged, but much more cash flowing out of the NHS into private pockets.
It’s also important to note that diverting a large proportion of the least complex cases to the private sector dislocates the training of doctors, which is the responsibility of the NHS. A varied case mix is required to equip tomorrow’s specialists to deal with the full NHS caseload. The completely atypical private hospital sector neither provides nor pays for training, but relies on poaching trained staff.
In other words using apparently or “spare” capacity from the private sector not only lines the pockets of their shareholders, but comes at a heavy price to the NHS.
The most logical and efficient way to expand capacity in health care in England is to expand the NHS, not divert vital resources, staff and funding, into small-scale, profit-seeking private businesses.
With the NHS in far worse shape than it was in 1997, there will be little time for a Labour government to take stock of the dire situation and draw up more appropriate policies than the glib headline grabbing nonsense rolled out by Streeting.
It would be best if he started now, by reading the recent reports of the BMJ Commission on the Future of the NHS, and listening to the warnings of NHS management and unions.
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