Forty years of failure – Private sector contracting and its impact on the NHS, by Dr John Lister, offers a scathing critique of the NHS’s privatisation experiments. Each chapter peels back layers of policy missteps and their consequences.
The report begins in the Thatcher era, when ideology-led policy dominated and outsourcing was sold as a panacea for public sector inefficiency. Hospital cleaning, catering, and portering were handed to private contractors—often with disastrous consequences for standards and staff. These early decisions laid the foundations for decades of fragmentation.
Lister charts the development of increasingly wild experiments with markets and outsourcing throughout the Lansley era and how, after multiple failures, these policies were partially abandoned.
With the current government now flirting with some of the flawed ideas of competition and outsourcing, Lister offers up a wealth of evidence from the last four decades that should stand as a strong warning to today’s policy makers.
Outsourcing sought to reduce costs, but it also cut into the morale of the NHS workforce. Staff transferred to private providers faced poorer pay, worse conditions, and chronic insecurity. The result was predictable: falling retention, rising sickness, and losing decades of institutional knowledge.
The report also details the vast waste of PFI, warning our current political leaders, who must find a way to attend to the current stock of crumbling hospitals, of the mistakes of their predecessors. It was Labour that signed off on the Tory led plan to use PFI, to build over hundred new hospitals, but left the NHS shackled to eye-watering repayments, trusts becoming crippled by PFI debt, with maintenance and staffing budgets raided to pay private financiers.
Despite being consistently under-resourced and the victim of policy experiments, the NHS is still popular with the public. Their perception of privateers has changed, though, and is now more cynical and negative. Failures have been exposed. Resistance has grown: campaigners, whistleblowers, unions, and communities have all stepped up, and in recent years, some services have been brought back in-house. These efforts and the growing body of evidence help to fuel the continuing resistance to privatisation.
Lister calls for a clear and urgent reinvestment in publicly delivered healthcare, guided by values of equity, universality, and accountability. That means ending the outsourcing experiment, restoring NHS employment for staff. The lesson of forty years is simple: public healthcare works—if we back it.
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