The NHS might be the last thing in this country we can all agree we like. I’ll be starting my first job as a doctor in a few months, and what I want is to have a long career working in a well funded NHS – treating patients because decent healthcare is their right, not to profit off of them at their most vulnerable. The Labour Party has been accused of scaremongering in recent weeks, but there’s a reason Johnson can barely show his face in a hospital. And NHS staff know what it is.
The NHS has been voters’ first choice for extra government funding for decades. With public support for its founding principles so consistently high, some people assume that a Conservative government wouldn’t dare privatise the NHS. I wish this were the case. The unfortunate truth is that it’s already happening. The allegation is not that a Conservative government will begin to privatise the NHS, but that it’s going to build upon the precedent it has set over the past few years. Don’t expect headlines and announcements. It will happen under the radar, through the back door, as it already is.
This is becoming common knowledge amongst doctors, particularly in primary care, where GPs are increasingly made to refer patients to private providers of essential services. Nationwide statistics on the issue are surprisingly scarce. The most frequently repeated estimates in the media indicate that just over 7% of the NHS budget goes to private providers, equating to about £9 billion. While a significant amount of money in its own right, a closer look at the maths behind this figure suggests that the total is actually closer to a much more alarming 26%.
An element of private service has been a reality in the NHS for some time now, but what’s important to note is how this portion of health expenditure is changing. An article published last month in The Guardian showed that in only the past 5 years, new contracts meant that private firms raked in £15 billion of the NHS’s money, an 89% increase since 2015.
Private solutions are, on the whole, much more expensive in the long run, as we sell off assets and pay billions for contracts with nothing to show for it when they end. There is no substitute for properly funded public services. Whether it’s Virgin, Arriva, or any other company, the consistent theme is that you can either prioritise profits or patient care; not both. This has been demonstrated in recent years by some major examples of government experiments with outside hires ending in disaster.
Patients vs Profits
The dramatic collapse of Carillion a year ago exposed the dire consequences of depending on private entities to deliver quality services on the cheap. Languishing in £1.5 billion of debt, the construction company went bust in 2018, leaving us with two half-built hospitals and an enormous bill to clean up the mess. Several trusts were left in disarray, including Liverpool’s Royal Hospital, which reported leaking ceilings, cancelled operations, and as many as 10 floods in a single year. Staff described ’slum’ conditions, with buckets collecting the dripping water and dark rooms and corridors as hospital lighting faltered.
In Huntingdon in 2012, management of an NHS hospital was put into private hands for the first time with Circle Health. By 2015, Hinchingbrooke Hospital had to be brought back into public control. Recklessly overbudget and receiving gradually deteriorating assessments, the Care Quality Commission (CQC) finally recommended that the hospital be placed into special measures after being found ‘inadequate’. Circle Ltd soon decided they’d had enough, announcing that Hinchingbrooke was ‘no longer [financially] viable’.
Included in the reports were appalling failings in patient care, ranging from uncontrolled infections to emotionally abusive staff, and patients who had been ’told to soil themselves‘. Amongst other poor results, it received some of the worst ratings for Caring across the board from the CQC since its inception. This is in addition to it being found to be the second least efficient hospital in the country financially; unsurprising, considering Conservative MP Mark Simmonds was being paid £50,000 a year for 10 hours a month of ‘strategic advice’.
The policy with these gambles is always the same – privatise the profits, socialise the losses. Not only is patient care no longer the priority, but these companies don’t care what happens. If it ends in disaster, it’s the NHS which cleans up the mess and taxpayers who foot the bill.
The 2012 Health and Social Care Act has played a pivotal role in opening the door to these privately-led but very public disasters, by enforcing ‘competition’ between the NHS, private firms, and charities. The principle behind this legislation isn’t a huge departure from the ‘New Labour’ ideas of the early 2000s, when Tony Blair’s government turned on the Labour Party’s core values.
However, coupled with the biggest NHS budget cuts for a generation, this act has been all the more destructive. The new system has been deemed ‘wasteful’ by the British Medical Association and ‘counterproductive’ by NHS England, with resources wasted on tendering contracts for large firms. When multi-billion pound companies like Virgin are suing a cash-strapped NHS to the tune of millions of pounds after losing out on one of these contracts – and getting away with it – it’s safe to say there’s something very wrong with the current arrangement.
Yet just last month there was an opportunity in parliament to right some of these wrongs and protect the NHS against growing privatisation, and the Tories voted overwhelmingly against it. The Liberal Democrats, who voted in favour of privatisation during the coalition government, decided to abstain. Unfortunately, the motion was defeated narrowly as Labour, SNP, Plaid, and the Greens weren’t able to make up the numbers.
We’re currently seeing the biggest funding squeeze in the history of the NHS. The Tories have attempted to mislead the public on this issue by sharing raw figures and insisting that the budget has increased, but the reality is that this barely keeps up with inflation. NHS demand increases every year as the population grows and people live longer, surviving conditions which they previously wouldn’t have.
In this way, the NHS is partly a victim of its own success, as it requires more and more resources to keep up with its ever-increasing demands and technological advancements. As community services struggle to keep up, more people resort to hospital visits with A&E attendance rising by over 40% in the last 13 years. Yet, in real terms, we’re seeing the largest cuts for a generation, and so the funding gap grows each year and the NHS and its patients suffer.
These cuts have had a tangible and demonstrable impact on the health and wellbeing of the country. Life expectancy has stopped improving for the first time since records began, and in some regions it’s even fallen, with poorest areas hit hardest. Cuts to health expenditure nationwide are causing avoidable deaths every day. A recent British Medical Journal study into the effects of health expenditure cuts in the last 10 years estimates that at least 120,000 people have now died, as a direct result of cuts to health and social care.
If all of this isn’t proof enough of the Conservative Party’s ideological pursuit of privatised healthcare, we may turn to the man himself, Boris Johnson, in his early days as a journalist: ‘There is a moral point. If NHS services continue to be free in this way, they will continue to be abused like any free service. If people have to pay for them, they will value them more’.
He’s not the only one, either, with NHS favourite Jeremy Hunt having called for a ‘denationalisation’ of the NHS in his 2005 policy book, advocating for an American-style ‘insurance market system’. Current members of Johnson’s cabinet, including Dominic Raab, Priti Patel, and Liz Truss seem to share the sentiment, co-authoring a book in 2011 which insisted that ‘the current monolith should be broken up … New non-profit and private and private operators should be allowed into the service, and, indeed, should compete on price’.
The case becomes all the more damning when you look into the government’s redacted trade negotiations with the United States, who are demanding ‘full market access’. The comparison with the US is an important one as I often see the argument made that ‘nothing is free, our taxes pay for the NHS’. True, but across the Atlantic their government actually spends more per head on healthcare and still can’t provide it free at the point of use. To reiterate – the American taxpayer spends more on average to fund healthcare, but still has to pay out of pocket for treatment when they need it.
There are many factors which contribute to this situation, but a key reason is that the USA doesn’t have a central bargaining system. In the UK, when a company offers a drug to the NHS, they of course must show efficacy and compare its effectiveness with current options. Then when it comes to agreeing a fee, if the NHS are unwilling to pay that price, the drug will not be offered at all in the UK.* This grants the NHS substantial leverage in their negotiations.
In the USA’s fragmented system, insurance companies and hospitals are also competing with each other. Not submitting to a pharmaceutical company’s extortionate pricing means your competitors may offer a medication that you don’t. This substantially weakens their hand and the end result is one-sided negotiations in which providers of pharmaceutical and medical equipment can set the costs of their treatments astronomically high, with buyers forced to submit and expenses shifted over to patients.
The National Institute of Health and Care Excellence (NICE) in the UK has a thorough, standardised approach to determining what represents good or bad value for the NHS. The trade talks revealed in recent weeks show that the Trump administration and US pharmaceutical interests are desperate for the British government to limit the influence of NICE and dismantle the safeguards that protect the NHS from paying sky-high prices for drugs. Crucially, US negotiators have explicitly stated that they want longer patents for American drugs, to boost profits and limit the ability of the NHS to produce much cheaper generic versions.
In the United States, 66% of bankruptcies are tied to medical bills. Factoring in that it’s the richest country in the world, the American healthcare system is an unmitigated disaster. As you might expect, working people are hit hardest by these failings, either with crippling debt or with their lives. A quick browse through GoFundMe will tell you all you need to know about a system that leaves the vulnerable to beg for life-saving treatments. The only parties who benefit from the arrangement are ultra rich corporations with eye-watering profit margins – and these trade talks that Johnson doesn’t want you to see are a clear statement that they’re coming for more.
One of the go-to defences for NHS difficulties in recent years is that the system has been unable to cope with an influx of migrants. Tory MP Philip Davies proclaimed to the Daily Mail that ‘It is the National Health Service, not an international health service and it is essential these charges are made for overseas visitors’. It’s a catchy soundbite that has appealed to many.
Yet, according to the best estimates we have, ‘health tourism’ costs, at most, 0.3% of the national healthcare budget each year. This is roughly the amount of money it costs to run the NHS for 15 hours. In fact, The King’s Fund claims that the true figure is likely to be less than half of this, somewhere between £60-80 million. Not quite enough to cover the reported £30 billion funding gap reported by the NHS.
Regardless, from what we know, it seems that a significant number of the patients that make up this cost are Brits living in other countries who come back to use the NHS. Perhaps not what opportunist politicians have in mind. Interestingly, around five times more is spent by EU nations in treating Brits abroad, so we’re certainly not getting a bad deal.
Jeremy Hunt, who’d told us that our hospitals were ‘clogged up’ with migrants, tried his best to prove the point in 2018, spending millions on a pilot scheme in which he targeted patients he suspected weren’t entitled to free NHS care. Doctors protested but to no avail. In Bart’s Hospital, one of the centres enrolled into the programme, 2752 patients were asked for ID prior to treatment. Two were found to be ineligible, and Hunt managed to recoup a grand total of £2500 from the pair.
This backfiring scheme is an excellent demonstration of the immigration red herring, but regardless of how much they ‘cost’ the NHS, immigrants have repeatedly been shown to be net contributors to the economy. They’re paying in far more than they’re taking out. An Oxford Economics report into the fiscal impact of immigrants on the UK concluded, ‘Taken together, this means that the migrants who arrived in 2016 will make a net positive contribution of £26.9 billion to the UK’s public finances over the entirety of their stay’.
And even still, all of the above ignores the undeniable fact that workers from around the world are essential to the functioning of the NHS. With 153,000 of our NHS staff coming from overseas, anybody who’s spent 10 minutes working in a hospital could tell you that the NHS would crumble without their contributions.
Protecting the Future
The NHS was formed by Attlee’s government in the 1940s. The Conservatives voted against it then, they’ve voted against it since, and they’re voting against it now.
It’s not immigrants, it’s not public sector inefficiency, it’s this government. They’ve had 9 years and they’ve made the situation almost immeasurably worse, so why on Earth would we trust them to fix it?
Listen to what doctors and nurses are saying, what NHS advocacy groups say, and what these politicians say – when they’re not trying to win your vote. Observe your interactions with healthcare: how long did you have to wait for your last GP appointment? What about 15 years ago (for those old enough)? How long did you wait last time you went to A&E? How much are you paying for prescriptions, dental appointments, and hospital parking? The media billionaires will tell you the Tories are looking after the NHS just fine, but don’t trust their words over what’s in front of you.
They’ll keep publishing headlines telling you that the NHS is failing, that it’s on its knees.
But the NHS isn’t failing, it’s being failed. Don’t be complicit in its failure. Vote for a government that will protect the only thing we can all agree on.