It’s Time to Fully Nationalise the Health Service

The scale of the coronavirus crisis requires decisive action in our health service. It's time to requisition private hospitals, insource all NHS staff and take public control of the production of essential medical equipment.

When countries are hit by crises, cracks in their social or economic structures are laid bare. The crisis around coronavirus is no different. As the government lurches from one insufficient measure to the next, our public services are creaking to breaking point. And the economic orthodoxy of the Conservatives is being torn up. Goodbye, ‘there is no magic money tree.’ Hello, state intervention in the economy.

Naturally, this is seen nowhere more clearly than in healthcare. As the number of Covid-19 diagnoses is expected to double every five days, the pressure on our NHS is becoming more and more intense. Already, we’ve seen one London hospital run out of intensive care beds due to the sudden increase in patients being admitted with Covid-19. Without a change of course, the number of hospitals facing similar shortages will continue to rise.

It’s easy to see why. The NHS has suffered decades of underfunding and privatisation which has brought it to its knees. Over 17,000 NHS beds have been cut since 2010 – so it’s no surprise that we’re hit with a shortage now. And if every winter, the health service enters a major crisis, is it any wonder it’s ill-equipped to deal with the biggest public health crisis of our generation?

The NHS is in desperate need of extra capacity. The obvious way to deliver this would be to bring it in from the private healthcare sector. According to the GMB union, there are 570 hospitals in the UK, with 8,000 beds. There’s no question that these should be utilised immediately to alleviate capacity concerns, and fight the coronavirus crisis.

After reports that the government was planning to do this by renting the beds from private health companies at a staggering cost of £2.4 million per day, a deal was finally reached with the private sector. According to the Financial Times, this will see the private health sector brought under contract with the government, with private companies being paid at cost value for their services, including the price of operating costs, assets and rent. Reports have indicated that private health companies won’t be making a profit from this deal.

Of course, this looks good on the face of it. And it could have been much worse. But we know that private healthcare companies are hungry for long-term NHS contracts. So the public needs to be shown the full details of the deal. We need to know what has been promised to the private health sector, and we need a commitment that these contracts won’t roll on after the crisis has abated and deliver stealth NHS privatisation. This demand has been supported by a coalition of campaign groups, including Momentum, GMB and War on Want all of whom have signed an open letter to Matt Hancock, co-ordinated by We Own It.

This all could have been much more straightforward. Rather than striking deals with the private sector, the government could have taken the sensible approach and followed Spain’s lead. All private health facilities and resources have been requisitioned by the Spanish government to use in the public fight against coronavirus.

That way the same outcome is achieved with the private sector having its resources brought in to fight the coronavirus crisis, but its operations are truly shifted to serve the public good rather than private profit. This could be done without a penny being spent to prop up private profits, and without behind the scenes deals that the public are yet to see.

That’s what a measured, appropriate and proportionate response to the health emergency looks like. This is especially the case because the private sector has, so far, shown no intention of ditching its model of making money from people’s illnesses. We’ve already seen how one private health clinic has sold 2,000 COVID-19 testing kits to the rich and famous. And we’ve also seen that Conservative MP Owen Paterson makes £100,000 a year from a company which has been selling tests at £120 to private clinics and the wealthy.

But private hospitals are just the first piece of the puzzle. Decades of government obsession with introducing market logic into the public services has come with a cost. Huge numbers of people working within our health services are outsourced to private companies – particularly in areas like facilities management, cleaning and catering.

Cleaning services in particular are absolutely central to managing the spread of coronavirus within hospitals. In this area, as in so many others, the outsourcing model is failing. Studies have shown that hospitals with outsourced cleaning services – around 40% of them – have lower health outcomes as well as having higher prevalence of MRSA. In good times this would be a scandal and dangerous. In a state of national crisis it’s beyond irresponsible.

That’s why in the current context, an immediate insourcing of all cleaning services is crucial in effectively securing public health. But looking only at hospitals themselves doesn’t go far enough. The barriers we currently face in delivering an effective public health response to coronavirus don’t begin and end at the hospital door.

Current estimates suggest the UK urgently needs an extra 20,000 ventilators to treat people who contract Covid-19 and are too sick to breathe without medical assistance. These aren’t a niche requirement – over 40% of those hospitalised in China from COVID-19 required a ventilator as part of their treatment. Once again, the government’s approach to this challenge is to stick to the status quo. It asked the private sector to step up to the plate and ramp up producing ventilators by converting existing manufacturing facilities. And now the government has placed an order for 10,000 ventilators with vacuum cleaner manufacturer Dyson, again for an undisclosed sum.

This response is slow, inefficient, and reliant once again on the benevolence of private companies. It fails to acknowledge the scale and urgency of the crisis. We’ve known for weeks that the number of ventilators currently in NHS hands is well below what is needed, and yet it has taken until now to take any kind of action. With the cost of the agreement with Dyson not yet public, we also don’t know precisely how much public money is being funnelled into the coffers of the private manufacturer.

The coming weeks will see the government forced to take greater control over production of essential medical equipment, not just for ventilators but for personal protective equipment (PPE). Now is the time to start contemplating larger-scale and more direct interventions like taking public ownership of a manufacturer to assist the NHS.

A publicly-owned manufacturer would be a dynamic weapon in the fight against coronavirus. It could use a variety of facilities – and wouldn’t just be limited to ventilators and PPE. It could mass produce hand sanitiser, as New York state has been doing. It could produce Covid-19 testing kits, currently in short supply, shown to be effective at quelling the spread of the virus. These are produced by only a handful of companies, usually at extortionate rates. There is an urgent need for an alternative to the government’s order of 3.5 million tests from the private sector.

Taken together, these three steps – bringing all private hospitals into public ownership, insourcing NHS staff, and developing a publicly-owned manufacturer – would be a response commensurate with the scale of the crisis our health service is facing. The government might say it’s too late to act on such a large scale, but the evidence suggests we are only at the beginning of our coronavirus curve. It has delayed decisive action already to great cost.

It is time for a long overdue shift in the way our healthcare system works. The coronavirus crisis necessitates that the public good is prioritised above private profit. Urgent and decisive action is about ensuring that we have the means at our disposal to stem the rapid spread of coronavirus and prevent an unnecessary escalation of deaths.

The coronavirus crisis requires reorientation of our attitudes towards the role of the state in the economy – away from one where the market and private enterprise is seen as the primary actor to deliver for the public, and towards one where the state becomes our social safety net.

This means having a real conversation about how we run our public services like healthcare. Do we want to continue with a system which lacks resilience, is reliant on private delivery, and which prioritises private profit? Or do we instead want to transition to one with public good, public safety and public care at its heart. The coronavirus crisis has exposed the cracks in the current system. We have to fill those cracks with the foundations of a new model.