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The Private Sector Won’t Save the NHS

The problem with Labour's support for using the private sector to bring down NHS waiting lists is that for private providers, profit will always come ahead of helping patients.

(bymuratdeniz / Getty Images)

While the invisible hand protects the private sector, the invisible foot kicks the public sector to pieces. Nowhere is this more evident than the encroachment of private healthcare into our NHS.

In normal times, the relationship between the private healthcare sector and the NHS is a parasitical one: the private sector cherry-picks the straightforward, uncomplicated cases, and the NHS pays out billions of pounds. But, as in so many other ways, the pandemic changed everything, and now more and more are claiming that private healthcare is going to be our saviour. Falling for this argument could be a costly error—and in more than just financial terms.

This week saw the announcement of new three-month arrangement struck between private healthcare providers and the NHS by Health Secretary Sajid Javid. The deal forms a collaborative partnership, nominally intended to increase NHS capacity.

Just a few days before, Labour’s Shadow Health Secretary Wes Streeting had signalled support for using private healthcare providers to bring down NHS waiting lists. ‘No doubt the next Labour government may have to use private sector capacity to bring down NHS waiting lists,’ Streeting told the BBC’s Nick Robinson, adding that he would, however, be ‘pretty furious at the costs involved’ in doing so.

The deal is being sold to the public as a brand-new initiative, but in reality, the government negotiated a similar deal in March 2020 with paltry returns. NHS data shows that the private sector, under the 2020 deal, cared for just 0.08 percent of Covid-19 patients during the pandemic. On average, that means the entire private sector cared for eight Covid patients a day between March 2020 and March 2021. The NHS, meanwhile, averaged 10,000.

Of course, the private sector was also contracted to continue routine care while the NHS was battling the Covid-19 pandemic. But even there, it failed to make any meaningful contribution towards patient care. Routine NHS-funded activity in the private sector actually fell by forty-three percent, resulting in 235,000 fewer elective procedures and 1.3 million fewer appointments for NHS patients compared to 2019. Instead of stepping up during the pandemic, the private sector took a back seat.

To the dismay of frontline NHS staff, the reality is that this contract was intended as a lifeline for the flailing private sector during the pandemic, rather than one for patients. One private provider, Spire, went as far as to state that the deal would provide ‘sufficient liquidity and financial stability during the Covid-19 outbreak’. Spire had already announced that it was at risk of breaching banking covenants and might have to suspend its dividends paid to shareholders.

What’s worse, under the 2020 contract, the private healthcare sector was incentivised to continue treating fee-paying patients, providing a rebate was paid to the government—a concession incomprehensible at the height of a public health emergency. As a result, private healthcare providers returned to their usual habit of cherry-picking straightforward cases and neglected their contracted NHS duties, in addition to receiving £300 per bed in a private hospital from the NHS.

So where are we now? With the country experiencing a surge of the Omicron variant, and six million people on NHS waiting lists, the NHS faces an unparalleled task. Patients seeking treatment and awaiting procedures are facing misery and turmoil, while ninety-two percent of hospital trusts have stated significant concern over staff burnout and work-related stress.

Radical times require radical solutions, rather than more of the same, and for a meaningful impact on the ever-growing NHS waiting list, one answer is the nationalisation of the private healthcare sector. The options available to the UK government can be weighed up by the outcomes seen elsewhere: Spain’s overnight renationalisation of private hospitals during the early stages of the pandemic, for example, substantially increased bed capacity; the deal negotiated with the private healthcare sector in Ireland, on the other hand, has been described as ‘a lost opportunity to integrate and simplify Ireland’s hospital system’. Nationalisation is the only real solution, at home and abroad.

Modelling by the Institute of Fiscal Studies (IFS) has shown that the NHS waiting list, in the worst-case scenario, may reach a staggering fourteen million by the autumn of this year. Even in the most optimistic scenario—a waiting list of over nine million—the NHS would need to increase capacity by 2023 and onwards to be able to return to pre-pandemic levels by 2025.

Bold decisions must be taken in these strange pandemic times. With the Tory government taking steps to further degrade the NHS, the duty falls to Labour to confront the reality ahead: a reality that the private sector will not and cannot solve.

About the Author

Jatinder Hayre is a GP in training and academic researcher with an interest in health inequalities. He recently co-authored the 'SAGE Report 21: COVID-19 and Health Inequality', and works with the Fabian Society. He is a campaigner and national spokesperson for Keep Our NHS Public.