The Guardian view on healthcare privatization: outsourcing will not save the NHS | Editorial
PSeveral hospitals in England carried out more procedures on behalf of the NHS last year than ever before. The total number of 1.67 million elective (non-urgent) treatments such as joint replacements and cataract removals amounted to 10% of the total – the first time this symbolically important threshold has been reached.
In the short term, the arrangement whereby the NHS purchases care from private providers will reduce waiting times for some treatments. But the benefits for patients, and for NHS administrators and ministers struggling with waiting lists and rising public discontent, should not blind anyone to the fact that the growth of private healthcare is undermining the NHS and the principles that underpin it.
The rising demand for private healthcare is not limited to NHS commissioners. As they spend more money than ever on private providers, the demand for insurance is skyrocketing. Last week, Aviva reported a 41% year-on-year increase in health policy sales through 2023. Customers were split between individuals and businesses, with more and more choosing to offer cover to employees, partly in response to NHS waiting lists. In addition, more and more people are unfairly forced to use savings to finance one-off treatments and avoid being on a waiting list for years.
Private healthcare is not new. The market has long ensured that those who can afford it have faster access to care. Some policies allow access to medicines or other treatments that are not available on the NHS. But the current expansion of private provision is unprecedented and involves significant capital investment. New hospitals have been jointly built in Birmingham and Surrey by NHS trusts and companies.
The systematic underfunding of the NHS during fourteen years of Conservative rule, combined with the failure to develop social care policies and the rising costs of ill health, have caused the current crisis. But the temporary relief provided by the expansion of private provision, for those whose circumstances allow them to access it, must be weighed against the longer-term consequences.
These include competition for personnel between public and private employers. Over time, there is a danger that the easier work typically performed in the private sector, combined with higher wages, will draw staff away from public hospitals. A related risk is that NHS doctors will see an increase in the proportion of their cases that are complex and chronic – compared to simpler, easier-to-treat problems that can be more easily outsourced. This could damage morale and make the NHS a less attractive place to work. At a time when recruitment and retention is already an acute problem, anything that negatively impacts job satisfaction must be taken seriously.
For supporters of Britain’s unique healthcare model, the overarching fear is that the growth of for-profit healthcare will gradually weaken people’s attachment to the NHS. If the share of the population with private insurance continues to rise and services remain underfunded, there may come a point where support for the principle of taxpayer-funded care, which is free at the time of delivery, begins to erode. If the NHS is to remain one of the cornerstones of our public domain, this must be prevented. It seems almost certain that it will be up to a Labor government to stop the rot. Without substantial government investment, it is unclear whether and how this will be achieved.