Let’s make this clear: private healthcare will and must work for the NHS – not the other way around | Polly Toynbee

OOur seriously injured public services are begging for help, but the totem that marks the state of the nation will always be the NHS. The monthly waiting time reports on ambulances, the state of emergency departments, the wait for cancer or GP appointments: they all determine the pulse of the country.

The last numbers showed a hint of improvement. Can a government that is only 100 days old claim any credit? Alastair McLellan, the editor of the Health Service Journal, suggests this is likely to happen as health funds accelerate activity. But, he says, the £3.2 billion elective recovery fund, which pays for weekend and evening operations, is running out. Hospitals say they can do more, but only with cash for staff overtime.

Entering that arena is an insidious player, apparently with gifts: the big beasts of the private sector, who have written to the Chancellor and the Minister of Health offering an investment of £1 billion towards eliminating the backlog of new surgical and diagnostic units. The Independent Healthcare Providers Network, which includes Bupa, Circle Health Group and Care UK, is offering 2.5 million treatments “starting in weeks”. So what is it: a gift horse or a Trojan horse? Health Minister Wes Streeting is handling it carefully. He’s right.

His team says they wouldn’t dismiss it out of hand for ideological reasons. But the nature of these contracts tells us that a £1 billion investment expects a nice return on investment in solid long-term contracts that guarantee fixed rates and patient supply. That sounds like a new straitjacket from PFI; about PFI, the Streeting team says: “We learned our lesson last time.” Streeting has red lines: no contract with private hospitals poaching NHS staff, a tall order as only the NHS trains staff; intensive care beds for difficult cases, no more singling out difficult cases; and any deal must be value for money, which they say “wasn’t in Covid”. Most private hospitals are located in affluent areas: they have to treat people in hard-hit areas. While the NHS still has the capacity to do more if it gets the money, private care would only be short-lived in some places. There are numerous problems here, not least that insistence on long hospital contracts runs counter to Streeting’s plan to get patients out of bed and into the community.

Tony Blair used private treatment centers to reduce waiting times to their lowest levels ever, but when treating orthopedic services the private sector charged 11% more, treated younger, wealthier patients and filled fewer beds than NHS rapid throughput centres. according to the BMJ.

Against this backdrop comes yet another self-interested attempt to take advantage of an NHS in need. The British Chambers of Commerce have appealed to the Chancellor for this tax benefits for private health insurance offered by employers, now taxed as an extra. It’s disguised as a way to prevent people from falling on sick leave, to “end the unemployment crisis,” but the answer is a flat-out no. “All public money goes to NHS patients,” Streeting’s team says. Yet they expect the Tories to campaign for it anyway.

To see how private healthcare can undermine the NHS, the fate of ophthalmology among the Tories there is a salutary warning: the Center for Health and the Public Interest finds that outsourcing cataract surgery has made many NHS eye departments barely viable, losing profitable, less complex operations while leaving them with the complex, expensive work to sit. Staff were stolen and there were too few routine surgeries left to train new eye surgeons.

But there is a good example of reversing that trend. The Maidstone and Tunbridge Wells NHS Trust is one of many hospitals now insourcing from the private sector. Its CEO, Miles Scott, has just purchased a local private hospital from Spire Healthcare, renamed Fordcombe Hospital, to all tall waiters in a region that does one in eight people on waiting lists, including thousands waiting more than a year. He convinced NHS England to pay the £10 million. What’s the benefit, I asked? “It was mainly staffed by our doctors, who took simple cases but sent us back if something went wrong because they didn’t have critical care. Now we can take 2,500 tall waiters with us. It’s cheaper and better,” he says, now that all staff have been redeployed from the NHS.

Bath is one of many others hiring private facilities. Chancellor Rachel Reeves said shelargest wave of insourcing in a generation”, while Streeting warns of a “broken” NHS reduced to a “poor service for poor people” if too many people go private. How scared should we be? As long as he sticks to his red lines, no big deal.

The private healthcare industry talks a big game, but it’s a minnow next to the NHS. Despite the Tories’ intentions, the number of NHS cases sent to private hospitals for elective procedures such as hip and knee replacements has risen only modestly, from 8% before the pandemic to 10% last year, the HSJ says, and the flight of patients to the private sector is less than feared.

The Health Foundation charity has reported a small increase in the number of people buying private care, especially for hip replacements. Despite the increasing waiting times, there was no “big wave” in private proceedings, which only rose from 7.4% before the pandemic to 8.3% last year. There is also no “statistically significant change” in the figures saying they might pay for private healthcare or insurance, consistently less than one in four people. The number of people who actually take out care or insurance “has remained relatively stable, around one in seven people”.

The Independent Healthcare Providers Network website calls out the government, saying: “Going private is becoming the trend new normal”, but it really isn’t. If Labor vastly improves the NHS, as every Labor government has done, and all the extra money goes to extra NHS work, the private sector will fail to undermine the ethos and values ​​of the NHS. The audience clings to it with remarkable determination. It has always been that way and it should always be that way.