The Privatisation of the NHS: A Threat to Public Health?

Izzy Humphreys for Distilled Post

With the recent bout of NHS strikes and the perpetual failure of the government to meet the needs of front-line workers, the looming threat of further NHS privatisation feels more real than ever. The covert nature of privatisation thus far leaves mostly ambiguity in its wake, so it’s an appropriate time to analyse the facts at our disposal and draw what conclusions we can at what may prove to be a pivotal point in our health system’s future. 

What we’ve seen so far

Since its inception in 1948, the NHS has slowly been turned into another profit-making government arm through what many have described as “stealth privatisation”, a concept pioneered by Oliver Letwin and John Redwood as early as the 1980s. Margaret Thatcher’s government was the first to introduce competitive tendering to outsource NHS services, beginning with just ancillary services but which now includes emergency care, hospitals and mental health services, to name a few. This massive increase in outsourcing was largely a result of the 2012 Health and Social Care Act, which introduced Clinical Commissioning Groups (CCGs) whose primary responsibility was to contract out high-cost health services to the highest bidder, including private companies. It was reported in 2019 that privatisation had nearly doubled from 2009/10 to 2018/19, and although this commonly quoted statistic has been dissected and partially debunked by Nuffield Health, rates of privatisation have undoubtedly been steadily growing. 

The pandemic presented another opportunity to further dismantle the NHS through a “gradual hollowing out” process. New privatisation came in the form of sourcing personal protective equipment (PPE) from private companies with connections to the government, and an obsolete and extortionate test and trace system funded by two massive corporations, Serco and Deloitte. The pandemic appears to be somewhat of a turning point when looking at the privatisation of the NHS and its ultimate deterioration. Not only was it a moment of opportunity for further privatisation but it also emphasised the intentional neglect of the NHS by the government for years prior, leaving it unequipped to deal with the pandemic and leading to unnecessary deaths amongst medical professionals and patients. The NHS has never made a full recovery from the conditions of the pandemic, and the government has happily watched it fall by the wayside in an attempt to make privatisation its only lifeline. 

Future prospects

The recent NHS strikes and lack of resolution to the pay disputes are shining a floodlight on the government and what route they will take moving forward. Either continue to privatise or rebuild the NHS, most evidence points to the former. Sharon Graham, General Secretary of Unite has been vocal about her beliefs that the unwillingness to negotiate a settlement in the pay disputes is down to their desire to privatise. It’s a volatile situation currently, and it seems the ball is entirely in the government’s court.

Just in January, Sir Kier Starmer spoke out about his belief in NHS reforms and admitted nothing is ‘off the table’. Though he maintains that the NHS should always be free at the point of use, he declared there is ultimately a role to play for the private sector, something that Labour are willing to look into and eventually back. This isn’t the first indication that the deciding powers are looking to further integrate private care into the NHS, with a report at the end of last year stating that a two-tier system, whereby some patients would pay for treatment, is being considered by NHS Scotland chiefs

This is essentially already happening, with NHS waiting times forcing an alarmingly high number of people to resort to crowdfunding. Reportedly, the number of people in the UK using platforms like GoFundMe to raise money to cover the cost of private medical care has tripled since 2019 to upwards of 40 a week in 2022. This makes the UK equal to the US in the amount of non-reimbursable spending on medical services, and research indicates it is the lowest earning fifth of the population who make up the majority in this area. 

What are the implications?

Originally, privatisation in the form of outsourcing as been touted has beneficial for patient care; a lifeboat to the understaffed NHS drowning in patients and hope for the seriously ill who face excessive, potentially life-threatening waiting times. A recent study has found, however, that privatisation may actually be responsible for increasing rates of treatable mortality, a term used to describe patient deaths considered avoidable with timely, effective healthcare. The study, carried out by Oxford University, indicates that over 500 additional deaths between 2014 and 2020 may be the result of outsourcing. There is some ambiguity as to whether this higher mortality rate is directly caused by outsourcing or just associated with it, but either way, it is a stark indication of the risks of privatisation. 

This study feeds the argument that private companies are delivering worse quality care. Whether it be due to competition for contracts leading to the prioritisation of shorter waiting times, the scope for private companies to cherry pick their cases, or cutting corners to treat as many patients as possible, it seems the façade that painted privatisation as beneficial to public health is beginning to fade. 

It is difficult to sit back and watch the evidence stacking up to indicate the NHS is facing further privatisation, but most people aren’t in favour of this agenda, and whilst outsourcing to private companies may continue and potentially increase, it seems unlikely that a fully privatised healthcare system in the UK is on the horizon.