The argument that the NHS is being ‘privatised’ is as old as the hills yet it still persists as a potent political issue. But why is this when the NHS remains funded through general taxation free at the point of use to patients, no frontline assets or services have ever been sold into private ownership and private provision of NHS services has been a feature of delivery since 1948?
The answer is multifaceted and revolves around a vagueness over the term ‘privatisation’ when used in an NHS context and an understandable loyalty which the public has to the NHS that is culturally deep-rooted. Polls have consistently shown the vast majority of the public do not mind who provides their NHS care – NHS, voluntary sector or private sector – so long as it’s free of charge and available to all. But when presented with a perceived threat that the NHS is about to be ‘privatised’ the public understandably recoil and conjure up images of the US healthcare system where universality of access has never been achieved.
When the term ‘privatisation’ is looked at in more detail the results reveal some quite interesting trends. Research conducted by IHPN showed that just 28 per cent of the public equated NHS ‘privatisation’ with the use of private companies delivering NHS care in a free at the point of use system. Far more people (62 per cent) equate ‘privatisation’ with being charged for care at the point of use or assets being sold into the private sector (57 per cent).
So the public are generally pretty relaxed about who provides their NHS-funded care provided it is high quality and remains free at the point of use. And they don’t generally equate the NHS using private sector providers with NHS ‘privatisation’.
Despite this the politics remain highly charged and an NHS without private sector provision is a point that is likely to be debated during the current election campaign.
This is why we decided to take a look at what the impact would be of removing private sector provision of NHS care from just one area of service delivery – planned or elective care.
We chose this since it is reasonably straightforward to calculate what would happen to NHS waiting times and the size of NHS waiting lists if this capacity were removed overnight, possible given that most hospital contracts are for one year. What hasn’t been included is the impact of removing private sector diagnostic capacity, mobile capacity from those organisations that help with short-term pressures or primary and community care provision, all of which are delivered in part by private sector providers and which support overall system sustainability.
The numbers that we have produced are stark and highlight very clearly what the impact would be of removing private sector capacity from frontline NHS elective care delivery.
For starters the average waiting time for planned care would nearly double in 12 months – from 13.1 weeks today to 22.2 weeks in a year. After three years it would have reached 40.3 weeks. This equates to an extra 436,000 people on the waiting list at the end of 2020 and 1.3 million more by the end of 2022. In specialties like orthopaedics where private sector provision is above the average 11.2 per cent across all specialties on the RTT pathway then waits would rise from would rise from 16.6 weeks to a staggering 93 weeks in just 3 years.
Clearly those that argue for an NHS free of private sector provision would also argue – perhaps justifiably – that the NHS would work to add capacity to absorb that which is lost. But this would take a considerable period of time and the NHS’s scope to increase its throughput in the coming years is challenged. Building the equivalent of 42 new NHS Trusts, which would be required if private sector NHS elective capacity were removed from the system, would take several years. Whilst new NHS infrastructure is always welcome, to deploy public sector capital to replace this ‘lost’ capacity would also be a complete waste of capital since private sector facilities are already operational with the NHS paying private providers the same tariff price as the NHS for the procedure.
So as the debate around the private sector’s role in the NHS hots-up, it is worth all commentators delving as deeply as possible into the detail, to ensure that the impact on NHS patients is fully understood.