Privatisation or Outsourcing in the NHS: A Philosophical Dilemma

Posted by :
Adam Preis
Friday, 18 May 2012 - 2:11pm

As we are all no doubt aware, the passage of the Health and Social Care Bill on 20 March 2012 (by a slim majority of 88) represents an important milestone in the evolution in the future design and delivery of primary care health services.  One (of many!) interesting arguments during the long drawn out, marathon-like legislative process was, and continues to be, as the below linked article from The Guardian suggests, about the supposed ‘privatisation of the NHS by stealth.’ 

 

At the extreme fringes of the progressive argument, the Health and Social Care Act appears to shift the responsibility for commissioning primary health services to Clinical Commissioning Groups (often described as ghastly entities daring to challenge the sacred principles the NHS was founded on), and invite  private sector health providers to help GP practices manage, and thus (so the argument goes) outsource this new found responsibility to organisations that wield by far a greater understanding of the commissioning process.

 

The counter argument put forward market liberals, adopts a diametrically different outlook for the NHS: one beset demand-led and demographic challenges, that cannot be met by a seemingly  monopolistic system, which doesn’t create space for competition between service providers, and one which therefore fails to guarantee quality and cost-effectiveness.

 

This argument throws confused patients into a mist of confusion and frustration, reminiscent of the frustration felt by US citizens during the economic recession of the early 1990s where a would be Presidential contender by the name of Bill Clinton once said 'it's the economy stupid!' to forever change the face of US political dynamic.  One can hardly be surprised that most tax-payers in England (perhaps excluding those who benefit from private medical schemes) are voicing a similar disdain whilst confidently shouting: ‘it’s the patient stupid!.’

 

This short blog does not explore this argument in depth, for if it did, it would most likely turn into an extensive research paper.  Read more about this debate by following this link, and decide where you fit within this discourse, or if you want to join other patients and scream out loud: 'it's the patient stupid'!

Comments

NHS reforms

Submitted by Anonymous on Tue, 2012-05-22 14:46.
I think the thrust of the article above is that it doesn't matter if private providers are brought into the NHS, so long as the service remains the same. Also we need private providers to get the costs down. If this were the case, I'm sure there would not be the torrent of objection that the Health and Social Care Act (HASCA) has invoked from professionals and the public alike. Let's deal with the cost aspect first. There is no evidence that bringing in the private sector will reduce costs. America spends something like $7000.00 per capita on healthcare, compared to $3000.00 in the UK. This figure is hides the fact that 25% of Americans are either not insured or are underinsured. Ie if they were all insured to the level of the UK the per capita spend would be even higher. Professor Colin Leys estimates that HASCA will add 20% to the cost of providing healthcare. We'll never know for sure because all the contracts with the private sector are secret (covered by comercial confidentiality). The Act has to be seen in context with the cuts to the NHS, the so called 'Nicholson challenge', purporting to be 'effiency gains' but actually resulting in cuts to the service. According to the Financial Times (I can't give links hence no references -- sorry) the government is planning to cut the NHS budget by 30% if it wins the next election. Together with the Nicholson challenge (20%) and the extra costs due to privatisation, we are looking at something like a 70% cut in the NHS budget over 10 years. That's right 70%. So when you go to your GP (which you'll probably have to pay for) he'll tell you that they don't do hip replacements anymore (in fact he might even be telling you this now) and you'll have to pay. In fact you'll have to go to one of those private hospitals that have been fattening up their portfolios with public money in the interim. In other words we will end up with an American style system. I think you should be changing the slogan from 'It's the patient stupid' to 'It's the transnational corporations profits stupid'. The latter has the merit, at least, of being the truth.

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