Stuff that makes no sense: privatisation in the NHS

Bringing private companies into the NHS is increasingly widespread. I think that must, logically, undermine the ability of the NHS to do what it is meant to do: make people healthier. 

It is expensive to treat ill people and make them well. And, indeed, sometimes more expensive to treat and support ill people who don’t get well. This is the major outgoing of the NHS. What is the major income stream of the NHS? Taxes. So the fewer people who are ill, the less money the NHS requires in taxes to treat them. Citizens are also, ultimately, in charge of the NHS, in that they choose the political direction that sets its policy. Bosses and backers: the people. 

Lots of illness is preventable, sometimes relatively cheaply. The NHS has an incentive to be part of that prevention, because the people who are ultimately both paying for it and in charge of it will have more money if illness is prevented. (Though we also have a society full of companies with an incentive to promote ill-health: the NHS can’t do it alone.) They also have an incentive to cure people quickly, effectively and with the cheapest effective treatments (though I’m not seeking to underplay the conflict that sometimes exists between those factors). Basically, when we’re talking collectively, at population level, the NHS’s stakeholders all want the same things.

Once you introduce a profit motive, there’s someone pulling in another direction. If a hospital has shareholders, they want money. Where will money come from? Bodies (live ones, we hope) in beds. Whose money? Well, the shareholders certainly won’t be paying out more in taxes than they get in profits.

Now, you can finesse things a bit by making contracts with private providers conditional on achieving health promotion aims. The NHS already does that with GPs, putting in a whole extra layer of bureaucracy to make private contractors behave a bit like a public service (doctor power having been the cause of the compromises in the structure of the NHS in the first place). But then, private providers won’t take on contracts that they risk not fulfilling. As we already know with other privatisations (say, Royal Mail), the easy, tasty, profitable plums will be pulled out and leave the bits of the pudding nobody else wants. And either we will have to maintain the public infrastructure to cover those things, or private contractors will name their price and/ or name what service we must find acceptable. Or, arguably, private contractors will fail to provide, and we will be left over a barrel with limited ability to punish them without punishing the public (anyone who’s tried living, travelling and paying council tax in Edinburgh in the last few years will be able to think of an example).

So there’s the USP of our NHS: we want to be well, and the system providing our care has a vested financial interest in us being well. I can’t see a reason to mess with that.


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