NHS set to spend £4.5bn on private care
The National Health Service is poised to spend £4.5bn a year - approaching 6 per cent of its budget - on privately provided clinical care and facilities management as the second wave of independent treatment centres and new diagnostic facilities come on stream.
But there could be a significant expansion in private provision once the government's white paper on care outside hospital is published next year.
Over the past few days Patricia Hewitt, the health secretary, has been holding the most surreal of conversations with her critics.
The government is in the process of awarding to the private sector contracts worth billions of pounds over the next few years to treat hundreds of thousands of NHS waiting list patients.
This, the British Medical Association, Unison, the biggest health union, and others, say is privatisation. Nonsense, says Ms Hewitt.
So who is right? Is this a privatisation of the supply of NHS services? Of course it is. But is it privatisation of the National Health Service? The difference, of course, is between supply and demand.
Supply is undoubtedly being privatised in that these operations will be provided by the private sector, either using staff from overseas, or NHS employees seconded to work for the independent contractors who, in some cases, will take over NHS premises for the duration of the contract.
These assets are not being sold to the independent operators so, in that narrow sense, this is not a privatisation on the lines of say BT or British Gas. But in any normal sense of the word it is a clear privatisation of supply.
What it is not, however, is privatisation of demand. Patients will not pay. Treatment will remain free at the point of use.
The heart of the argument lies in what people believe to be the founding principles of the NHS. Are they merely that it is a tax funded system, largely free at the point of use? In other words, as Gordon Brown, the chancellor, has put it, the best health insurance system in the world? Or do the founding principles go way beyond that and require it to be a monopoly state provider of services as well?
The truth is, it has never been the latter. Even today, although they may not always behave like it, 70 per cent of family doctors are independent contractors, not salaried employees - and they always have been.
About 65 per cent of the NHS budget goes into wages (including GPs' pay). But most of the remainder goes into the private sector. The service spends about £8bn a year on pharmaceuticals - and no one has suggested since the early 1960s that the pharmaceutical industry should be nationalised. It buys huge quantities of other supplies from the private sector - beds, buildings, medical equipment and much else. And for well over a decade now it has been buying a growing range of clinical care from independent sector suppliers.
Indeed, one of the oddest aspects about the current row over waiting list operations is that there has been no such fierce political dispute over the way the NHS has handed over significant chunks of care for some of its most vulnerable patients to the independent sector.
Last year it spent about £360m on privately supplied mental health services - much of it on medium secure accommodation for people who are compulsorily detained under the mental health act.
Some £400m was spent in private and voluntary nursing homes on people with long-term conditions: patients who have ceased to be "curable" but who require permanent intensive nursing. Both these groups are far more vulnerable than the average patient needing a waiting list operation.
And there is no comparison with what has happened to NHS dentistry and long-term care. There, patients unable to find an NHS dentist (thanks to a cock-up over a contract meant to improve NHS dentistry), or whose long-term care has been shifted out of the NHS to means-tested social services, now have to pay. That is privatisation of both supply and demand.
The drive to use independent diagnostic and treatment centres is merely privatisation of supply.
The truth is that for many health policy analysts, along with Tony Blair, Patricia Hewitt and her predecessors, and maybe even Gordon Brown, it has become perfectly possible to conceive - at least in theory - of a National Health Service that is entirely privately provided but which remains true to its founding principles because it remains largely free at the point of use.
That is not going to happen, at least in any foreseeable future. But it does mean the debate now should be about whether patients are getting high quality care at good value for money for the taxpayer, whether from services owned and run by the NHS, or from those privately provided to it.
But there could be a significant expansion in private provision once the government's white paper on care outside hospital is published next year.
Over the past few days Patricia Hewitt, the health secretary, has been holding the most surreal of conversations with her critics.
The government is in the process of awarding to the private sector contracts worth billions of pounds over the next few years to treat hundreds of thousands of NHS waiting list patients.
This, the British Medical Association, Unison, the biggest health union, and others, say is privatisation. Nonsense, says Ms Hewitt.
So who is right? Is this a privatisation of the supply of NHS services? Of course it is. But is it privatisation of the National Health Service? The difference, of course, is between supply and demand.
Supply is undoubtedly being privatised in that these operations will be provided by the private sector, either using staff from overseas, or NHS employees seconded to work for the independent contractors who, in some cases, will take over NHS premises for the duration of the contract.
These assets are not being sold to the independent operators so, in that narrow sense, this is not a privatisation on the lines of say BT or British Gas. But in any normal sense of the word it is a clear privatisation of supply.
What it is not, however, is privatisation of demand. Patients will not pay. Treatment will remain free at the point of use.
The heart of the argument lies in what people believe to be the founding principles of the NHS. Are they merely that it is a tax funded system, largely free at the point of use? In other words, as Gordon Brown, the chancellor, has put it, the best health insurance system in the world? Or do the founding principles go way beyond that and require it to be a monopoly state provider of services as well?
The truth is, it has never been the latter. Even today, although they may not always behave like it, 70 per cent of family doctors are independent contractors, not salaried employees - and they always have been.
About 65 per cent of the NHS budget goes into wages (including GPs' pay). But most of the remainder goes into the private sector. The service spends about £8bn a year on pharmaceuticals - and no one has suggested since the early 1960s that the pharmaceutical industry should be nationalised. It buys huge quantities of other supplies from the private sector - beds, buildings, medical equipment and much else. And for well over a decade now it has been buying a growing range of clinical care from independent sector suppliers.
Indeed, one of the oddest aspects about the current row over waiting list operations is that there has been no such fierce political dispute over the way the NHS has handed over significant chunks of care for some of its most vulnerable patients to the independent sector.
Last year it spent about £360m on privately supplied mental health services - much of it on medium secure accommodation for people who are compulsorily detained under the mental health act.
Some £400m was spent in private and voluntary nursing homes on people with long-term conditions: patients who have ceased to be "curable" but who require permanent intensive nursing. Both these groups are far more vulnerable than the average patient needing a waiting list operation.
And there is no comparison with what has happened to NHS dentistry and long-term care. There, patients unable to find an NHS dentist (thanks to a cock-up over a contract meant to improve NHS dentistry), or whose long-term care has been shifted out of the NHS to means-tested social services, now have to pay. That is privatisation of both supply and demand.
The drive to use independent diagnostic and treatment centres is merely privatisation of supply.
The truth is that for many health policy analysts, along with Tony Blair, Patricia Hewitt and her predecessors, and maybe even Gordon Brown, it has become perfectly possible to conceive - at least in theory - of a National Health Service that is entirely privately provided but which remains true to its founding principles because it remains largely free at the point of use.
That is not going to happen, at least in any foreseeable future. But it does mean the debate now should be about whether patients are getting high quality care at good value for money for the taxpayer, whether from services owned and run by the NHS, or from those privately provided to it.
posted by Dr Search- Principal Consultant at the Search Clinic at
8:48 AM
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