Our critically injured public services beg for help, but the totem signifying the state of the nation will always be the NHS. The monthly waiting time reports on ambulances, the state of A&E, the wait for cancer or GP appointments: all take the nation’s pulse.
The latest figures showed a twitch of improvement. Can a government only 100 days old claim any credit? Alastair McLellan, the editor of the Health Service Journal, suggests it probably can, as health trusts accelerate activity. But, he says, the £3.2bn elective recovery fund that pays for weekend and evening operations is running dry. Hospitals say they could do more, but only with cash for staff overtime.
Into that arena comes an insidious player, apparently bearing gifts: the private sector big beasts, who have written to the chancellor and the health secretary offering £1bn investment towards clearing the backlog with new surgical and diagnostic units. The Independent Healthcare Providers Network, including Bupa, Circle Health Group and Care UK, proffers 2.5m treatments, “starting in weeks”. So what is that: a gift horse or a Trojan horse? Health secretary Wes Streeting approaches it gingerly. He’s right to.
His team says they wouldn’t turn it down out of hand for ideological reasons. But the nature of these contracts tells us that a £1bn investment expects a handsome payback in solid long-term contracts guaranteeing fixed tariffs and supply of patients. That sounds mightily like a new PFI straitjacket; on PFI, Streeting’s team says: “We learned our lesson last time.” Streeting has red lines: no contract with any private hospitals poaching NHS staff, a tall order since only the NHS trains staff; intensive care beds for difficult cases, no more cherrypicking the easy ones; and any deal must be value for money, which they say “it wasn’t in Covid”. Most private hospitals are in affluent areas: they must treat those in hard-pressed places. While the NHS still has capacity to do more if it gets the money, private care would only be short term in some places. There are myriad issues here, not least that locking into long hospital contracts defies Streeting’s plan to shift patients out of beds and into the community.
Tony Blair used private treatment centres to help cut waiting to its lowest ever, but in dealing with orthopaedic services the private sector charged 11% more, treated younger, richer patients and filled fewer beds than NHS rapid throughput centres, according to the BMJ.
Against this backdrop comes another self-interested bid to profit from the NHS in distress. The British Chambers of Commerce has appealed to the chancellor for tax breaks for private health insurance offered by employers, now taxed as a perk. It is dressed up as a way to stop people falling into sick leave, to “end the worklessness crisis”, but the answer is a flat no. “All public money goes to NHS patients,” says Streeting’s team. Still, they expect the Tories to campaign for it anyway.
To see how private healthcare can undermine the NHS, the fate of ophthalmology under the Tories is a salutary warning: the Centre for Health and the Public Interest finds that outsourcing cataract operations left many NHS eye departments barely viable, losing profitable, less complex operations while left with the complex, expensive work. Staff were stolen and too few routine operations remained to train new eye surgeons.
But there is a great example of reversing that trend. The Maidstone and Tunbridge Wells NHS Trust is one of several hospitals now insourcing from the private sector. Its chief executive, Miles Scott, has just bought a local Spire Healthcare private hospital, renamed Fordcombe hospital, to treat all long waiters in a region that has one in eight people on waiting lists, including thousands waiting more than a year. He persuaded NHS England to pay the £10m. What’s the advantage, I asked? “It was staffed mostly with our doctors, taking simple cases, but sending us back any that went wrong, as they had no critical care. Now we can take 2,500 long waiters. It’s cheaper and better,” he says, with all the staff reemployed by the NHS.
Bath is one of several others that are insourcing private facilities. Chancellor Rachel Reeves said she would unleash the “biggest wave of insourcing in a generation”, while Streeting warns of a “broken” NHS reduced to a “poor service for poor people” if too many go private. How afraid should we be? So long as he sticks to his red lines, not very.
Private healthcare talks a big game, but it’s a minnow alongside the NHS. Despite Tory intentions, NHS cases sent to private hospitals for elective procedures such as hip and knee replacements only rose modestly from 8% pre-pandemic to 10% last year, says the HSJ, and patient flight to the private sector is less than feared.
The Health Foundation charity reports minor increases in people buying private health, mostly for hip replacements. Despite soaring waiting times, there was no “major surge” in private procedures, which only rose from 7.4% pre-pandemic to 8.3% last year. Nor is there a “statistically significant change” in numbers saying they might pay for private healthcare or insurance, consistently less than one in four people. The number of people actually buying care or insurance “has remained relatively stable, at around one in seven people”.
Wooing the government, the Independent Healthcare Providers Network website boasts, “Going private is becoming the new normal”, but it really isn’t. If Labour greatly improves the NHS, as every Labour government has, if all extra funds go to extra NHS work, the private sector will fail to undermine the ethos and values of the NHS. The public holds on to them with remarkable determination. It always has, it always should.
Polly Toynbee is a Guardian columnist
