Is the NHS being privatised?

This current election has seen people on edge about the potential increase of private providers in our National Health Service (NHS). Many of the electorate worry that if the Conservatives are elected, the NHS will slowly be syphoned off to the private sector with less provided nationally for free. Lifting up the bonnet of this particular political debate and having a peer inside, we become aware of the ability, or the necessity, of politicians, and those in their field, to use words or phrases without understanding what those words or phrases actually mean. 

Therefore, I thought it was necessary to begin by looking past the broad brush strokes of the sound bite headlines, and to dig into the minor details to understand just what is really going on with our NHS, and potentially what the future may hold. 

The figure that seems to be floating around concerning how much of the NHS is privatised (services and contracts out-sourced to the independent sector) is 7.3%[1]. This figure seems, to me, quite small in the larger reality of just how big the NHS budget is (around 113.8 billion per year). But, as David Rowland suggests, the reason for this figure seeming so small is because the Department for Health and Social Care(DHSC) calculates expenditure on the independent sector as a percentage of the total departments budget, not just NHS England.[2] This move distorts the figure to make the percentage seem smaller against a bigger budget – i.e. the DHSC budget is 129bn and NHS England’s budget is 113.8bn. A small difference, but when you are talking billions it can make a whole world of difference. And with that in mind, if we were to calculate the percentage spent on the private sector just out of the NHS England budget alone the figure of 26%[3] pops up. 

Wait a second though, hold your horses before you start blasting those stats all over Twitter. We need to look at the methodology. This is a point that divides many and debate still rages on about what you put in the numerator. By numerator, I mean what independent sector components are included when we consider how much of the NHS England budget is spent on the independent sector. 

Rowland explicitly states that his 26% figure has different components to those found in the DHSC accounts. First of all let’s touch on the denominator. As discussed, Rowland uses the NHS England budget rather than the larger DHSC budget. All is fine there, in my view that’s the way it should be. Our denominator is settled. 

But in Rowland’s numerator, he has included expenditure on all primary care services. This includes GPs, pharmacies, optical and dental services which are and have been provided by private providers for a long time. The reasons for them being provided privately is because they help individuals reach treatment more frequently, build on greater bonds within the local communities, allow for greater patient choice and can contribute to lowering waiting times. Both Labour and Conservative governments since the 2000s have contributed to expanding competition, in the form of PFI contracts under the Blair and Brown governments, but also the 2012 Health and Social Care Act introduced by the Conservative/Liberal coalition. This therefore is not just a one sided political affair and those on the right should not be lambasted with criticism.

To me it is not a bad thing to have some private choice, if the patient can receive the treatment free at the point of use why does it matter if it is the NHS or a private provider is providing the service? This then results in it being argued that including the expenditure on primary care services might not provide a truer reflection of how much of the NHS England budget is spent on the independent sector. If we remove the spending on GPs from the primary service figures (whilst leaving in spending on pharmacies, dentists and opticians), the percentage then falls to 18%.[4] A stark contrast between the revised 26% and also the DHSC original figure of 7.3%, which perhaps makes up a nice middle ground compromise figure. 

So what do politicians, and those in their field, mean when it is said that ‘the NHS is up for sale?’ This would come down to who you believe in this scenario, because there is obviously no 100% certainty about what the future may bring. I do think it is correct to add that completely syphoning off the NHS to the private sector, to American business or to anyone else that makes citizens pay for their healthcare is complete hokum. This would be political suicide and would be the end of any party should they take that absurd and ludicrous step. 

But according to the Nuffield Trust Health think tank, ‘A trade deal would not have the power to stop the NHS being a free, universal service.’ There is not ability here for the USA to reshape the funding of our public healthcare services. This, according to the Nuffield Trust, has never happened with countries who have public healthcare services who have entered into a trade deal with the USA. So what does the NHS being up for sale mean if it is not referring to the infiltration of our NHS by the American private sector, or any private sector? 

The website Full Fact suggests it perhaps could be in relation to drug prices[5]. Labour have put forward a £519 million pound additional cost each week if the NHS is opened up to a trade deal with the USA. This figure is generated by comparing how much more American’s pay for their drugs than those in the UK do. The Nuffield Trust and Full Fact suggest that this number is in an extreme case scenario and perhaps doesn’t hold much credence. This is because it lacks pragmatism, but price movements (all though it has never happened before with other countries and USA trade deals) should still be a concern if in any deal changes the ability the NHS has in its ability to bargin pharmaceutical prices.

So given this information, and I stress this is only some of what you can find on this topic, it is now your choice to decide whether you believe that the NHS is really up for sale. No one can be 100% certain what the outcome of our future will be, but that goes for most, if not all, of politics.

JL


[1] as per the Department for Health and Social Cares annual reports and accounts for 2018/19, which can be found here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832765/dhsc-annual-report-and-accounts-2018-to-2019.pdf

[2] https://blogs.lse.ac.uk/politicsandpolicy/nhs-spending-on-the-independent-sector/

[3] https://blogs.lse.ac.uk/politicsandpolicy/nhs-spending-on-the-independent-sector/

[4] https://blogs.lse.ac.uk/politicsandpolicy/nhs-spending-on-the-independent-sector/

[5] https://fullfact.org/health/500-million-nhs-drug-prices/

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