Private v. Public in the NHS – isn’t it time the debate grew up?

David Madden

Yesterday’s reports that a recently proposed amendment to the Health & Social Care Bill could see National Health Service foundation hospitals allowed to raise nearly half of their funding through private work have generated predictably stormy responses.

From Shadow Health Secretary Andy Burnham’s accusation that the proposals were further evidence of ‘David Cameron’s determination to turn our precious NHS into a US-style commercial system, where hospitals are more interested in profits than people’ at one end, to the Daily Mail’s dismissal of his statement as ‘autopilot opposition’ at the other, we saw yet more evidence of the highly emotional responses common to any discussion about the relationship between the NHS and the private or independent sector.

The debate has become increasingly strident in recent months as we struggle with the challenges imposed by economic austerity.  Yet the relationship between the NHS and the independent sector is actually a long standing and successful one.  Most people think of their family doctor as the living embodiment of what the NHS stands for – the professional you go to see when you or a loved one is unwell, and who provides you with medical care and advice at no direct charge.  Yet the vast majority of General Practitioners are, in a very real sense, independent providers.  They are self-employed (and often very well remunerated) contractors working with the local NHS Trust.  In fact, less than 20% of GPs are directly employed by the NHS.

The NHS will celebrate its 64th birthday in July 2012.  Aneurin Bevan’s three core principles: that it meets the needs of everyone; that it be free at the point of delivery; and that it be based on clinical need, not ability to pay remain at the heart of the service.  The NHS’s principles and aspirations are respected around the world (except perhaps by a few Republican presidential hopefuls in the US…), yet it faces many different challenges in the 21st century.

When the NHS was first established demand was substantially greater than anticipated (and budgeted for), because so many people had been living with untreated acute conditions.  In 2012 the service faces new challenges; a dramatically higher proportion of people with illnesses and conditions associated with obesity, substantially increased life expectancy and the availability of many more treatments, at a cost, to name just three.  So, how are we going to pay for it all?

There is only so much money in the pot to spend, yet there is an increasing level of demand.  Cost savings can and are being made through increased efficiency.  But NHS services should be free to derive additional revenue from private patients as long as it does not impact on those core duties so clearly expressed in 1948.  At the same time, for many specialist services, independent providers offer treatment and care of a higher standard and more cost effectively than their NHS peers.

We are rightly proud of a National Health Service that provides healthcare free at the point of delivery for us all.  It needs to be protected and it needs to be paid for and the utilisation of spare capacity to generate revenue through the treatment of private patients is one sensible way of achieving this.  We should be equally proud of those independent providers who support the NHS, who deliver healthcare services of the highest standard efficiently and effectively, and who have been doing so in partnership for many years.  They all have a critically important role to play in supporting the NHS in the future, not undermining it.

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