The medical journal, The Lancet has published a paper this month with the following heading:
The Summary of the piece is as follows:
Over the past 40 years, many health-care systems that were once publicly owned or financed have moved towards privatising their services, primarily through outsourcing to the private sector. But what has the impact been of privatisation on the quality of care?
A key aim of this transition is to improve quality of care through increased market competition along with the benefits of a more flexible and patient-centred private sector. However, concerns have been raised that these reforms could result in worse care, in part because it is easier to reduce costs than increase quality of health care. Many of these reforms took place decades ago and there have been numerous studies that have examined their effects on the quality of care received by patients.
We reviewed this literature, focusing on the effects of outsourcing health-care services in high-income countries. We found that hospitals converting from public to private ownership status tended to make higher profits than public hospitals that do not convert, primarily through the selective intake of patients and reductions to staff numbers. We also found that aggregate increases in privatisation frequently corresponded with worse health outcomes for patients.
Very few studies evaluated this important reform and there are many gaps in the literature. However, based on the evidence available, our Review provides evidence that challenges the justifications for health-care privatisation and concludes that the scientific support for further privatisation of health-care services is weak.
I added the paragraph breaks: there were none in the original.
Let me be clear about what this paper does not say. It does not suggest what form of state-supplied medical care might be best for a population. This is not, therefore, an article that by itself justifies the existence of the NHS in its current form.
That said, what the paper does suggest is that over a wide range of surveys, privatisation of whatever form of state-delivered healthcare there might have been has not improved health outcomes.
What the paper does, however, suggest is that the privatisation of previously state-provided services did deliver an improvement in the profitability of private healthcare companies. In other words, a clear winner from privatisation can be identified, but it is not the patient or the state that then funds the provision of privately supplied health services. Only health companies gain.
Is there, in that case, any reason for labour or anyone else to think that the answer to healthcare supply in the UK might rest with the private sector? The straightforward answer would appear to be, 'No, there is not.'
In that case, why are Labour so keen on using private medicine and privatising the NHS? Is it simply that the private healthcare lobby has got to them? Or is there more to it than that, about which we should know?
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“Is there, in that case, any reason for labour or anyone else to thnk that”……….gov finance operates like a corner shop & a gov can have a “maxed out credit card”.
In this case the meme is: private (health) efficient & good, public (health) inefficient and bad.
The UK public don’t read the Lancet & I can’t see the MSM (Daily Torygraph, Daily Heil or the Spectator (Football Hooligan?) publicising facts which go against 40 years of right whinge propaganda. LINO is “going with the flow” & finds it easier to ignore realities as outlined by the Lancet (or indeed the realities wrt gov finances), it is all too much hard work & uncomfortable – ………….waiter! I’ll have another glass of cognitive dissonance – make it a big one.
It certainly seems to be the case that investors in private healthcare are also ‘investing’ in Labour… https://inwhoseinterests.uk/category/labour-and-the-nhs/
I shudder to think how much NHS will be left after 5 years of a Starmer/Streeting Labour government. People who don’t have first-hand experience just do not realise how far ‘NHS’ is already down the road to being just a brand name.
As an example, I work in a hospital where already ~1/3 of all MRI scans are outsourced. The hospital management are enthusiastic about that because they see outsourcing as the way to deal with waiting lists. But if only the same money could be invested in in-house resources! It is clear that outsourcing undermines, not helps the NHS, by diverting resouces from where the could make the most impact and be the most effective.
Radiology outsourcing is being set in stone with the opening of CDCs, including in our town. These ‘Community Diagnostic Centres’ are set not to help the NHS, but just carry on creaming off the easy work and often doing a bad job at it. In our region, several radiology departments try to avoid sending all but the most straightforward work to the outsourcing companies, because experience has shown that they can’t be trusted to do a good job.
At our local CDC, due to be opening this year, the contract that has been agreed with the provider stipulates that only 2.5% of their annual workload is to be ‘complex’. They define complex as anything taking over 20 minutes! So the in-house teams become ever more saturated with more challenging work, the demand for which seems to only increase as the years go by.
Our working life is all about fire-fighting, trying to match limited capacity to ballooning demand. Working in the NHS really feels like we’re trying to bail out a sinking ship. The powers that be – the politicians and higher management that dictate the overall direction of the service – seem to have little interest in making the NHS work better, and are just using it as a conduit to channel public resources to the private sector.
So if privatisation results in a “worse health outcomes for patients”, why continue with it?
This is another neoliberal core belief: profits before people.
We can see why Labour want to continue with this — they’ve sold out.
“Labour front bench takes £650k from health privateers – more than Tories”
https://skwawkbox.org/2024/01/17/labour-front-bench-takes-650k-from-health-privateers-more-than-tories/
What was it Adam Smith said, he didnt like Landlords because whatever happened they expected to get paid and thats what Shareholders are expecting however poor the service their company provides
The NHS as many of us have known it since 1948 is the closest we have been to a truly socialist enterprise (barring of course the exceptions granted to consultants and GPs at the time of its creation). When you have spent a lifetime with such a system, where you never have to consider your family’s budget before you go to doctor, it comes as a shock when you experience the health systems abroad, or indeed the NHS in 2024. The value of health care free at the point of use is immense in maintaining a population healthy in body and mind, as the state does its job and takes care of us.
Why does the Labour party seem so keen to privatise the NHS?
Or you might ask:
When did the Labour party abandon any pretence of espousing socialist values?
As is becoming increasingly obvious, sick people can’t work. If the state refuses to pickup the costs of efficient healthcare, then wages/salaries have to rise to reflect the need to pay for it. Any suggestion these costs might be covered by a modest insurance premium can be discounted by observing the presence of the American insurance company Unum on these shores and a glance at their chequered history. Bearing all this in mind, manufacturers contemplating UK investment will obviously be discouraged and find themselves looking elsewhere. One assumes both present and incoming govts will be well aware of this and indifferent, suggesting what’s happening here is simply more looting of the nation’s resources with no thought given at all to the wellbeing of the electorate.
Politics is useless to us then.
So what’s next?
Further to my comment, if it comes out of moderation, I note that the vulture capitalists prefer the shop window of the NHS, with an army of lobbyists fending off the public, to a system where their pillage is exposed. That fiction is not to be sniffed at and is better than the US.
There’s always a politician on the make and on the take to help out. One even became US president, although it was his wife who was the initial lobbyist. His healthcare reforms* were written by the Heritage (sic) Foundation on behalf of insurers and copying the big pharma and insurer dominated Swiss system. *His banking reforms were written by Citi, who also drafted his list of cabinet members. That was not a surprise as he raised a record amount of Wall Street money for his presidential run and appointed a friend from school, not in the US, as Treasury secretary.
`Obamacare’ was indeed not ideal, but was perhaps as much as was politically achievable at the time. And it was crafted in a way that made it difficult to get rid of – Trump tried and failed.
This link – https://messaging-custom-newsletters.nytimes.com/dynamic/render
– gives Paul Krugman’s take on it. Do say if you think that’s wrong.
I looked at Daniel Hannam’s Initiative for Free Trade some years ago and saw a number of links, e.g. CATO Institute, Tax Payers Alliance and Heritage Foundation. I saw what Brexit was really about. Searching further I saw the Heritage Foundation claimed to have written two-thirds of Trump’s legislative agenda. It exposed the lie that Trump was interested in helping ordinary people-just exploiting their often genuine grievances. Brexit too.
Thank you, Ian.
I was talking about Obama and his friend from school, Tim Geithner.
The donors make sure they own both sides of the aisle. There’s even a Wall Street funded think tank to facilitate, the Bipartisan Policy Center.
Alan Milburn circa 2002. Already in the pocket of health companies. All the corruption in LINO can be traced to the fountainhead, Blair/Mandelson, still running the racket today.
Thank you and well said, John.
The corruption at the heart of New Labour was breathtaking.
Some years ago, I was stunned to hear some Blairites belittle John Smith and Charles Kennedy. I felt Blairite corruption was much more serious.
Starmer’s Scammer Party sounds about right!
So still free at point of delivery for patients but what if NHS only pay private providers if and when health outcomes are achieved.
Pay for results
OK, tell me how you define results, most especially when vast numbers of people only need reassurance – or are told they are actually well?
Seeing a patient would be a definable result
Paying doctors for having a register of patients regardless of whether they are seen would bit a result.
The research paper you mention measures many types of definable results, that’s just an example although not from the paper.
You do realise that you have just suggested some of the elements on which GPs are paid, don’t you?
Why waste your time and mine suggesting what already happens?
But why would the state want to pay private providers/profiteers to do what the publicly owned and run NHS could do cheaper and better if only the government would invest in it?
As I understand it GP Practices have all been private since the day the NHS started, which leads me to ask …
Don’t the same issues apply to your local GP Practice and wouldn’t the NHS be better if GP Practices weren’t private?
Probably, yes. But you would need to employ a lot more doctors, because at present many GPs work excessive hours albeit that they enjoy quite high levels of remuneration, but not nearly as high as most people think once adjusted for the amount of time input.
Those favouring privatisation of healthcare constantly claim that the NHS is inefficient and has too many managers. When anyone has a look at the actual staff figures, just 2% of NHS staff are managerial bureaucrats, much less than any business. In the US healthcare system (if you call it that) 25% of all staff are apparently nonclinical managers/administrators, with billing patients being a large workload.
Of course in the NHS a large proportion of clinicans will have roles managing others, whether the senior nurse on a ward, the senior consultant in a specialty, or the GP principal in primary care. But that would be true in any healthcare system, and their jobs are about managing provision for patients, not managing the organisation.
Whether the NHS is actually inefficient is a different question, I would argue it is insufficiently effective – largely due to being underfunded. For example, if every hospital bed is occupied and there is a queue to re-occupy each bed when it is vacated you could argue there is maximum efficiency. But it isn’t very effective at dealing with the needs of the population for hospital treatment, and as we discovered with Covid it has no flexibility in a crisis.
Private health care usually means taking out supplementary private insurance even if you’re retired and past the statutory age to receive a state pension. The problem is these private health insurance companies are always looking to whittle down your right to full coverage in order to maximise profit and minimise risk. Healthcare needs to be available as full coverage period and not subject to greed or risk uncertainty.
Secondly, the cost of healthcare for government is entirely dependent upon how tough a government is prepared to be. In the United States, for example, the American Medical Association annually submits uplift figures for a long list of medical procedures. This is largely rubber stamped by the Health Department at federal level. This is a significant factor why American healthcare costs are double that per capita of the UK.
I was 6 days short of my 8th birthday when the NHS was declared open for business. I well recall listening to the BBC covering the the opening with my Mum. She wept tears of joy . The working class had good reason to welcome the service. She had experienced life in the Thirties under the Tories. The Tories have always hated the NHS because it is socialism in action and it worked. The defunding of the service has been happening for a long time . Read the history since 1979 when our country began its descent from social democracy which had given us the Golden Age. Full employment for the very first time in history. I didn’t realise that was the first and only period of full employment. I am now in my 84th year and I have never seen it again. When the Tories took office in 2010 the funding was 0.8% each year. 4% was the the expected norm. The service must have been defrauded of billions in those years alone. To accuse people of lying about defunding is ludicrous. My daughter has just retired from nursing. My niece is a senior nurse in Blackpool. They inform me of the state of the service they love. Their wages have been held down for years. The pension scheme has been changed fotr the worst. The first half of my life was a time of hope. The latter half has been a time of despair . The younger generation have nothing like the advantages I experienced I expected the Labour Party to change things for the better. There was a glimmer of hope when Corbyn was leader. Alas, that was dashed by a tissue of lies about antisemitism etc coming from the Establishment. I was a member of the Party for over 6 decades. I mourn the abandonment of democratic socialism
Thanks