A report published today by 2020health shows that 1 in every £4 of NHS spending is already in the private sector. Looking at figures from Labour’s last year in office (2009-10), it shows that the NHS is already operating an extensive mixed economy of public, private and independent providers of health care.
Today’s report “Business and the NHS” is the first of a series of reports that will be produced by 2020health in the coming months on the subject of Healthcare and the Economy. The aim of the first report is to clarify the current state of the NHS in terms of commissioning and provision and to set out the facts about what is being proposed by the health bill. Whilst many hospitals are still run in the public sector, a large part of primary care and mental health care, and other industries vital to the running of the NHS, including all pharmaceuticals, clinical equipment and some diagnostics are done in the private sector.
The difficulty with communicating this message lies in the misunderstanding by the public of what constitutes the NHS. For example, whilst GPs are widely viewed as part of the NHS, they are in fact independent businesses. In fact GPs have the best of both world, with an NHS contract which guarantees them benefits such as the NHS pension, but the freedom to run their practice as they see fit and to make a profit.
Given the large dependence of the NHS on the private sector, it is nonsensical to speak of the dangers of ‘privatisation’. Before the debate can progress to a finer consideration of the details of the Health Bill, we need to understand that the private sector is not the enemy of choice but an important contributor to the health service.
Many people have expressed concern that the health bill will change the balance of collaboration and competition. Issues like this will be dependent on the quality of the commissioning. Private providers are able to collaborate where required by commissioners. Rather than arguing over private or public we need to work on ensuring that clinical commissioning groups are well set up and have the support required to commission the best possible service for patients.