Introduction
The NHS is being privatised through a deliberate programme of:
- Outsourcing a full range of clinical and non-clinical work including: cleaning, laundry, catering, building maintenance, ambulances, Urgent Care Centres, pathology, radiology, sexual health and other community services. (See NHS For Sale? for details)
- The Private Finance Initiative (PFI). See the Private Finance Initiative (PFI) page on this website.
- Contracting out elective surgery to private hospitals and clinics especially for hip replacements and cataracts and to reduce the huge NHS waiting lists.
- Reorganising GP surgeries to make them profitable for private companies to take over.
- Reductions in funding are part of the process as they force cuts on NHS hospitals. This encourages people to take out private medical insurance while preventing hospitals from expanding capacity to meet public need. It is a mistake to see funding as an issue separate from the whole planned process of privatisation (see History of NHS privatisation below).
The aim of opening up the NHS for profiteers to cherry pick what they want has dictated all the government policies on the NHS since the 1980s – whether Labour, Conservative or Lib-Dem/ Conservative governments.
WE SAY: Renationalise the NHS!
- Nationalise all private hospitals and private clinics which are or have been taking NHS patients;
- Bring all services, clinical and non-clinical back ‘in-house’;
- Nationalise the consortium of investment companies which operate the PFI contracts;
- End the use of representatives from private companies on the boards of all NHS committees, boards, enquiries etc;
- Make health and social care a political priority so that funding is directed to a major increase in capacity: of staff, beds and equipment, this to be a achieved through a publicly owned and operated National Care Service (see Social Care);
- Establish an NHS manufacturing capacity in drugs, medical equipment and surgical appliances. This would end the profiteering from the NHS in these sectors as well as insuring Britain against supply insecurity.
The Extent of Privatisation
A 2018 calculation estimates that £29 billion or a quarter of the NHS England budget is on non-NHS providers – the so-called ‘independent sector’. If spending on primary care (GP practices, optical, dental and pharmacy services) are excluded the figure reduces to 18%. Given the growing extent of private takeovers of GP surgeries the higher figure is increasingly relevant.
These figures do not include annual unitary charges for PFIs – which is currently £2 billion. More recently it has been shown that privatised health services treat 10% of patients compared with 3% in 2011.
A high and rising proportion of NHS expenditure is effectively fragmenting NHS provision and creating additional expenditures on ‘transactional’ tasks such as tendering, negotiating and monitoring contracts.
In addition, instead of increasing NHS capacity to deal with Covid and the waiting lists for operations, special deals have been negotiated with private hospitals. A £2 billion deal during Covid was the first major example of this and it is now a continuing process. In 2023 the NHS paid nearly £2 billion to private hospitals and clinics to treat NHS patients. One third of all ‘episodes’ handled by private hospitals and clinics are funded by the NHS.
The Labour government recently announced a longer term ‘new deal’ which would increase the number of operations, appointments and scans performed in private hospitals by 1 million. This is a 20% increase on the existing 5million such treatments. In return the private sector will receive an extra £2.5 billion per year.
What has been privatised?
The private sector charry picks those parts of the NHS which are relatively straightforward and from which it can make a good profit. Hence certain sectors have been heavily privatised such as hip operations and ophthalmology. They exist in:
- ‘back-office’ functions including a massive contract for handling NHS data;
- building and maintenance, cleaning and other ‘non-clinical’ services in hospitals, (both through PFI contracts),
- A range of operations and procedures especially cataract and hip operations, diagnostic tests such as blood tests and CT scans;
- ambulances,
- mental health – the NHS pays £2 billion a year to private hospitals for mental health patients;
- community healthcare such as health visitors and sexual health, including a recent contract of £300 million per year awarded to a private equity company by Bath and Somerset health board;
- GP surgeries are increasingly being privatised.
To browse further details of these see NHS For Sale? website
The impact of privatisation
It robs the NHS of vital funds – instead these are directed to private profit and administrative costs within the NHS. The process has been on-going for decade. We Own It calculates that £6.7 billion, or £10 million each week, has left the NHS’s budget in the form of profits on all private contracts given by the NHS from January 2012 to May 2024.”
It leads to poorer care: – an Oxford university study in 2022 concluded that “Private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services.”
Hospitals cleaned by outsourced companies are dirtier and patients therefore contract more hospital-acquired infections.
Cost-cutting puts patients at risk: private providers are viewed as a cheaper solution by cash-strapped hospitals. But that cheapness is achieved through cutting costs – in particular wages and standards.
Private companies FAIL to deliver: Serco failed to deliver the Test and Trace programme, Carillion failed to deliver a unified primary care support service.
Companies can walk away from a contract if they find it unprofitable of if they face financial collapse.
Corruption arises where politicians have interests in private healthcare companies: the National Audit Office has shown that “companies with political connections were ten times more likely to be awarded a contract than companies that did not have such connections”. Members of Labour’s Cabinet have received £500,000 in donations from lobbyists and others with links to private healthcare companies.
See also: Kick Private Companies out of the Public Health Service! html pdf