Free at the Point of Delivery
Where should we stand on the creeping privatisation of the NHS? The question is topical because the Hastings Independent recently received a request to run an advertisement for a private GP service in Hastings. The view of the Editorial Management Committee was that this would be contrary to the paper’s ethos. But they also felt that the question should be debated. So here are some thoughts garnered from various people connected with this paper – readers, writers and volunteers. They do not represent an editorial line or policy – there is none – but rather seek to open a discussion for readers.
Seventy-Five Years On
The National Health Service was established in 1948 as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery – a health service based on clinical need, not ability to pay. Right from the start, though, an element of private medicine was incorporated. In order to get consultants to agree to participate in a national service, Health Minister Nye Bevan had to, in his own words, “stuff their mouths with gold”, allowing them to continue to run a private practice alongside their salaried NHS job. Over the past 75 years, private health insurance groups like BUPA have proliferated. Today around 22% of UK adults have private insurance, and one fifth of all health provision in the country is from the private sector. The Thatcher government introduced competitive tendering and outsourced ancillary services such as porters, kitchens and cleaning. John Major introduced an internal market and formed NHS trusts. The Conservative initiative of funding new hospitals via private finance was continued with alacrity by Tony Blair, who also allowed routine surgery to be contracted out to private hospitals.
Arguably it’s gone steadily downhill from there, and currently there are around 7.5 million people waiting for NHS treatment; nearly five million patients each month in England wait more than a fortnight for a GP appointment.
Can Private Health Care spread the load?
The fundamental question arises: does increasing private provision help or hinder a National Health Service free at the point of delivery? For instance, would a private GP service in Hastings free up NHS doctors to see more patients more quickly?
Here are some views of people associated with the Hastings Independent on whether it would be appropriate to run an advertisement for private GP care:
“Treatable mortality was linked to an increase in outsourcing of health services to the private for-profit sector, in a study last year by Oxford Social Policy researchers, published in the Lancet Public Health. In other words more deaths occur when you increase private health care at the expense of the NHS.”
“I don’t see how a private GP practice in Hastings which very few people would be likely to use could be seen to be undermining the NHS. Do we condemn private dentistry, given that there are not enough NHS dentists around and that NHS dentistry charges are massive anyway?”
“Outsourcing has always had a cost, and the dismantling of combined, comprehensive hospital care into lucrative, atomised private provision is more costly and less efficient. Never mind the associated loss of expertise and equipment to the wider organisation. Furthermore, the Royal College of General Practitioners is currently most concerned with costly screening and diagnostic services that are often offered by doctors in these companies with little to no therapeutic benefit, which then have to be followed up, wasting still more NHS resources.”
“If someone needs elective surgery like a hip replacement, is it really detrimental to the NHS if it’s done in a private hospital within two months instead of an NHS hospital within two years – but paid for from NHS funds? Doesn’t this ‘free-up’ an NHS hospital bed, rather than reducing the capacity of public hospitals? It’s almost impossible to discover how much private providers charge the NHS for such an operation, but it’s probably comparable to their own costs. The mixture of state and private medical provision works well in France. It could work here.”
“France, like the rest of Europe, has an insurance-based system. It’s not free at the point of need. One of the great innovations, and greatest benefit, of the NHS. Ireland for example has a 40 – 65 Euro charge for a GP appointment. France is about 30 Euros. Wait times are not substantially lower either.
“France runs a statutory health insurance (SHI) system providing universal coverage for its residents. ‘The system is financed through employee and employer contributions, and increasingly by earmarked taxes on a broad range of revenues. Pretty much like national insurance employer/employee payments in the UK. SHI covers about 90% of hospital care and those not on benefits tend to take out private insurance to cover the other 10%. But what does seem to work are the private laboratories and diagnostic centres which are generally available in most towns … and their charges are covered by SHI.”
“Yes, France does provide universal coverage. But unlike the NHS there is an expectation of payment for the provision of primary care. Which is the big difference. The UK government certainly has the same system in mind (for the time being) and we are seeing the associated increase of private laboratories and diagnostic centres. Where it is different is that France NEVER had what we had.”
“Without considerably increased funding, the NHS will continue to decline and more and more people will vote with their feet and go private if they can possibly afford to. The problem is that the electorate in Britain has shown over and over again they are not prepared to pay higher taxes … so where’s the money going to come from?”
“I think we can all agree, the NHS, and in particular GP services, have been intentionally run down to facilitate further incursions of private finance into UK healthcare. The use of private hospitals/clinics has been deliberately cultivated, to the detriment of NHS hospitals – with them losing experienced staff, materials, research and development. The Royal College of General Practitioners (RCGP) have, for decades, been warning about GP numbers as well as the reliance on older GPs nearing retirement only for successive governments to do nothing. Private GPs are not an addition to UK healthcare but a REDUCTION of the available doctors for the general public. I don’t think it is the ethos of this paper to participate in a policy that is injurious to the people of Hastings by assisting in healthcare vandalism.”
A number of participants asked to remain anonymous, so we decided not to use any names. We do seek more views on this subject however. Please email your thoughts or letters to [email protected].
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