The involvement of the private sector in the NHS has already had awful consequences, but Labour seems determined to expand the failed privatisation model, explains Graham Kirkwood

Last week’s publication of the ten-year health plan for England set out a stark choice for the NHS: ‘reform or die’. The plan promises ‘transformational change that will guarantee its sustainability for generations to come.’

Three ‘radical shifts’ are promised: hospital to community; analogue to digital; and sickness to prevention; in addition to a promise to narrow health inequalities. Science and technology will be central to these shifts.

Also central will be the involvement of the private sector in the delivery of even more NHS services. The plan states, ‘We will continue to use private providers to improve access and reduce waiting times, to return the NHS to its constitutional standards. As we outlined in our Plan for Change, we will not let spare capacity go to waste on ideological grounds. We will continue to make use of private sector capacity to treat NHS patients where it is available, and we will enter discussions with private providers to expand NHS provision in the most disadvantaged areas … Our use of a plurality of providers – from within the NHS, the voluntary sector, the independent sector or social enterprise – will not be limited to elective care.’ 

Elective surgery

Since 2003, the private sector has increasingly been used to provide treatment to NHS patients in England for planned (elective) surgery. The NHS pays the private provider to deliver the treatment at a cost agreed nationally.

In eye care, the total spend on cataract surgery doubled between 2018/19 and 2022/23. In 2022/23, more than half the £522 million the NHS spent on cataracts went to the private sector. Cataracts are relatively straightforward with patients generally treated as day cases. NHS hospitals had been able to use the money they were paid for cataract surgery to cross subsidise treatment for more complicated eye conditions. The transfer of cataract surgery into the private sector has had a negative effect on the provision of comprehensive NHS eye services. It is also impacting the training of surgeons within the NHS.

In hip and knee-replacement surgery, researchers have found a two-tier system developing with longer waiting times for NHS-funded patients treated within the NHS compared to those NHS-funded patients treated by the private sector. Patients treated within the NHS tend to be poorer with more additional health issues. The shift of surgery into the private sector is leading to a drop of in-house NHS provision and a widening of inequalities.

In addition, the researchers found an association between increasing privatisation and increasing waiting times. This may be because the market is responsive and as waiting times increase, private providers expand to bring waiting times down; or it could that as the share of the NHS-funded market provided by the private sector increases, waiting times increase in response. There are at least two studies by health economists which favour the latter explanation. There is also a study by researchers at Oxford University which found increasing levels of outsourcing in the NHS more generally was associated with an increase in deaths in the population.

At this year’s Jarrow Rebel Town Festival commemorating the ‘Seven Men of Jarrow’ who in 1832 were deported to an Australian penal colony for organising among miners, Mick Lynch, former general secretary of the National Union of Rail, Maritime and Transport Workers (RMT) said there hadn’t been a single privatisation which has made things better for the British public. Faeces in the rivers, overpriced, unreliable and declining bus services, a crisis in gas and electricity prices which required the government to step in to support customers, and failing rail companies are just some of the privatisation disasters we have seen. Why the NHS should be uniquely placed to benefit from privatisation is not addressed at all in the ten-year plan.