The faults with large, state-owned organisations are well-documented and too great to describe here, and so are the problems associated with having a fully market-based attitude to healthcare (just look to the US). However the debate surrounding NHS spending gives a false choice to patients and the public between the two and understandably leads most to conclude we must accept the fully public model of healthcare and ignore the problems people have when using its services; even at its peak only 64% of people were either ‘satisfied’ or ‘very satisfied’ with it according to the British Medical Journal, meaning over a third of the population is dissatisfied. Yet the calls to try and improve NHS satisfaction for patients are frequently drowned out by anger that £10 billion of the NHS budget is spent on contracts given to non-NHS bodies and how this is evidence of ‘privatisation by the back door’. With a budget of £110bn this 9% of spending on outside sources either disproves the idea the NHS is being ‘privatised’ (a term now thrown around haphazardly to try and stir up anger felt during the Thatcher era rather than try and find fault in any proposal) or demonstrates a degree of ineptitude even David Cameron’s fiercest critics would find hard to believe, a privatisation which saw the government maintain over 90% of services would have to be described as a failure.
If one digs deeper into such websites and reads why the use of the private sector is wrong arguments such patients not having sufficient knowledge to make informed choices and competition leading to the closing of NHS services and job cuts are typically made.
The argument: ‘competition leads to patients having to make choices; patients currently do not have enough knowledge to make such choices therefore competition must not happen’ is non-sequitur, this argument actually suggests that patients need to be given fair, impartial and understandable information before they make any choice. In the age of the internet the NHS website could easily achieve this, publishing patient satisfaction levels for each service as well as the safety record of each provider and reviews by patients themselves; similar to how I Google reviews to restaurants and look at its food hygiene certificate before I book a table. This use of competition allows the best healthcare experience to become the most popular and ensures NHS funds are channelled in a manner that patients want, rather than simply having one provider we must use for free regardless of how satisfactory it is or pay for private healthcare; the real elitist system which gives the best healthcare to the few. If the NHS is really the single best provider of this service then even those suspicious of private sector involvement need not worry, patients will use the NHS service and private companies who have given poor service will leave the field or try and beat the NHS – either way this benefits patients.
The second point that the use of private sector threatens current jobs and services; well this is just an idiotic reason to not do something. No person – especially one with a taxpayer funded job – should be immune from losing their job for the sake of progress simply because this would negatively affect them, this just helps breed inefficiency and does not bode well for the taxpayer of tomorrow (i.e. my generation) if we are to be expected to continue to fund services people do not want or need so as to prevent people having to enter the job market and look for a placement which benefits society. Indeed this argument could actually be turned round on NHS for Sale and the like – why should those currently employed by the NHS via private firms lose their jobs if the government – as they wish – reverses the ‘privatisation’ they deplore?
Thus I stand in the bizarre position of being against the actual privatisation of the National Health Service but, apparently, being in favour of ‘privatisation’, that is the involvement of non-NHS providers of healthcare at the government’s expense. This rhetoric – now employed by the Labour Party’s health spokesman Andy Burnham despite him being in the dubious position of being a member of a government that doubled private sector involvement in the health service – does not benefit patients or our democracy, seeing ‘spin’ overtake the facts in political debate; the single most infuriating part of 21st century politics. Unfortunately this appears to be a successful tactic; I recently overheard someone in a coffee shop asking when ambulance drivers would hold credit card readers, and so we can expect a real debate on how the NHS will deal with an ageing population and tight budgets to remain elusive.