Have you ever had a discussion with someone who is a supporter of the NHS based on the ideal and not the reality? There is quite a few. It’s a difficult debate to have. The discussion usually begins with “privatisation!” It’s one word, but for the NHS idealist, it spells death, doom and destruction. You have to hand it to Unite and the BMA; they have so thoroughly brainwashed sections of the great British public, that with the mere mention of privatisation, people have an immediate Pavlovian fit. Such extreme physical discomfort immediately solicits the question from those who have not drunk the Kool-Aid, why is privatisation so bad? As you ask it, you might be thinking about the rich and the Royals who flock to private healthcare so they avoid the NHS. Why is private healthcare such a godsend for the privileged and well-heeled, but when it is available to the average man in the street free at the point of use and paid for by the NHS, it becomes a death trap? After you have placed them in the recovery position, by yourself because the doctors are on the picket line, and calm them down, the answer is usually one word. “Profit!” Profit? You mean the money companies make? The same money that pays my salary and with which I make my rent payments? Is that a bad thing? I wasn’t aware.
Someone who would want to discuss the problems of the health service in a balanced way might ask about the hundreds if not thousands of deaths in NHS hospitals attributed to neglecting the needs of patients. “Thousands!?!” “Propaganda”, they say dismissively, not that many made to die in their beds and anyway, it’s the fault of the “managers!” Not the people in the wards with day to day responsibility of care, like junior doctors? “Paperwork!” Again another revelation, the doctors and nurses were only sitting in the break room ignoring patients and their needs because managers forced them to do paperwork, sometimes they even stopped them from doing their job. Why, you ask? “Politicians!” Politicians in Whitehall? Exactly. Politicians create the policy that does not allow doctors and nurses to care for patients. I was taken aback, you mean a doctor will follow a policy even when it’s not right for the Patient and can cause harm or death? Don’t they have any self-determination or professional ethics they must follow? That’s very worrying, instead of applying a proven medical pathway learned over years of study and practice, doctors become babbling piles of easily manipulated jelly when faced with managers, politicians and policy which is detrimental to the patient. Now that is disturbing. No wonder you see so many expensive cars in the Consultant parking lots. They need the luxurious environment of a Bentley or Porsche for the drive home, so they can recover from the beating they take at work. This is much worse than I had imagined. If doctors are reduced to something akin to superbly educated and paid maintenance staff, no wonder thousands are dying from poor or no care.
Needless to say having a conversation around the privatisation question with someone who believes the service must be defended at all costs is frustrating. Unfortunately, those who have the most reason to question the care they did or didn’t receive while a patient in the NHS, have frequently died.
If we return for a moment to the privatisation is bad argument, we have to ask who in the private sector would want to own parts of the NHS? Okay, if we adhere to the theory that the industry is all bloodsuckers married to Tory MP’s, then buying the NHS shutting down all operations and pocketing the cash from the Department of Health may sound viable. The reality is that commerce doesn’t work that way and government payers are not stupid, and if you have a variety of providers and not an NHS monopoly, those providers would be forced to compete on quality and not just price. That doesn’t happen in today’s NHS; that’s why they can afford to ignore patients and not provide quality care, there are no other alternatives to a failing NHS hospital, we are forced to suffer below standard care if we are unfortunate enough to live in a troubled hospital’s catchment area. If you constantly received poor service or below standard goods from a business in your area, would you return, or simply go to a competitor? The suggestion that choice in healthcare doesn’t work is nonsensical. If you don’t beleive me ask the French. They have a significant amount of competition and one of the world’s best performing health systems.
My question remains, who would want to own NHS hospitals? Many are dysfunctional, inefficient and provide substandard care. They are also money pits because of the dysfunction and lack of reform. Circle Hospitals, a private healthcare company that operates and owns state-of-the-art surgical centres, bid for and won a contract to run Hinchingbrooke NHS Hospital, a failing trust not far from Cambridge. Instead of starving Hinchingbrooke of cash, Circle injected some millions into the hospital to raise performance and clinical quality. They incentivised staff financially for above average performance, and introduced employee ownership not unlike the John Lewis Partnership. After several years of significant losses, Circle had to step out of the contract with the Department of Health. They were unable to make an impact on the culture within the surrounding NHS network. The other hospitals Circle runs are new and efficient facilities controlled and owned by the company. They supply high-quality care to patients from both private pay and the NHS. Their patient satisfaction ratings are consistently better than NHS facilities. Their failure raises some interesting questions and answers a few others. Far from sucking cash out of Hinchingbrooke, Circle injected money. The statement by those who don’t want to see the NHS change, that private companies are in healthcare just for the money, is false, a lie. Injecting top level management and money were never going to change behaviours at the coalface. From the standpoint of the privatisation fear mongers, Hinchingbrooke was the worst of all worlds, and therefore, Circle should have sucked it dry and disappeared into a room with shareholders to distribute their spoils. Instead, they almost went bankrupt.
That finally brings me on to the furore around the Transatlantic Trade Partnership or TTIP. Once again the troops of the privatisation apocalypse have latched onto something that has not even finished being negotiated and stated: “It will privatise the NHS!” It is claimed American insurance companies will flood the UK and buy the NHS lock stock and barrel. Clearly the people saying this have not seen the bloodbath Obamacare has created in the American health insurer market. All of the big insurers are withdrawing from the Obamacare programme because they are losing huge sums of money. Does anyone who puts some thought into the possibility of American insurers trading a freer market for a significantly more constrained one in the UK after their Obamacare experience, believe they will be on the next flight to Heathrow? Why would they? Please explain the attraction the NHS would have for these embattled firms? I’ll answer that for you; there is none and they would turn and run the other way.
Those who would like us to believe that there is a queue of American companies waiting to buy the NHS are wrong, they are not telling the truth. Most American firms come to the UK, take one look at the health service and quickly return to where they came from. There are a few exceptions but those companies are usually suppliers such as drug and medical equipment companies. There is a strong presence in eldercare, primarily retirement villages, but that is the exception and not the rule. NHS privatisation is a false dawn, a scare tactic with little basis in reality which is used by the NHS to avoid change that would ultimately benefit the patient. I wish that there were companies who would roll the dice and bring world-class care to the UK, give patients a choice and drive out those NHS trusts who can’t, or choose not to, move to 21st-century care models. The fact remains that if those who put the NHS forward as the world’s best healthcare provider are right, the NHS providers would see off any competition in very short order. Wouldn’t they? And if they are the best in the world, why worry about any shareholder focused pretender? They would be noise in the system, unable to compete or compare to the world-class NHS. Am I wrong? Should we be worried that the NHS monopoly is terrified of competition? I think we should.
Privatisation isn’t the issue. If the private provider of healthcare were such a bad choice, the Queen and her family wouldn’t choose to use them instead of the NHS. Why should the average woman or man in the street not be given the same choice in a fair and equal society? I’ll repeat, that if the NHS is the world’s best health service as many like to claim, then why do they fear new entrants into a market they should control based on the quality of care, and not the protection the government conveniently provides? Something doesn’t add up.
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