Increasing attention has been paid in recent years to the idea of privatising the NHS, largely due to the influence of successive conservative governments. With Brexit having happened, the idea of the NHS being part of trade between the US and UK prompted 400 medical professionals to write to the government in 2020, urging them to pass a mandate that would see the NHS taken off the table in discussions over trade deals. That bill failed to pass, leaving the future of the NHS still, theoretically at least, up in the air.
The arguments over whether to privatise the NHS can be largely broken down into the following categories. For each we will try to establish a balanced view.
Health Equality
The moral argument centres simply around the notion that the NHS is the fairest possible way to deliver healthcare. It is free at the point of use to any British citizen, regardless of their background, personal wealth, status, insurance, or any other factor. However, we should note that the NHS, when it was set up, was politically vilified. The public’s opinion may shift again in future, and perhaps our notion of fairness with it.
Continuity of Care
Looking at continuity of care, we can only assume that the NHS provides a better option than any private company might. Unlike a private entity, the NHS will continue to provide an unprofitable service as long as it must to ensure a patient’s health; whereas a company may be in place only for a short time, hold a short contract, or have other reasons for trying to move a patient on into the care of another organisation. Whilst the NHS could be better at providing continuity, privatisation would inevitably make the situation worse.
Efficiency
The efficiency of public healthcare might seem to be worse than that of private – certainly it should if one subscribes to the idea that a free market will produce greater competition, and in turn greater efficiencies. However, if you look at healthcare around the world you find that a publicly funded healthcare service is generally more efficient than the alternative. Government provision or government insurance leads to a lower cost. The US in fact spends more, per capita, than any other country in the world.
Transparency
Transparency would seem largely in favour of keeping the NHS public, as commercial interests can lead to it being far harder to scrutinise spending. US hospitals famously have bills that are nigh-on impossible to follow, and to investigate them further is incredibly difficult.
Patient Choice
Greater patient choice would seem to be possible if the NHS were privatised. Certainly it is somewhat lacking with the NHS in its current state. However, one should bear in mind that the majority of patients are far less interested in choice than they are in an efficient service. Greater competition would mean greater choice, but if it came at the cost of some being unable to afford it, or your local hospital becoming specialised at the expense of another, it likely would not be popular with the general population. Indeed, that choice would be available only to those with the money to afford it. Those with less money, or worse insurance, would find themselves at the bottom of the ladder.
Perhaps the final large argument to consider is that the NHS is outdated, and needs to be refreshed. It was a great service, but isn’t fit for the challenges it is facing today. Some urge that we ought to increasingly pay for elements of our healthcare, through insurance. Indeed, countries with government health insurance like Germany or Italy routinely come right at the top of worldwide surveys looking for the best healthcare services.
However, one could argue that privatisation isn’t the correct solution to an organisation, and perhaps an ideal, becoming outdated. Greater focus on its real current issues (like an overstretched workforce, and an ageing population with significant comorbidities) and less focus on privatisation might be a good thing for the NHS, and the British public.
Do not let your personal point of view come in the way of providing a balanced answer. This question often falls along ‘party lines’ in terms of Conservatives being in favour and Labour against. You should offer a balanced view that shows you are more concerned about all patients being able to receive great care across the country than you are about financial incentives.
Should we privatise the NHS?
I do not believe that we should privatise the NHS. Whilst privatising the NHS, or parts of it, could allow for greater choice of treatments, as it stands the NHS is one of the fairest healthcare systems – if not the fairest – in the world. It is free at the point of use to any British citizen. I also believe that the NHS provides more continuity of care than would be provided by a succession of private providers, who might shift a patient between them. Although one might assume that the NHS is less efficient than a private healthcare system – as a publicly funded system supposedly ought to be less so than a free market alternative – in fact, public healthcare systems generally have far fewer inefficiencies than private alternatives. I therefore believe that we should not privatise the NHS.
Do you think that privatising the NHS would fix the issues it faces?
No. The NHS faces many issues – it certainly is outdated in many ways, and when faced with today’s challenges it sometimes scarcely seems fit for purpose. Understaffing is a continuous problem, especially with a huge number of nurses having left after Brexit – understaffing is a particular problem in mental health departments, and with mental health deteriorating across the country this problem will increase. The NHS has lowered the number of beds it provides, despite an aging population and increasing rates of obesity and comorbidities like diabetes leading to potentially far higher rates of hospital admission over the coming years. However, a drive to privatise the NHS would scarcely fix these issues – instead, we should focus on the issues themselves, and how our country, government and health service can come together to fix them.
What is your opinion on private healthcare?
I believe that private healthcare being available is not an issue, assuming that its existence does not damage the core ability of the NHS to provide a universally high-quality service that is free at the point of use. Whilst NHS Trusts now increasingly make money from private work as well, this money must be reinvested into the NHS, and allows them to increase their revenue. Other areas of private healthcare that are frequently used – be it private GPs, therapy, tests or scans, will often serve to take pressure off the NHS. Indeed, many GPs in wealthy areas will refer patients on to private providers as often as possible, as this will not only be quicker for the patient but relieve pressure on the local NHS system.
What could we learn from other countries’ healthcare systems that would inform the debate on whether to privatise the NHS?
We can see from countries with fully privatised systems – notably the USA – just how inefficient such a system is. It spends more capita on health than any other country, and yet has some of the lowest patient satisfaction scores across the globe. However, if we look at other countries that operate a government health insurance policy, we might find inspiration for a possible future model for the UK. Both Germany and Italy, for example, operate a government health insurance scheme, and both health systems consistently rank as amongst the world’s best.
If you were Minister for Health, what changes might you make to the NHS?
I would try to bring the NHS to focus more on both patient empowerment and preventative medicine. Firstly, patient empowerment might involve giving doctors the ability to prescribe social activities like gym memberships alongside drugs, the use of technology driven care plans that allow for patients to make decisions remotely, or remotely contact their doctor – creating greater efficiency for both patient and healthcare worker – and the development of more support networks for those with certain conditions. I would also look to expand the NHS’s preventative medicine efforts, with more investment into public health campaigns – as being reactive will cost huge amounts more in the long term than a proactive strategy.
What positives and negatives can you think of for privatising the NHS?
I would consider the following as positives: there would likely be greater patient choice, with more accessibility to a greater array of services. There would also certainly be faster turnaround times than the NHS for those able to afford it.
I would consider the following as negatives: we would no longer have a universal, high quality healthcare system that is free at the point of care. We would likely have less continuity of care, due to different health providers becoming involved. We would have a less efficient healthcare system that would result in a higher cost per capita than the NHS. We would likely have less transparency on spending and on patient outcomes.
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