No. Labour aren’t going to privatise the NHS.
I have seen multiple claims on social media that Labour will expand privatisation of the NHS if elected. Mostly these claims come from the Green Party, or from the anti-Labour left. The leader of the Greens made the same claim in the debate last night. This makes a change from “Tories have secret plans to sell the NHS to Americans, only liking and sharing this Facebook status can stop them”.
Clearly these stories aren’t true, but the truth is interesting enough to warrant explaining why it is nonsense.
When the NHS was established hospital and community health services (secondary care) were nationalised, but family health services (primary care) were left in the private sector. This was always how the NHS operated – with a mix of private and public provision. There never was a pre-lapsarian state of grace when the NHS was 100% nationalised.
At the time of Nye Bevan roughly 1/3 of the NHS budget went to the private sector, the rest to the public sector. Now that share has shifted – roughly 80% goes to the public sector. There hasn’t been stealth privatisation; there has been stealth nationalisation. Tory voters love the NHS just as much as Labour voters, and the majority of Tory MPs feel the same. Apart from a tiny number of ideological obsessives there is no enthusiasm in the Tory Party to import US style healthcare.
So what are Labour’s actual plans?
Labour are promising reform as well as more money. This is logical, if not always popular. Central to their reforms are changes to how Primary Care works; GP services will be consolidated into ‘neighbourhood health centres’, where patients can walk in at evenings and weekends, bringing together doctors, dentists and treatment of minor injuries to take pressures off A&E.
This changes the contractual status of primary care professionals, and makes them NHS employees. Labour’s plans for Primary Care would result in the largest programme of nationalisation of healthcare services since Attlee. I was always a huge supporter of keeping independent contractor status for GPs (ie not making them NHS employees) but I think that ship has sailed; young GPs just aren’t as interested in running their small businesses as the older generation, particularly non-UK qualified Drs who came to the UK in the 60s and 70s and who gravitated towards running small General Practices as a way to escape racism elsewhere in the NHS. I do still worry that neighbourhood health centres will end up being run by hospital trusts who will use them to manage patient flows. One of the great advantages of GP independent contractor status is that it removed any incentive to refer fewer patients, handing control of GP practices to secondary care brings with it that risk.
I also expect Labour to deal with the last remnants of the NHS internal market. Back in the 80s the internal market (sometimes called purchaser/provider split) was established under Margaret Thatcher to make it easier for private sector providers to deliver NHS care. It has been a total disaster, there simply isn’t any enthusiasm from the private sector to deliver more than a tiny range of healthcare services.
In most years since it’s introduction the value of private sector contracts handed out has been less than the costs of operating the internal market. The Landsley reforms were meant to reinvigorate private sector interest, but were an expensive failure, some US healthcare companies actually closed their London office and left the UK market altogether.
When Sir Simon Stevens was CEO of NHS England a lot of work was done to replace the internal market with Integrated Care Boards, and to end some of the older outsourcing deals. When Stevens left the work of dismantling the internal market stalled, and ICBs are still full of staff doing the purchasing part. There are some easy savings to be made by putting the last remnants of the purchaser/provider split out of their misery.
The one bit of evidence given to support the assertion that Labour are planning more privatisation is that they are planning to use spare capacity in the private sector to reduce waiting lists. This is an entirely sensible plan. I will declare an interest in this – when I was an NHS CEO I used private sector outsourcing to reduce waiting lists. It was a massive success. But outsourcing isn’t privatisation, and to conflate the 2 is totally dishonest.
I have little sympathy for anyone who would refuse to use the private sector in this way. If you would rather stop the use of the private sector to reduce waiting lists and leave patients in pain to suit your ideology you’re not a left winger
You’re an arse.
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