“In [the] future, the NHS will be a state insurance provider not a state deliverer.”— (Mark Britnell, former Head of Commissioning, Department of Health)
Much of what is happening to the NHS is because the current government wants to massively reduce the size of the public sector (see http://www.guardian.co.uk/news/datablog/2012/oct/16/government-spending-countries-gdp#data) and to open up public services to private companies.
Despite denials, it is increasingly clear that the government ‘reforms’ are leading to the privatisation of the NHS (see http://nhsforsale.info/). NHS services are already increasingly run by multinational companies and investment firms (see http://www.express.co.uk/posts/view/355999/Who-now-owns-the-NHS-and-can-they-cure-it-), with the NHS becoming a kind of collective ‘brand name’ for a host of NHS and private health care providers.
In the year following the Health and Social Care Act, the majority of new contracts to provide NHS services went to private companies. In 2013, private providers received more than £10 billion from the public purse. And in 2014 a further £5.8 billion of NHS work is being advertised to the private sector, up 14% on the previous year. (https://www.opendemocracy.net/ournhs/kailash-chand/“nhs-reforms-our-worst-mistake-coming-from-tories-this-is-too-little-too-late)
The creeping privatisation of services is leading in some cases to increased clinical problems, low morale and financial instability. (See what is happening, for example, after pathology services were outsourced to Serco from KingsCollege Hospital Trust and Guy’s and St Thomas’ Hospital Trust, http://www.corporatewatch.org/?lid=4550). Researchers at Imperial College, London found that private sector and other non-NHS providers of GP services performed worse than traditional GP practices on 15 out of 17 indicators, such as patient satisfaction, control of diabetes or high blood pressure, and keeping patients out of hospital. (http://www.independent.co.uk/life-style/health-and-families/health-news/private-sector-providers-of-gp-services-being-outperformed-by-traditional-practices-10199610.html).
Until now, there has been no profit motive driving the NHS. However, the first duty of a private healthcare business is to make profits for its shareholders – and this profit has to come out of the NHS money allocated for patient care.
Private health care companies are protected by rules on ‘commercial confidentiality’. This lack of transparency will make it difficult for those who are monitoring services to find out if the public is getting the best deal when private companies are involved.
Private companies are free to decide which NHS services they compete for, so they will inevitably chose to work in areas where they can make the most profit – for example where there is high turnover. This will leave the NHS to cope with the most complicated, costly and unprofitable services such as A&E, care of the elderly and the chronically ill.