Dr Phil Hammond, broadcaster and sessional GP in Bristol

Does the Health Bill imply privatisation for the NHS?

OK, I know I said I was bored with the Health Bill and would move onto something else, but on my way to the Nuffield Health Policy Summit at a posh hotel in Surrey to hear our dear Health Secretary and other esteemed experts debate the finer points of the Bill in a more nuanced and intelligent way than you get in the Commons or the media I made the mistake of listening to Prime Minister's questions. This turned into a competition to see who could shout the names of professional organisations either supporting or opposing the Bill. The balls were definitely in Ed Milliband's court—he had at least 27 to choose from—but alas, some of them had longish names and as he stumbled over the pronunciations, David Cameron swatted him away.

The previous weekend, I had watched Andrew Neil pin shadow Health Secretary Andy Burnham down on his precise objections to the Bill. Burnham was absolutely certain that the Bill would lead to 'privatisation' of the NHS, conveniently ignoring the fact that many of the things he calls privatisation were introduced by Tony Blair, and all the latest Bill does is to cement them in even more unnecessary legislation. But it's a good starting point for a debate.

What do you mean by 'privatisation of the NHS'? Here are some of the 'expert' answers I collected at the Nuffield summit:

  • ‘The NHS is not privatised so long as it is funded by taxpayers' money. It doesn't matter who's doing the purchasing or providing, so long as they deliver value for money and sustainability.’
  • ‘The NHS is not privatised if all of the above applies and it remains free at the front door.’
  • ‘I largely agree with the above but believe the commissioning must remain in public hands. As soon as you hand the purchasing power over to private companies, it becomes privatised.’
  • ‘The NHS is already partly privatised. GPs are independent contractors and are extremely fortunate to have such a generous public sector pension. We buy all our "things” from private companies—e.g. drugs, wheelchairs, and management consultancy. Hospitals are run and owned privately; large swathes of psychiatric care have been handed over to the private sector; private independent treatment centres and hospitals helped get waiting lists down. More private provision is a logical extension if it delivers value for money.’
  • ‘The use of any private company in the NHS is morally wrong if there is a public alternative. Private companies have to generate profits for shareholders, which drags money away from patient care. When they can't, they just pack up and leave the NHS, dropping patients in it. Look at the care homes' scandals and private companies that have just pulled out of the NHS market. Many of the hospitals built with private finance initiative funding are perilously close to bankruptcy. And then there's the power and control shift of handing taxpayers' money to unaccountable, unelected boards of public limited companies and their profit-hungry shareholders. It always leads to commoditisation, cherry picking, and inequality.’
  • ‘So long as GPs are in control of the money, we’ll make sure there’s lots of value and very little profiteering. People trust GPs.’
  • ‘GP commissioners simply lack the expertise and time to protect the public purse. Large companies and Foundation trusts with slick lawyers and management consultants will run rings around them.’

I could go on, but you get the picture. Opposing views in the privatisation debate are held so deeply that a hundred summits won’t resolve them. Which is why the NHS will always be a politician’s shouting toy.G

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