A lot of accusations have been flying around about the NHS, the other parties falsely pointing the finger at UKIP and claiming our policy is to (variously) “scrap the NHS”, “privatise the NHS” or “charge you for using the NHS”. Yes, our own leader has brought some of this on by an “off the cuff” remark at a public meeting about needing to consider some kind of insurance basis, but effectively he was just thinking out aloud, and it was 2 years ago.

All these claims, we know, are false when set against our present declared policy, summed up in one sentence:

– UKIP will ensure the NHS is free at the point of delivery and time of need for all UK residents. (UKIP Website Policies for People)

However, I want to show you how, since formation of the NHS in 1948, Labour and Conservative have introduced varying degrees of “privatisation” into the NHS, which I class in three areas, as privatisation of the provision of:

  • Facilities
  • Services
  • Income

Privatise all three of those, and you have the pre-Obamacare American model of a totally insurance-based, private provision solution, bar an Accident and Emergency safety net. But, let’s look at each in isolation.

Facility Provision

Many Health Facilities are expensive: hospitals, operating theatres, radiology, cancer and cardiology centres et al require specialist buildings and facilities which are definitely not cheap. When an existing hospital building can no longer be adapted to modern needs, or outgrows the premises, or the brickwork starts to crumble, a new Hospital is required.

In the past, the Treasury would be asked to stump up the cash as an investment. It is always much, much harder extracting investment money out of the Treasury than operating cost money, as it adds to the Public Sector Borrowing Requirement (PSBR), on the basis that such investments would be backed up by a business case that would generate future savings (e.g. a high maintenance, listed, crumbling Victorian building replaced with a low-maintenance modern concrete block)

When the 1997-2010 Labour government started to indulge in heavy borrowing, just to finance operating costs, they looked for “smart” ways of avoiding some of that borrowing, to “spin” a good line with us, the gullible plebs (or rather that’s how they saw us). They came up with the “Private Finance Initiative”, to get commercial companies to finance and build new facilities for the public – not just hospitals, but also roads, jails, railways, military barracks, buildings and medical centres.

How much PFI have we got? How much does it cost? Frankly, PFI contracts are extremely opaque, many are badly let, the government stitched up by the banks and finance houses that provide the money. In the annual PFI report, HMG claimed in 2013 that the capital value of PFI contracts was “only” £54Bn (a new hospital costs nearly a Billion to build), but more revealing was the annual “service” cost in 2014-15 of £10.2Bn, which represents very poor value for money considering that most projects will be financed over 20-30 years – the government is being stung by interest rates that have not dropped to match currently prevailing levels.

The capital value of PFI is disputed. This Wikipedia article claims it was £68Bn with a future spend commitment of £215Bn over the life of the contracts… in 2007 (and there has been more of it since).

The main point is: this kind of privatisation of the NHS has already been done… and badly.

Service Provision

This is where a commercial provider takes over the management of day-to-day provision of services, hiring the staff, paying the running costs, delivering the care to the patients. However, the government pays it a fixed sum per year, and they have to deliver in budget, or make a loss. The service is provided to patients free at the point of delivery and time of need.

There has been a trial with an NHS hospital that was going broke, and Circle Healthcare came to the rescue with an innovative and initially effective contract.  All the clinical staff were re-employed, but one suspects some bureaucrats lost their jobs. The hospital is owned by the public, the premises and staff are NHS-badged and it’s free to patients. The hospital’s performance outstripped many other NHS hospitals, and Circle started to make a small profit – so what, the taxpayer profited too. However, this was too much of a fairy tale story, and it seems that the CQC has now branded the hospital’s care inadequate, so that experiment appears to have failed.  By the way, it was Labour that initiated this contract, although the Coalition finalised it’s letting.

Meanwhile, LibLabCon have been quite successfully privatising other elements of the NHS. Recently, I had a tooth extraction (after being referred to the Orthodontist at the hospital) with a private company, the best I have ever experienced, and a one-time test for an aneurism with another. The BBC reports that a lot of NHS contracts are going private, and I have seen a figure of around 9% for the amount by value of the NHS where service provision is commercial.

Income Provision

A lot of this has been going on already, for years and years! How much do you pay your Dentist and Optician? Have you ever had NHS funding provided for a visit to the Chiropractor?

Dentistry and Optics effectively remained privately provided from 1948, albeit state-subsidised. However, nowadays, many Dentists will have nothing to do with the NHS, so for many it has been a private service. Why should your teeth and eyes be treated differently to the rest of your body?

Conclusion

There is an awful lot of emotion around “privatisation of the NHS”. Much of it has gone on already, as I have evidenced above. Some of it is sensibly privatised, like services provided within a controlled budget, to controlled standards, unhampered by NHS bureaucracy. But, for some “privatisation”, they have made a “right Horlicks” of it, notably PFIs and Dentistry.

No politician, however, has seriously talked about moving to a fully insurance-funded solution, and that IS political suicide in the current climate.

When talking about “privatisation” we must be very, very careful, defining exactly what we mean, and if proposing an extension of proven good practice, then perhaps using a different term would be better, for example, “commercial service provision” rather than the emotive “privatisation”.

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