I first published this article over 4 years when I was the Lib Dem PPC in Bassetlaw. I am republishing it here, with changes to bring it up to date and added some new thoughts. Some of these thoughts have been sparked by my over 20 years working with Health IT services, for a supplier, as a self employed contractor and, for the last few months as an IT manager for a large East Midlands Acute NHS Trust, poacher turned gamekeeper as it were.
Let me state this clearly so it cannot be misunderstood. I support the NHS, I am fully behind a universal, “free at the point of care” Health Service, paid for out of general taxation. Indeed, I have refused to take up the offer of private health insurance in a former job (ironically a large supplier to the NHS) as I felt it would be a betrayal of my personal principles. While I am involved in politics, I will do all I can to protect the principle of “free at the point of care”.
Where I differ from Labour, the Greens and others on the left, is that I put getting the best care possible and value for taxpayers’ money ahead of out of date ideology.
This doesn’t mean that the NHS should not change and that how it delivers on that principle cannot be improved. The one constant in the NHS is change in how it provides services to meet the changing needs placed on it.
We are all living much longer, and the conditions & diseases older people suffer from are presenting new challenges. Also, healthcare is developing, new treatments and procedures are being available, tests that were a few years ago only just becoming possible are now commonplace. However, many of these developments are not as cheap as the simpler, less complicated (but less effective) tests & treatments that were all that was available even in the recent past. In my area, IT has made the sharing of data between systems and between providers much better allowing for better informed care for patients.
In addition, the nation has to be careful how taxes are spent, we need to find new and better ways to face those challenges and make sure that we, the taxpayers, get best value for our money.
Because of this we need to be open to allowing ways apart from just the state-owned “in-house” NHS to provide these services. This is not privatisation of the NHS, it is extending something that has been part of the NHS since in inception. GPs have always been private partnerships working with the NHS to provide a service. Opticians, including big chains run by multinational companies, have provided eye checks & NHS funded glasses from the start of the NHS.
To make sure we the taxpayers get value for our money, there should be two tests for any private sector provider.
The care of patients must be as good as, if not better, than the in-house NHS equivalent can give. This must include data protection and the sharing of relevant data with other care providers (something the NHS is not particularly good at) so that continuity of care is maintained regardless of who provides any one service.
The cost to taxpayers is less than the in-house NHS equivalent and there are no hidden subsidies or “sweet-heart deals” such as the Labour Government made with some providers (and have now been made illegal by the Coalition). The calculation of cost should include the element of training & career development that the NHS provides but isn’t usually accounted for in the pricing of these services by those who commission them.
The NHS and whoever provide services in it must remain publicly funded and publicly accountable. While there may be some on the far right of the Conservative party (and the Brexit Party) who want to scrap the NHS, I along with most people in the UK want to keep it. I have no problem with any provider that passes these tests working with the NHS. Indeed, sometimes it is the new providers that can put into action better ways of working the NHS often finds hard to do and the “in-house” providers can learn from this.
The biggest threat to the NHS today is that since 2015 and the end of the Coalition, the NHS has been under attack by a right-wing Tory Government where many ministers seemed intent on replacing it with an American-style Insurance based health care system. It has been starved of funds and small scale, local healthcare partnerships have been squeezed out in favour of ever bigger Trusts or suppliers.
We definitely need a rethink. Perhaps a local cooperative of Therapists can provide a better, cheaper service than by the Trust employing those therapists with the added overhead of bureaucracy needed in any large organisation. While ever large Acute Trusts generate some saving in overheads, closing or moving services away from being provided locally have a cost that is harder to define in making it harder for less mobile people to access those services.
Most of all we need to increase the funding to all levels of the NHS and decrease the bureaucratic overload we are placing on Healthcare Professionals.
However, we must never allow the simplistic approach of Labour that reduces the arguments to slogans like ‘“Private” Bad – “Public” Good’ to go unchallenged. While the NHS must always remain in public control, how it delivers its services must always be a mixed economy of pubic & privately owned suppliers.