I used to think, perhaps naively, that even the current Conservative government valued the NHS’s “national treasure” status too much to let it go the way of the debt-fuelled US healthcare system. Now, I’m not so sure: NHS privatisation, by the backdoor, is well under way.
While other countries continue to grow health spending as a share of GDP, in the UK it continues to decline, along with wages (nurses’ pay is now 12% lower in real terms than before the 2010 election). And in the absence of proper funding, other sources of money start to swoop in. With a budget allocation of £168.2 billion for 2022-23, the NHS is the UK government’s biggest financial burden, but also the biggest cash cow for vulture capitalists. The next biggest spenders — education (£77.1 billion) and defence (£32.1 billion) — not only have smaller tills to dip into, but also offer far less opportunity for private investment.
As the pandemic illustrated, any enterprising fool can tap up the NHS, if you know which backdoor to go through. Take Conservative peer Michelle Mone, who, along with her three adult children, reportedly received £29 million from at least £65 million in profits paid to her husband, Douglas Barrowman by PPE Medpro — a supplier the Government now alleges supplied defective gowns to the NHS.
Then there is Sarah and Richard Stoute, whose Full Support Healthcare company netted £1.8 billion in contracts for medical gowns and masks — making them the single biggest beneficiaries of NHS PPE deals, as well as the proud new owners of a £30-million Caribbean villa, a £6-million English mansion and an equestrian centre. They haven’t broken any laws — and they insist that they are not Covid profiteers. But with the British government estimating that £84.7 million of PPE bought from Full Support Healthcare remains unused, at the very least it demonstrates that private investment doesn’t guarantee efficiency.
PPE scandals aside, Big Pharma is seen as one of the NHS’s greatest predators, not least because it is associated with the sort of rapacious capitalism we identify with America. Certainly, the way that drug companies do business often leaves much to be desired. Last summer, the Competition and Markets Authority (CMA) fined Pfizer and Flynn a total of £70 million for abusing their dominant positions to overcharge the NHS for the life-saving epilepsy drug, phenytoin sodium. The previous year, the CMA handed down fines worth more than £260 million to more than 10 pharmaceutical companies following a lengthy investigation into a staggering 10,000% price hike for generic hydrocortisone tablets. Officials said that Auden Mckenzie, the drug’s sole provider for many years, “paid off would-be competitors” to stay out of the market after acquiring generic rights to the medicine. To put the ruse in perspective, pre-2008 NHS England was spending around £500,000 a year on the drug. By 2016, that figure had ballooned to over £80 million.
Several agencies work together to procure medicines, pharmaceutical products and services for acute care in the NHS, including the Commercial Medicines Unit (CMU), which is responsible for tendering, awarding and managing frameworks for licensed medicines for the regional purchasing groups. There is no suggestion that the CMU and its agencies procure medicines for the NHS with anything but integrity. But drug companies spend millions each year on partnerships with the NHS, which the British Medical Journal found was only transparent in one in five cases involving NHS trusts.
Sometimes, this lack of transparency appears to pay off. For instance, work on a Covid vaccine developed by the University of Oxford and AstraZeneca benefitted from long-term funding from UK Research and Innovation (UKRI), followed by an additional £2.6million in Rapid Response from UKRI-National Institution for Health Research (NIHR). What AstraZeneca put in the R&D budget is harder to determine, but in early 2022, two years into the pandemic, the company had recorded nearly $4 billion in Covid vaccine sales for the previous year and a record $37.4 billion in revenue.
Join the discussion
Join like minded readers that support our journalism by becoming a paid subscriber
To join the discussion in the comments, become a paid subscriber.
Join like minded readers that support our journalism, read unlimited articles and enjoy other subscriber-only benefits.
SubscribeThis article is quite amazing in its restatement of the NHS religion and is frankly unreconstructed Leftist nonsense. Private is bad, profits are wicked, state-run is benign and wonderful. Horror, the NHS is using private more efficient providers for some services! Just spend more taxpayers money, the only solution ever offered. Perhaps, just perhaps, governments are somewhat aware that while people love the NHS (is this becoming out of date?) they are also not so keen on ever rising taxes to pay for it.
The complaints are also incoherent: not enough funding – but the dreaded private providers presumably need to be paid?! And dental charges specifically mentioned have in place almost from the outset of the NHS. I haven’t heard anyone even calling for them to be abolished, but the cost to taxpayers if they were would be enormous.
NHS spending has been going up in real terms since it’s inception. Even a reduction in the rate of increase is greeted with howls of outrage. Sheer logic tells us that this is not sustainable in the long (or even medium) term (a health system with a country attached, perhaps?).
We are either going to need other non taxpayer sources of funding, to reduce the expectations of what can be delivered, more efficiency or probably a combination of all three.
So which system would you swap it with, that can still provide all the services people expect on the budget it’s given?
Most western European countries have systems that provide health services as good and usually better than the NHS.
And most are more expensive, with many not attempting to cover as much as the NHS (GP visits for instance). The UK still spends around 1% difference in terms of GDP compared to the Germans, and that is after a massive increase. To put this in perspective the difference between the German and UK spending on defence has often been less than 1%, and the difference between the capability and equipment of those forces (not to mention Trident) is immense.
I’m not arguing that the NHS could be improved immensely, I just don’t believe that privatisation would magically cure those ills unless we match the funding levels of those countries that are often held up as examples.
And most are more expensive, with many not attempting to cover as much as the NHS (GP visits for instance). The UK still spends around 1% difference in terms of GDP compared to the Germans, and that is after a massive increase. To put this in perspective the difference between the German and UK spending on defence has often been less than 1%, and the difference between the capability and equipment of those forces (not to mention Trident) is immense.
I’m not arguing that the NHS could be improved immensely, I just don’t believe that privatisation would magically cure those ills unless we match the funding levels of those countries that are often held up as examples.
The German system based on compulsory insurance with state paying for those who can’t afford it and the govt regulating the insurance companies. Works a treat and free at the point of need with customer able to choose.
“…the govt regulating the insurance companies.” That bit wouldn’t happen here. That’s the problem.
It’s also 20% more expensive per capita. Would you be happy paying the extra money?
Yes. But not for 2 week waits for a GP appointment and 8 hours in A&E
Yes. But not for 2 week waits for a GP appointment and 8 hours in A&E
“…the govt regulating the insurance companies.” That bit wouldn’t happen here. That’s the problem.
It’s also 20% more expensive per capita. Would you be happy paying the extra money?
Countries such as France have a much greater mix of providers and competition between them – with much better results than the NHS. They have the equivalent of a mixed economy – which performs better than either a state controlled economy or a purely free enterprise economy.
Most western European countries have systems that provide health services as good and usually better than the NHS.
The German system based on compulsory insurance with state paying for those who can’t afford it and the govt regulating the insurance companies. Works a treat and free at the point of need with customer able to choose.
Countries such as France have a much greater mix of providers and competition between them – with much better results than the NHS. They have the equivalent of a mixed economy – which performs better than either a state controlled economy or a purely free enterprise economy.
The problem is the author’s ignorant blaming of “capitalism” for the problem of monopoly and collusion. In a capitalist economy, prices are restrained by competition. But pharma, just as in the US, doesn’t like the role of competition in capitalist economies and uses every trick it can to stamp it out. Does NHS have full powers to use the international pharma market to route around restraint of competition taking place in the ways described here? It should have the power to bust patents, if necessary, as a remedy for anticompetitive practices.
I stopped about a line or two at the rather insulting fib that state spending on the dysfunctional fax using NHS is going down. Oh please. Just like all your striking staff starving in food banks (somehow forgetting their gold plated pensions) and your legions of no show millionaire ‘Zahawi’ GPs swanning off at 55 to avoid paying tax (tut tut). Why not write about NHS complicity in the lockdown madness and the shocking excess death toll? We are not clapping anymore. We are all talking about a broken dangerous NHS internal culture and the need for a new French or German system to save it. Why are you not listening?
Most public sector pensions are a fraction to what they used to be. Final salary schemes have all but disappeared, nobody who has joined in the last 15 years will be on one
Look at private sector pensions.
Private sector wages are higher though for most. My wages nearly doubled moving from public to private sector
Private sector wages are higher though for most. My wages nearly doubled moving from public to private sector
There is a still huge discrepancy between the state/employer contributions offered in the public sector and NHS and those of the private sector. You do not get a two trillion plus liability on the cheap.
Look at private sector pensions.
There is a still huge discrepancy between the state/employer contributions offered in the public sector and NHS and those of the private sector. You do not get a two trillion plus liability on the cheap.
Most public sector pensions are a fraction to what they used to be. Final salary schemes have all but disappeared, nobody who has joined in the last 15 years will be on one
‘Just spend more taxpayers money, the only solution ever offered. ‘ – And the solution that worked under New Labour
‘NHS spending has been going up in real terms since it’s inception.’ – yes as you should expect with a growing elderly population, and one that you can expect to keep growing while this government remains unable to stand up to the interests of capital and landlords, intent on strangling the aspirations of the young.
As Tory MP Lee Anderson effectively put it very well last week, denying that there is a cost of living crisis since his aide, a single 23 year old with a rich father, lives very well for herself on a nurse’s equivalent salary in a room in a shared house. So long as the path to prosperity encouraged by this government is one of childlessness, inherited wealth and smaller and smaller living spaces, which other direction do you expect government health spending to be going in?
So which system would you swap it with, that can still provide all the services people expect on the budget it’s given?
The problem is the author’s ignorant blaming of “capitalism” for the problem of monopoly and collusion. In a capitalist economy, prices are restrained by competition. But pharma, just as in the US, doesn’t like the role of competition in capitalist economies and uses every trick it can to stamp it out. Does NHS have full powers to use the international pharma market to route around restraint of competition taking place in the ways described here? It should have the power to bust patents, if necessary, as a remedy for anticompetitive practices.
I stopped about a line or two at the rather insulting fib that state spending on the dysfunctional fax using NHS is going down. Oh please. Just like all your striking staff starving in food banks (somehow forgetting their gold plated pensions) and your legions of no show millionaire ‘Zahawi’ GPs swanning off at 55 to avoid paying tax (tut tut). Why not write about NHS complicity in the lockdown madness and the shocking excess death toll? We are not clapping anymore. We are all talking about a broken dangerous NHS internal culture and the need for a new French or German system to save it. Why are you not listening?
‘Just spend more taxpayers money, the only solution ever offered. ‘ – And the solution that worked under New Labour
‘NHS spending has been going up in real terms since it’s inception.’ – yes as you should expect with a growing elderly population, and one that you can expect to keep growing while this government remains unable to stand up to the interests of capital and landlords, intent on strangling the aspirations of the young.
As Tory MP Lee Anderson effectively put it very well last week, denying that there is a cost of living crisis since his aide, a single 23 year old with a rich father, lives very well for herself on a nurse’s equivalent salary in a room in a shared house. So long as the path to prosperity encouraged by this government is one of childlessness, inherited wealth and smaller and smaller living spaces, which other direction do you expect government health spending to be going in?
This article is quite amazing in its restatement of the NHS religion and is frankly unreconstructed Leftist nonsense. Private is bad, profits are wicked, state-run is benign and wonderful. Horror, the NHS is using private more efficient providers for some services! Just spend more taxpayers money, the only solution ever offered. Perhaps, just perhaps, governments are somewhat aware that while people love the NHS (is this becoming out of date?) they are also not so keen on ever rising taxes to pay for it.
The complaints are also incoherent: not enough funding – but the dreaded private providers presumably need to be paid?! And dental charges specifically mentioned have in place almost from the outset of the NHS. I haven’t heard anyone even calling for them to be abolished, but the cost to taxpayers if they were would be enormous.
NHS spending has been going up in real terms since it’s inception. Even a reduction in the rate of increase is greeted with howls of outrage. Sheer logic tells us that this is not sustainable in the long (or even medium) term (a health system with a country attached, perhaps?).
We are either going to need other non taxpayer sources of funding, to reduce the expectations of what can be delivered, more efficiency or probably a combination of all three.
Utter rubbish. Real terms funding for the NHS continues to rise. It is the fact that we continue throwing ever more money at a dysfunctional organisation that is the problem !
If a huge monolithic organisation like the NHS isn’t able to negotiate favourable deals with big pharma companies (relative to small organisations), it needs to hire some commercial purchasing managers.
Poor organisation, leadership and management is at the root of the problems in the NHS. Don’t throw any more money at it until that’s been sorted. It will only be wasted on subsidising failure.
Utter rubbish. Real terms funding for the NHS continues to rise. It is the fact that we continue throwing ever more money at a dysfunctional organisation that is the problem !
If a huge monolithic organisation like the NHS isn’t able to negotiate favourable deals with big pharma companies (relative to small organisations), it needs to hire some commercial purchasing managers.
Poor organisation, leadership and management is at the root of the problems in the NHS. Don’t throw any more money at it until that’s been sorted. It will only be wasted on subsidising failure.
The author should focus on the BMA before criticising others.
Also, the drug budget for the NHS represents 10-12% of the total NHS budget.
Whilst the NHS has cult like status, unless it is reformed and rebuilt in a major way, no amount of tinkering, scaremongering or distortion of the facts will lead to any change. Criticising big Pharma is easy and gets the clicks but leaving 90% of the spend out of your ‘argument’ will get us nowhere.
The author should focus on the BMA before criticising others.
Also, the drug budget for the NHS represents 10-12% of the total NHS budget.
Whilst the NHS has cult like status, unless it is reformed and rebuilt in a major way, no amount of tinkering, scaremongering or distortion of the facts will lead to any change. Criticising big Pharma is easy and gets the clicks but leaving 90% of the spend out of your ‘argument’ will get us nowhere.
The article written by this consultant adds nothing useful to the debate about the NHS.
It consists of a stream of disconnected snippets of news and anecdotes without analysis. Were the operations conducted by the private sector conducted more cheaply, more efficiently and with less bureaucracy or not? No comparison is made.
In the Telegraph Dr Gordon Caldwell, a former NHS consultant commented on ‘horribly inefficient’ paperwork around patients moving in and out of wards that is fuelling record NHS delays. Nothing is said by Dr Emma Jones about the absurd levels of bureaucracy clogging the NHS.
She trots out complaints about pharmaceutical companies overcharging but what is her solution? Would the NHS be a better pharmaceutical company – unlikely or might it not be an idea to employ competent people to purchase what is needed by the NHS. Of course, in the mad scramble to purchase equipment when the covid crisis arose many mistakes were made and money wasted but this could all have been avoided by sensible long term planning with preselected partners with the capacity to expand reliable equipment production. If you leave things to the last moment you tend to get duff deals.
Dr Emma Jones with her narrow view that the services of private suppliers if competently procured have nothing useful to offer the NHS and are ideologically unacceptable as being privatisation is part of the problem. The fact that nurses pay has declined in real terms is meaningless without asking whether we have too few nurses or whether their time is wasted by the NHS bureaucracy in filling in excessive numbers of forms as highlighted by Dr Caldwell, who at least identifies a problem that has a solution if the NHS could be induced to do something about it.
The problem is that the Conservatives are too fearful of bad PR to properly grapple with the multiple problems of the NHS and the Labour Party is the party of the bureaucrats and consultants like Dr Jones so nothing effective will be done by them either.
I would like to know a major public sector service that isnprovidinga qualitybser ice? Health, policing, home office, local authority, teaching? Why would I abandon private sector provision for state provision?
I would like to know a major public sector service that isnprovidinga qualitybser ice? Health, policing, home office, local authority, teaching? Why would I abandon private sector provision for state provision?
The article written by this consultant adds nothing useful to the debate about the NHS.
It consists of a stream of disconnected snippets of news and anecdotes without analysis. Were the operations conducted by the private sector conducted more cheaply, more efficiently and with less bureaucracy or not? No comparison is made.
In the Telegraph Dr Gordon Caldwell, a former NHS consultant commented on ‘horribly inefficient’ paperwork around patients moving in and out of wards that is fuelling record NHS delays. Nothing is said by Dr Emma Jones about the absurd levels of bureaucracy clogging the NHS.
She trots out complaints about pharmaceutical companies overcharging but what is her solution? Would the NHS be a better pharmaceutical company – unlikely or might it not be an idea to employ competent people to purchase what is needed by the NHS. Of course, in the mad scramble to purchase equipment when the covid crisis arose many mistakes were made and money wasted but this could all have been avoided by sensible long term planning with preselected partners with the capacity to expand reliable equipment production. If you leave things to the last moment you tend to get duff deals.
Dr Emma Jones with her narrow view that the services of private suppliers if competently procured have nothing useful to offer the NHS and are ideologically unacceptable as being privatisation is part of the problem. The fact that nurses pay has declined in real terms is meaningless without asking whether we have too few nurses or whether their time is wasted by the NHS bureaucracy in filling in excessive numbers of forms as highlighted by Dr Caldwell, who at least identifies a problem that has a solution if the NHS could be induced to do something about it.
The problem is that the Conservatives are too fearful of bad PR to properly grapple with the multiple problems of the NHS and the Labour Party is the party of the bureaucrats and consultants like Dr Jones so nothing effective will be done by them either.
What a rant! It’s a bit risky to extrapolate from a single article, but I suspect this view is typical of the attitudes across the NHS, and indicates why the institution is unreformable.
To pick up on a couple of things. Firstly, people forget the clamour of the early COVID period. Formula-1 racing manufacturers were re-tooling to make ventilators and the army built Nightingale hospitals, which were never used. The lack of PPE led to a howling hysteria at the time that things were moving too slowly, so corners were cut. Now there is howling hysteria because corners were cut The PPE ‘scandal’ is worthy of some investigation but it is ridiculous to use it to condemn the normal operation of the NHS.
So big pharma is ‘vulture capitalism’? It is also the engine of phenomenal scientific and medical progress, which takes huge commercial risks on product development and innovation before any profit is made. I am trying to imagine a parallel universe in which NHS Pharmaceuticals is responsible for research, development and supply of medicines in the UK: a 6 month waiting list for a paracetamol, with supply prioritised to historically disadvantaged groups in accordance with today’s flavour of EDI ideology.
The article is tagged as ‘Analysis’. Come on Unherd, you can do much better than this.
Lost any credibility for me the moment she offered PPE procurement in the panic phase of the pandemic as an example of creeping privatisation in the NHS. A perfect example of inept public central planning if ever there was one.
And as for there being ‘far less opportunity for private investment in education and defence’, who does she thinks runs the best schools in the country and manufactures the hardware the MOD requires if not the private sector?
Sorry Paul, but you are, as most of us are, a victim of a medicine developed based on investment decisions to provide/sell treatments, and not interested making people healthy, and believe, like most people, that they have done a great thing for humanity. Look for the pharma part of the below report…
https://www.goldmansachs.com/insights/pages/gs-research/survivors-guide-to-disruption/report.pdf
Creating health is VERY different form treating people but very few realise the difference. The NHS is a normal result of a health care model created by a investment-return decision based industry for the last 60=70 years. It provides an illness service model no country can afford…
For acute cases we are brilliant, for the chronic issues the modern medicine system fails…
Sorry Ed (since we seem to be on first-name terms), but I have no idea what you are talking about. To take a personal anecdote: I pop a small but growing number of pills each day, and have done for 20+ years, to control high blood pressure. I’m advised that this has greatly reduced my risk of a serious heart problem, and so far, so good. Isn’t this then both treatment (reducing blood pressure) and health creation (preventing heart attacks)? If those medicines were developed based on an investment decision to offer treatments to the market and drive profits, then great, I’m happy with that. Or is there an alternative that no-one has explained to me?
Or statins or the immuno suppressants I take. Totally agree
Or statins or the immuno suppressants I take. Totally agree
Sorry Ed (since we seem to be on first-name terms), but I have no idea what you are talking about. To take a personal anecdote: I pop a small but growing number of pills each day, and have done for 20+ years, to control high blood pressure. I’m advised that this has greatly reduced my risk of a serious heart problem, and so far, so good. Isn’t this then both treatment (reducing blood pressure) and health creation (preventing heart attacks)? If those medicines were developed based on an investment decision to offer treatments to the market and drive profits, then great, I’m happy with that. Or is there an alternative that no-one has explained to me?
Name a single state owned pharmaceuticals company that produces world class medicine. I cannot think of a single one
Unfortunately, it’s not a single article. Emma Jones has a track record of similar rants on Unherd, to which she’s perfectly entitled, just as we’re perfectly entitled to see through them and the mindset with which her articles arise. I’ve absolutely no reason to doubt her qualities as an A&E Consultant, but her insight into the wider issues with which the NHS has been grappling unsuccessfully for decades is severely lacking. Part of the problem, as the saying goes, rather than part of the solution.
Lost any credibility for me the moment she offered PPE procurement in the panic phase of the pandemic as an example of creeping privatisation in the NHS. A perfect example of inept public central planning if ever there was one.
And as for there being ‘far less opportunity for private investment in education and defence’, who does she thinks runs the best schools in the country and manufactures the hardware the MOD requires if not the private sector?
Sorry Paul, but you are, as most of us are, a victim of a medicine developed based on investment decisions to provide/sell treatments, and not interested making people healthy, and believe, like most people, that they have done a great thing for humanity. Look for the pharma part of the below report…
https://www.goldmansachs.com/insights/pages/gs-research/survivors-guide-to-disruption/report.pdf
Creating health is VERY different form treating people but very few realise the difference. The NHS is a normal result of a health care model created by a investment-return decision based industry for the last 60=70 years. It provides an illness service model no country can afford…
For acute cases we are brilliant, for the chronic issues the modern medicine system fails…
Name a single state owned pharmaceuticals company that produces world class medicine. I cannot think of a single one
Unfortunately, it’s not a single article. Emma Jones has a track record of similar rants on Unherd, to which she’s perfectly entitled, just as we’re perfectly entitled to see through them and the mindset with which her articles arise. I’ve absolutely no reason to doubt her qualities as an A&E Consultant, but her insight into the wider issues with which the NHS has been grappling unsuccessfully for decades is severely lacking. Part of the problem, as the saying goes, rather than part of the solution.
What a rant! It’s a bit risky to extrapolate from a single article, but I suspect this view is typical of the attitudes across the NHS, and indicates why the institution is unreformable.
To pick up on a couple of things. Firstly, people forget the clamour of the early COVID period. Formula-1 racing manufacturers were re-tooling to make ventilators and the army built Nightingale hospitals, which were never used. The lack of PPE led to a howling hysteria at the time that things were moving too slowly, so corners were cut. Now there is howling hysteria because corners were cut The PPE ‘scandal’ is worthy of some investigation but it is ridiculous to use it to condemn the normal operation of the NHS.
So big pharma is ‘vulture capitalism’? It is also the engine of phenomenal scientific and medical progress, which takes huge commercial risks on product development and innovation before any profit is made. I am trying to imagine a parallel universe in which NHS Pharmaceuticals is responsible for research, development and supply of medicines in the UK: a 6 month waiting list for a paracetamol, with supply prioritised to historically disadvantaged groups in accordance with today’s flavour of EDI ideology.
The article is tagged as ‘Analysis’. Come on Unherd, you can do much better than this.
Cripes, I hope the author takes a more rational and structured approach to her work in A&E than when writing this article.
If that were the case, the NHS would be a well-run success, no?
If that were the case, the NHS would be a well-run success, no?
Cripes, I hope the author takes a more rational and structured approach to her work in A&E than when writing this article.
“a close friend recently underwent a shoulder operation in a private hospital after being fast-tracked for treatment through the NHS. Describing the procedure and overnight stay as “better than most hotels I’ve ever stayed in”, the only expense my friend incurred was the cab fare home from hospital and a course of painkillers.”
Three acquaintances have very recently had this experience – two hip replacements and one shoulder replacement. The only difference I can see is that the service providers paid for their transport home. The biggest barrier they had to prompt treatment was NHS GP referral. Draw your own conclusions.
That’s because the private clinics can pick and choose which procedures they do. They’ll have all the relatively simple ones where patients can be discharged in a day or two, but won’t touch the expensive complicated ones with a long recovery stay with a barge pole.
Much like when Royal Mail was privatised, the new private companies snapped up all the profitable urban routes and left the more rural unprofitable ones to be funded by the taxpayer. The same thing is now happening with the health service
I don’t understand the point you are making. If private health can provide a fast, high care and caring solution for routine operations why can’t the NHS?
Because the NHS has limited capacity and has to try and treat both the simple and fiendishly complicated. It also has the problem of having to accept those it can’t discharge afterwards due to a lack of community care capacity so ends up with large numbers of beds becoming blocked. The private sector doesn’t have this as it simply refuses to take those that will be slow to process
Because the NHS has limited capacity and has to try and treat both the simple and fiendishly complicated. It also has the problem of having to accept those it can’t discharge afterwards due to a lack of community care capacity so ends up with large numbers of beds becoming blocked. The private sector doesn’t have this as it simply refuses to take those that will be slow to process
The issue is not whether the private clinics can pick and chose the procedures they do but whether they do those procedures quicker, cheaper , better and in a better environment. If the answer to those questions is yes then perhaps the NHS should concentrate on the expensive complicated procedures that are uneconomic for private clinics to do and increase commissioning the private clinics to do the simple ones. The advantage the private clinics have is that they are not burdened with NHS bureaucracy and form filling. If the NHS concentrated on what private clinics can’t do better they could slim down their bureaucracy and do better themselves.
Are they cheaper though? I’d wager the NHS pays more to subcontract out each operation than it would cost to do it themselves if they had the capacity.
Are they cheaper though? I’d wager the NHS pays more to subcontract out each operation than it would cost to do it themselves if they had the capacity.
That’s like complaining that bookshops only sell the easy to read books lots of people want to buy, leaving taxpayer funded libraries to provide the books only a few are interested in.
My thoughts exactly. “ISPs are cherry-picking relatively routine operations and procedures because they don’t have emergency care facilities or staff to deal with complex patients.” GOOD!
And then the austerity drive closed thousands of libraries because they were unprofitable
A thought experiment, why do others disagree with you? Are they all stupid?
Some will be, as will some who agree with me. That’s a rather stupid question in my eyes to be honest.
My being wary of increasing privatisation is that I’ve rarely seen it deliver the benefits that were promised. The privatised public transport system in the UK is a joke compared to most publicly owned European ones. Privatising the utilities never led to cheaper bills, it simply meant vast amounts of taxpayer money were shovelled into the pockets of large shareholders. Likewise selling the council houses meant the state instead ended up paying a large portion of rent to private landlords, and leaving the housing sector to “the market” resulted in a lack of housing and excessive land banking by large building firms. Whilst the private sector is the correct model for 90% of the economy, I don’t believe it always leads to the best outcomes in regards to public services or where monopolies occur.
Some will be, as will some who agree with me. That’s a rather stupid question in my eyes to be honest.
My being wary of increasing privatisation is that I’ve rarely seen it deliver the benefits that were promised. The privatised public transport system in the UK is a joke compared to most publicly owned European ones. Privatising the utilities never led to cheaper bills, it simply meant vast amounts of taxpayer money were shovelled into the pockets of large shareholders. Likewise selling the council houses meant the state instead ended up paying a large portion of rent to private landlords, and leaving the housing sector to “the market” resulted in a lack of housing and excessive land banking by large building firms. Whilst the private sector is the correct model for 90% of the economy, I don’t believe it always leads to the best outcomes in regards to public services or where monopolies occur.
A thought experiment, why do others disagree with you? Are they all stupid?
My thoughts exactly. “ISPs are cherry-picking relatively routine operations and procedures because they don’t have emergency care facilities or staff to deal with complex patients.” GOOD!
And then the austerity drive closed thousands of libraries because they were unprofitable
I don’t understand the point you are making. If private health can provide a fast, high care and caring solution for routine operations why can’t the NHS?
The issue is not whether the private clinics can pick and chose the procedures they do but whether they do those procedures quicker, cheaper , better and in a better environment. If the answer to those questions is yes then perhaps the NHS should concentrate on the expensive complicated procedures that are uneconomic for private clinics to do and increase commissioning the private clinics to do the simple ones. The advantage the private clinics have is that they are not burdened with NHS bureaucracy and form filling. If the NHS concentrated on what private clinics can’t do better they could slim down their bureaucracy and do better themselves.
That’s like complaining that bookshops only sell the easy to read books lots of people want to buy, leaving taxpayer funded libraries to provide the books only a few are interested in.
That’s because the private clinics can pick and choose which procedures they do. They’ll have all the relatively simple ones where patients can be discharged in a day or two, but won’t touch the expensive complicated ones with a long recovery stay with a barge pole.
Much like when Royal Mail was privatised, the new private companies snapped up all the profitable urban routes and left the more rural unprofitable ones to be funded by the taxpayer. The same thing is now happening with the health service
“a close friend recently underwent a shoulder operation in a private hospital after being fast-tracked for treatment through the NHS. Describing the procedure and overnight stay as “better than most hotels I’ve ever stayed in”, the only expense my friend incurred was the cab fare home from hospital and a course of painkillers.”
Three acquaintances have very recently had this experience – two hip replacements and one shoulder replacement. The only difference I can see is that the service providers paid for their transport home. The biggest barrier they had to prompt treatment was NHS GP referral. Draw your own conclusions.
The NHS is the last remaining example of “5-year tractor production” planning in the UK. The state decides how many doctors and nurses to train each year, provides the only work environments in which they can complete their training and gain full qualification and then complains it can’t recruit enough of them.
The NHS is the last remaining example of “5-year tractor production” planning in the UK. The state decides how many doctors and nurses to train each year, provides the only work environments in which they can complete their training and gain full qualification and then complains it can’t recruit enough of them.
“I used to think, perhaps naively, that even the current Conservative government valued the NHS’s “national treasure” …”
Only the most blinkered left wing NHS employee could make such a preposterous statement
It was an award winning piece of question begging, I’ll give it that.
It was an award winning piece of question begging, I’ll give it that.
“I used to think, perhaps naively, that even the current Conservative government valued the NHS’s “national treasure” …”
Only the most blinkered left wing NHS employee could make such a preposterous statement
This article is so naive that it makes me wonder whether the author is part of some cult.
Claiming that a poor contract outcome for the NHS is a sign of inefficiency in the private sector supplier is a staggering rewiring of logic. The reverse is true. If you bought into a terrible contract in the private sector for £1.8 billion you would lose your job so fast your head wouldn’t have time to spin. And you’d have trouble getting another job as a buyer even for a whelk stall. I expect that the person who hired you might also lose their job or at least not be trusted to decide much else ever again. It’s not that the private sector doesn’t make mistakes like that, but they do regard that sort of sum as real money. And they would take some care. That’s not the same as taking your time. The consequences of carelessness would be clear to them. They’d take it seriously. Losing that kind of money may cost not only your own job but those of all your colleagues. Did the person who signed the contract on behalf of the NHS get fired? I doubt it. Lose any pay? – probably not. No, they just pointed out not that they were careless or stupid, not that they didn’t do their homework, but some clever big boy did it to them and then ran away.
The lesson most people would get from that outcome is that the NHS is commercially useless, despite having to purchase everything from bandages to ambulances to whole hospitals and everything in between, they’re not very good at it. The good doctor though thinks the NHS is just fine, not at all cavalier with public money, That’s probably because the NHS’s answer to everything is for us to give them yet more money to waste.
This article is so naive that it makes me wonder whether the author is part of some cult.
Claiming that a poor contract outcome for the NHS is a sign of inefficiency in the private sector supplier is a staggering rewiring of logic. The reverse is true. If you bought into a terrible contract in the private sector for £1.8 billion you would lose your job so fast your head wouldn’t have time to spin. And you’d have trouble getting another job as a buyer even for a whelk stall. I expect that the person who hired you might also lose their job or at least not be trusted to decide much else ever again. It’s not that the private sector doesn’t make mistakes like that, but they do regard that sort of sum as real money. And they would take some care. That’s not the same as taking your time. The consequences of carelessness would be clear to them. They’d take it seriously. Losing that kind of money may cost not only your own job but those of all your colleagues. Did the person who signed the contract on behalf of the NHS get fired? I doubt it. Lose any pay? – probably not. No, they just pointed out not that they were careless or stupid, not that they didn’t do their homework, but some clever big boy did it to them and then ran away.
The lesson most people would get from that outcome is that the NHS is commercially useless, despite having to purchase everything from bandages to ambulances to whole hospitals and everything in between, they’re not very good at it. The good doctor though thinks the NHS is just fine, not at all cavalier with public money, That’s probably because the NHS’s answer to everything is for us to give them yet more money to waste.
“The NHS makes terrible decisions about when it procures goods and services. This explains why the NHS is good and private companies are bad.”
I rather liked the bit about Full Support Healthcare. £1.8bn of equipment provided, £0.0847bn remaining unused. “At the very least it demonstrates that private investment doesn’t guarantee efficiency.” Doesn’t it? That’s a hair over 95% of what was paid for having been used! (Leaving aside the question of whether any of it was any bloody good against Covid, of course).
I rather liked the bit about Full Support Healthcare. £1.8bn of equipment provided, £0.0847bn remaining unused. “At the very least it demonstrates that private investment doesn’t guarantee efficiency.” Doesn’t it? That’s a hair over 95% of what was paid for having been used! (Leaving aside the question of whether any of it was any bloody good against Covid, of course).
“The NHS makes terrible decisions about when it procures goods and services. This explains why the NHS is good and private companies are bad.”
I have neither the time nor the energy to Fisk this appalling piece however I would point out that all comparator countries have universal healthcare, all have better outcomes than the benighted NHS and recent increases in NHS spending to not lead to improved outcomes.
Imagine if the NHS’s model were applied to food: shortages, rationing, possibly even starvation; imagine if the the supermarket model were applied to healthcare: effective, adaptive, responsive with a range of competing providers.
Belgium has the best cancer survival rates in the world, not a single hospital in the Netherlands is state owned or run, etc. etc.; there are a plethora of better systems for funding and delivering healthcare, let’s magpie from each and every one.
I have neither the time nor the energy to Fisk this appalling piece however I would point out that all comparator countries have universal healthcare, all have better outcomes than the benighted NHS and recent increases in NHS spending to not lead to improved outcomes.
Imagine if the NHS’s model were applied to food: shortages, rationing, possibly even starvation; imagine if the the supermarket model were applied to healthcare: effective, adaptive, responsive with a range of competing providers.
Belgium has the best cancer survival rates in the world, not a single hospital in the Netherlands is state owned or run, etc. etc.; there are a plethora of better systems for funding and delivering healthcare, let’s magpie from each and every one.
I agree. Utter rfubbish. Incorrect statements, misleading figures, selective evidence…
For example, the John Burn Murdoch figures referenced for NHS expenditure stop conveniently in 2019, before NHS expenditure went up from 9 to 12%. Yes, it’s gone down since, but be fair. Look at the King’s Fund’s figures.
The section on ISPs fails to mention the start of the “privatisation” with Independent Sector Treatment Sectors (ISTCs) by Labour in 2003.
The dropping of Astra Zeneca’s non-profit model didn’t happen till the end of 2021 when the pandemic enteredthe endemic phase, as originally agreed. In the meantime, Pfizer were charging a much higher price and supposedly taking 20+% profit.
Of course ISPs do the routine operations. They are something the NHS fails to handle efficiently and the ISPs are much better at. What could possibly be wrong with that?
All in all, a piece with a story to tell, and the author not willing to let mere facts get in the way of it.
I agree. Utter rfubbish. Incorrect statements, misleading figures, selective evidence…
For example, the John Burn Murdoch figures referenced for NHS expenditure stop conveniently in 2019, before NHS expenditure went up from 9 to 12%. Yes, it’s gone down since, but be fair. Look at the King’s Fund’s figures.
The section on ISPs fails to mention the start of the “privatisation” with Independent Sector Treatment Sectors (ISTCs) by Labour in 2003.
The dropping of Astra Zeneca’s non-profit model didn’t happen till the end of 2021 when the pandemic enteredthe endemic phase, as originally agreed. In the meantime, Pfizer were charging a much higher price and supposedly taking 20+% profit.
Of course ISPs do the routine operations. They are something the NHS fails to handle efficiently and the ISPs are much better at. What could possibly be wrong with that?
All in all, a piece with a story to tell, and the author not willing to let mere facts get in the way of it.
I am confused. Either the NHS is underfunded, or we spend £168.2 billion a year on it. We should not be spending under half as much on health as we do on educating children or a quarter as much on protecting the country. Sheer bloat.
It is underfunded. The German model that is often used to show how inefficient the NHS is actually costs 20% more per capita to run, and was as high as 33% only 5 years ago. Whilst the NHS needs restructuring and more thought out into social care to avoid beds becoming blocked, I don’t believe it’s any more bloated than any other system, public or private
I think if you study business turnarounds (and let’s be honest, that’s what’s required here – we must stop thinking about the NHS being some sort of charity), you’ll notice that the restructuring needs to happen before increasing resources and not afterwards. Otherwise the extra resources will be largely wasted.
The NHS is fundamentally dishonest here. Instead of constantly whining “we need more money”, they need to come clean and say “we need help – help with better leadership, management and organisation”. I would actually cut the budget of a failing organisation that couldn’t accurately define its priorities and key challenges. And fire those who don’t know what they’re doing.
I’m not arguing that the system needs reform, however my complaint lies with the fact that many who favour privatisation use the German or French examples of being better systems yet neglect to mention both are much more expensive to run, and in the case of France only covers 80% of the costs I believe (perhaps somebody with experience of the French system could correct me if I’ve been misinformed on that one)
I’m not arguing that the system needs reform, however my complaint lies with the fact that many who favour privatisation use the German or French examples of being better systems yet neglect to mention both are much more expensive to run, and in the case of France only covers 80% of the costs I believe (perhaps somebody with experience of the French system could correct me if I’ve been misinformed on that one)
So why does nobody copy our system?
Because many already had their own, and those that don’t haven’t got the money available to nationalise the private healthcare facilities in that country.
I’m interested if you think those European models would work as well as they do if they received the level of funding the NHS receives? Would the German model work as well with 20% less funding and having to fund GPs visits? Would it have the same capacity if the government hadn’t chosen to spend treble the UK on improving infrastructure and capacity over a 5 year period at the end of the previous decade?
Because many already had their own, and those that don’t haven’t got the money available to nationalise the private healthcare facilities in that country.
I’m interested if you think those European models would work as well as they do if they received the level of funding the NHS receives? Would the German model work as well with 20% less funding and having to fund GPs visits? Would it have the same capacity if the government hadn’t chosen to spend treble the UK on improving infrastructure and capacity over a 5 year period at the end of the previous decade?
I think if you study business turnarounds (and let’s be honest, that’s what’s required here – we must stop thinking about the NHS being some sort of charity), you’ll notice that the restructuring needs to happen before increasing resources and not afterwards. Otherwise the extra resources will be largely wasted.
The NHS is fundamentally dishonest here. Instead of constantly whining “we need more money”, they need to come clean and say “we need help – help with better leadership, management and organisation”. I would actually cut the budget of a failing organisation that couldn’t accurately define its priorities and key challenges. And fire those who don’t know what they’re doing.
So why does nobody copy our system?
Sorry. Back to school on the arithmetic (or sums really). Assuming the figures in the article are correct we spend twice (not half) as much on health as education. However, we do indeed also spend four times as much on health as we do on defence which is ludicrous.
It is underfunded. The German model that is often used to show how inefficient the NHS is actually costs 20% more per capita to run, and was as high as 33% only 5 years ago. Whilst the NHS needs restructuring and more thought out into social care to avoid beds becoming blocked, I don’t believe it’s any more bloated than any other system, public or private
Sorry. Back to school on the arithmetic (or sums really). Assuming the figures in the article are correct we spend twice (not half) as much on health as education. However, we do indeed also spend four times as much on health as we do on defence which is ludicrous.
I am confused. Either the NHS is underfunded, or we spend £168.2 billion a year on it. We should not be spending under half as much on health as we do on educating children or a quarter as much on protecting the country. Sheer bloat.
What a bizarre and uninformed take on things. She blames profiteering off COVID PPE on greed in the private sector, rather than nepotism and lack of free market in the public sector (who are the ones who made these sweetheart deals).
She criticizes the private sector for skimming off the easy work. But if they are not costing the taxpayer more than the NHS would for the same service, what is her complaint?
Methinks the author doesn’t understand the difference between publicly-FUNDED healthcare and government-RUN healthcare. These are very different, but many simpletons manage to ball them up into one incoherent concept.
If she wants an example of why government-RUN healthcare is untenable, look no further than us here in Canada, where I work as a doc. Our system is completely monopolistic and 100% government run, with no private alternatives. Morale among docs and nurses is in the toilet. Waiting lists are long enough that more than a million Canadians are dying and suffering on them.
And since we have outlawed private alternatives, patients with the financial means (and even those who have to borrow to do so) are voting with their feet and going outside of Canada (usually to the US) to have hips replaced, shoulders repaired, or even to have cancer diagnosis and surgery in a reasonably timely fashion.
I knew our system had hit rock bottom when I recently referred a healthy 66 year old patient (still working and hoping to continue) to a neurologist for early signs of Parkinson’s disease and received a notice back saying “Our current waitlist is now more than 4 years”. Officially we still have publicly-funded healthcare, in reality we no longer have healthcare.
But, but, everyone knows you have “better outcomes” and “better healthcare” than here in the US!
But, but, everyone knows you have “better outcomes” and “better healthcare” than here in the US!
What a bizarre and uninformed take on things. She blames profiteering off COVID PPE on greed in the private sector, rather than nepotism and lack of free market in the public sector (who are the ones who made these sweetheart deals).
She criticizes the private sector for skimming off the easy work. But if they are not costing the taxpayer more than the NHS would for the same service, what is her complaint?
Methinks the author doesn’t understand the difference between publicly-FUNDED healthcare and government-RUN healthcare. These are very different, but many simpletons manage to ball them up into one incoherent concept.
If she wants an example of why government-RUN healthcare is untenable, look no further than us here in Canada, where I work as a doc. Our system is completely monopolistic and 100% government run, with no private alternatives. Morale among docs and nurses is in the toilet. Waiting lists are long enough that more than a million Canadians are dying and suffering on them.
And since we have outlawed private alternatives, patients with the financial means (and even those who have to borrow to do so) are voting with their feet and going outside of Canada (usually to the US) to have hips replaced, shoulders repaired, or even to have cancer diagnosis and surgery in a reasonably timely fashion.
I knew our system had hit rock bottom when I recently referred a healthy 66 year old patient (still working and hoping to continue) to a neurologist for early signs of Parkinson’s disease and received a notice back saying “Our current waitlist is now more than 4 years”. Officially we still have publicly-funded healthcare, in reality we no longer have healthcare.
For me, the biggest worry for the NHS is the influence of monopolistic Big Pharma, (which is mentioned in the article). Their main interest seem to be profit before health. I am a right leaning reader, who believes in capitalism as the engine of a healthy society, but monopolistic tendencies must be regulated and thank goodness we have various regulatory organisations that continue to do this. So shocking that a bill for £50,000 for meds supplied to the NHS was increased to £80 million by the company just upping its prices! I also worry that the MHRA is over 80% funded by Big Pharma. What a conflict of interests!
For me, the biggest worry for the NHS is the influence of monopolistic Big Pharma, (which is mentioned in the article). Their main interest seem to be profit before health. I am a right leaning reader, who believes in capitalism as the engine of a healthy society, but monopolistic tendencies must be regulated and thank goodness we have various regulatory organisations that continue to do this. So shocking that a bill for £50,000 for meds supplied to the NHS was increased to £80 million by the company just upping its prices! I also worry that the MHRA is over 80% funded by Big Pharma. What a conflict of interests!
No mention of the abysmal management of the NHS and the role it plays in increasing the use of private facilities.
No mention of the abysmal management of the NHS and the role it plays in increasing the use of private facilities.
When in doubt, I think we need to rely on The Science.
And The Science that applies here is the Curious Case of Regulatory Capture. Now I don’t know of a more perfect case of a regulated industry than health care, except that in the case of the NHS we have Britain’s real Established Church, with every hospital a health care monastery or a health care nunnery.
Yeah, when the noble lords set out to regulate an industry they end up being captured by the regulated. Science(TM). You could look it up under Stigler, George.
I dare say that one fine day another corpulent English monarch will effect the dissolution of the NHS monasteries and give them away to his supporters (I wonder if Downton Abbey was one such). Yep:
When in doubt, I think we need to rely on The Science.
And The Science that applies here is the Curious Case of Regulatory Capture. Now I don’t know of a more perfect case of a regulated industry than health care, except that in the case of the NHS we have Britain’s real Established Church, with every hospital a health care monastery or a health care nunnery.
Yeah, when the noble lords set out to regulate an industry they end up being captured by the regulated. Science(TM). You could look it up under Stigler, George.
I dare say that one fine day another corpulent English monarch will effect the dissolution of the NHS monasteries and give them away to his supporters (I wonder if Downton Abbey was one such). Yep:
Absolute tosh!
Absolute tosh!
There is nothing inherently wrong with NHS work being outsourced provided there is competition and proper procurement and management practices. The NHS is in crisis and needs to find new ways of delivering services.
There is nothing inherently wrong with NHS work being outsourced provided there is competition and proper procurement and management practices. The NHS is in crisis and needs to find new ways of delivering services.