Private health care and the NHS.

By Bernadette Meaden
September 6, 2014

A parasite lives off its host, taking what it needs, contributing little or nothing, and often causing harm. It could be said that the private health care industry is a now a parasite on the NHS.

Private providers do not train doctors, nurses, and other healthcare professionals, they rely on the public sector to do that for them, at great expense. Of course in recent years students will have paid tuition fees, but broadly speaking, the vast majority of healthcare professionals (HCPs) now working in the UK will have received training largely paid for by taxpayers, either in the UK or in their country of origin. Private health care companies then employ these highly skilled people, incurring very little in the way of training costs.

But surely the private sector contributes through its taxes? Perhaps: but maybe not as much as one would hope. In 2012 Corporate Watch revealed that the top five companies gaining from NHS ‘reforms’ were making extensive use of tax havens to ensure they pay the minimum of tax. Happy to take from the public purse, but not to contribute, it seems.

There are moves to get the private sector to contribute to the training of medical staff, but there are major concerns about the quality of what may be provided. As one doctor has pointed out,"Private providers’ main priority is to treat as many patients as possible at the lowest cost. But generating profits doesn’t fit with the way education is structured in NHS hospitals... Education and training is expensive, so it’s not in the interests of private employer organisations to encourage a large amount of training for doctors.”

As more and more private companies win NHS contracts, they move into hospitals, clinics and GPs surgeries, built and equipped with public money, and use these facilities to run a business. Contracts are carefully selected for profit-making potential, leaving difficult and therefore unattractive services like Accident and Emergency with the NHS.

Even when a private company secures an NHS contract, its ‘commitment’ may be almost worthless. In 2012 Care UK won the contract to run a GP practice in a deprived area of Newcastle. The contract was to run until August 2017, but a few months ago the company announced "after reviewing our business strategy and having conversations with the commissioner, it was decided that Care UK will not run the service past January 2015." Perhaps the contract was not as profitable as Care UK had anticipated.

Because private medical care has traditionally been the preserve of the wealthy, it is often assumed to be of superior quality. This may be far from the truth. Last year a private hospital in Stevenage was taken over by the NHS after patients died following routine surgery. The Care Quality Commission was in the process of suspending its licence due to serious concerns for patient safety, when the government bought it from the construction company Carillion, at a cost of £54 million.

In fact we have no way of really knowing how good private hospitals are, because they are not required to provide the extensive data we get from NHS hospitals. This means they are far less accountable. The Centre for Health and the Public Interest recently produced a report on this, and co-author Professor Colin Leys said: "The public and regulators have access to more information than ever before about how NHS services are performing but the same cannot be said for private hospitals."
The reality is that when a patient in a private hospital develops complications, they are often transferred to the NHS, perhaps because they have become unprofitable, or because the private hospital does not have the capability to deal with those complications.

And as with banks, so with private healthcare. Profits are privatised, risks and losses are nationalised. The usual rate for complications in cataract operations is one in four hundred. In Somerset, half the people who had cataract operations performed by private contractor Vanguard experienced complications, including partial loss of sight. It now appears that the NHS will have to pay compensation to patients who had their eyesight damaged by a private provider, taking more money away from patient care.

And as we have seen with outsourcing contracts in other areas, there is always the potential for the taxpayer to be ripped off. Serco (which overcharged the government by £68 million for tagging offenders)stands accused of overcharging the NHS by millions for pathology services, whilst at the same time cutting costs so far that it left some laboratories ‘close to disaster’. Clinicians said that Serco had an “inherent inability… to understand that you cannot cut corners and put cost saving above quality.”

This goes to the heart of the problem. Public services and private profit-making companies are completely different animals. The sole purpose of the NHS and the people who work in it is to provide care to patients. The primary purpose of a business is to make a profit, all other aims are secondary. Of course individual HCPs want to care for people, and whether employed directly by the NHS or by a private company will do their best for patients. But when decisions are made, a profit-seeking business will always prioritise the bottom line.

And at the risk of stating the blindingly obvious, to make a profit, one has to charge the customer more for a service than what it costs you to provide it. Why should NHS funds be diverted into the pockets of shareholders? There simply seems no good reason to do this. The private sector is taking from the taxpayer, and giving the minimum in return. Sometimes it is doing harm. So why should we allow this to continue?

© Bernadette Meaden has written about political, religious and social issues for some years, and is strongly influenced by Christian Socialism, liberation theology and the Catholic Worker movement. She is an Ekklesia associate and regular contributor. You can follow her on Twitter: @BernaMeaden

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