Wednesday 11 December 2019 4:08 am

Britain needs a ‘national’ health service, not a ‘nationalised’ one

David Hare is chief executive at the Independent Healthcare Providers Network.

Throughout this election campaign, the Labour party has returned time and time again to the issue of NHS “privatisation”.

This won’t have come as a surprise to anyone. Indeed, it is now standard fare during elections for the argument to be put that the government of the day is pursuing “backdoor” or “creeping” privatisation. 

But in 2019, add in the politics of a potential post-Brexit trade deal with the US, with Jeremy Corbyn brandishing leaked documents supposedly showing American interest in the NHS, and the issue is a heady mix of claim and counter-claim.

Unpicking fact from falsehood is challenging, but as we prepare to go to the polls tomorrow, there are several often-overlooked truths which need to be borne in mind, particularly when confronted with Labour’s vision of a fully “publicly provided” NHS.


The first big truth is that the National Health Service has never been a Nationalised Health Service. 

As the healthcare think tank the Nuffield Trust pointed out recently, around 22 per cent of NHS service provision is already delivered by organisations that are not NHS Trusts or other statutory organisations. This includes almost all of General Practice (your GP, in other words, is a private provider), dentistry, community pharmacy, and optometry. 

It also includes a large number of voluntary, social enterprise and other private sector organisations, such as private hospitals delivering care to NHS patients free at the point of use.

It is true that a future government could choose either to remove this non-public provision or “nationalise” it. Nationalising health services from the high street pharmacy onwards would be a herculean task, and it is unclear what the benefits to patients would be.

In the main, patients are satisfied with the care that they receive across these services, and the cost of taking them all into public ownership would be considerable.

On the other hand, simply restricting private provision in order to boast a fully publicly provided NHS, with all services brought back “in-house”, would mean removing significant capacity from the system. This would add to pressures in what we know is already an overstretched service.

The impact would be felt by patients. Recent research by the Independent Healthcare Providers Network has found that stripping out private hospital capacity from the provision of planned NHS care — things like hip and knee operations and cataracts removal — would see waiting times nearly double in 12 months, from 13 weeks to 22 weeks. After three years, average waits would have reached 40 weeks, with delays for orthopaedic procedures at a staggering 93 weeks.


This would require the NHS to build 42 new hospitals (and that means actually new, not the existing hospitals Boris Johnson has pledged to revamp) just to stand still. With NHS waiting times are at record levels and forecast to continue to grow as pressures mount, this is simply not an option.

It is likely that a fully publicly provided NHS would also remove vital diagnostic, community and home care provision from the system, not only hampering capacity, but also the innovation, expertise, and efficiencies that such services can bring.

Again, this would add substantially to the existing pressures faced by NHS providers and jeopardise the quality of care which patients expect and deserve.

Promising to end “NHS privatisation” is a line that is guaranteed to generate applause at rallies or debates. But a distinction needs to be drawn between moving to a private healthcare model where patients must pay for their own care, and allowing private provision within the free-at-the-point-of-use system as already exists — and has existed since the NHS was first founded.

Voters need to look carefully at what a fully publicly provided NHS would mean in practice, and how it would impact frontline patient care. The facts suggest that it would be enormously damaging.

Main image credit: Getty

City A.M.'s opinion pages are a place for thought-provoking views and debate. These views are not necessarily shared by City A.M.

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