Are we actually heading towards an American-style health system?

29 Aug 2017

A fortnight ago, Stephen Hawking drew the Health Secretary, Jeremy Hunt, into a war of words over the direction of the NHS. Hunt tweeted on August 19th that Hawking’s ‘Most pernicious falsehood’ was the ‘idea govt [sic] wants US-style insurance system’.


However, is it really a claim the physicist even made? In an op-ed in The Guardian on August 18th, Hawking wrote that ‘the balance of power in the UK is with private healthcare companies, and the direction of change is towards a US-style insurance system’. Hawking, in this quote, which Hunt seemed to have been referencing, does not claim it is the government’s intention to create an insurance-based system, but that that is the direction in which the NHS is heading.


It’s unlikely the Conservatives would fully privatise the NHS - it would be extremely unpopular. A YouGov poll from May 2017 found that 84% of people believed the NHS should be run by the public sector. Only 10% believed it should be run by private companies. Importantly, in the same polling, over 80% of Tory voters believed that the NHS should remain nationalised.

In terms of manifesto promises then, the Tories are unlikely to be flying the flag of privatisation. For the NHS, anyway. So Hunt is right in the sense that the government has not publicised intentions to privatise.


Interestingly, however, he did not really challenge the statement that the balance of power lies with private healthcare companies, although, the second part of his August 19th’s tweet rebuttal of Hawking included the claim that the number of individuals ‘with private med insurance DOWN since 2009 [sic]!’


That’s not really Hawking’s point, though. He never claimed the number of people with private health insurance was increasing, he claimed that is the way the health service is headed, with the increased involvement of private healthcare providers in the NHS.


The Health and Social Care Act of 2012 enlarged market-based approaches as a means of improving health care. A diverse provider market, competition, and greater patient choice was thus made a priority. In December 2014, The BMJ investigated claims that the Act (which came into effect in April 2013) led to scores of contracts being awarded to private providers. They found that, in total, between April 2013 and August 2014, non-NHS providers were awarded 45% of contracts; one-third of those contracts were given to private sector providers. However, private providers secured 80% of the contracts that they bid for. They do not control the majority of the NHS, but they are clearly securing the majority of the contracts that they want.


The benefit of competition is, however, mutable in the NHS.


In 2016, a study of NHS Scotland found that aims to increase patient choice were unsuccessful. Graham Kirkwood, leader of the study by Queen Mary University, published in the Journal of Public Health, stated that, ‘The involvement of the private sector was supposed to provide extra capacity to tackle long waiting times, so in theory we should see NHS treatments stay at the same level or increase. Instead our results show the level of NHS treatments going down during a period of high private sector activity’. This was due to private provision of hip surgeries (the studied operation) increasing, whilst NHS provision shrank. Rather than expanding patient choice, this just moved provision from one body to another.


Why does that matter? some might ask. Who cares, as long as the operation is done?


The issue is many private providers have failed, rather spectacularly. In May of this year, a private breast surgeon, Ian Paterson, was convicted for seventeen counts of wounding with intent after carrying out unnecessary operations. The Royal College of Surgeons then called for a review of the private sector, asserting that the private sector did not necessarily have the same safety rigour as the NHS. 


The NHS props up failed private sector endeavours. Private providers do not provide competition or increase choice, they just displace the NHS.


Full privatisation is deeply unpopular, and rests on shaky ground. GP surgeries are, however, largely private ventures, and private ambulance contracts, agency nurses, and various PFIs are likely to stay part of our NHS.


The priority, if private providers are to be used, should always be how they can effectively alleviate the stresses on the NHS arising from a growing, ageing and obese population.


Fair access to treatment and control of costs is vital. There should be no postcode lottery that shapes who lives and dies, and it should certainly not be exacerbated by private sector contracts. The aforementioned NHS Scotland survey, for example, found that elderly rural patients suffered poorer care because of the effects of distributing private contracts for hip surgery (namely the reduction of NHS services).


Hawking may be hyperbolic in saying that we are heading towards a US-style insurance system, but we are heading towards the same essential issue as Americans: with an ever-growing, ageing, needful population, how do we make sure everyone has the best healthcare possible? There is no easy answer, but freeing ourselves from the dogma of free market competition and its claimed unending benefits is certainly the start of how to effectively, fairly, and reliably begin to rebuild our NHS.






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