Does Low Funding Lead to Privatisation of the NHS?

Margaret Greenwood MP

Former Shadow Secretary of State for Work and Pensions

Margaret Greenwood writes an impassioned piece on the importance of funding the NHS and the blurring line between public and private provision.

The NHS is being starved of resources, and patients and staff are suffering as a result.

More than 120,000 people in England died last year while on NHS waiting lists for hospital treatment, double the number who died in 2017-18. Underfunding has devastating consequences. Waiting lists for routine treatment recently hit 7.68 million for the first time. There are still well over 100,000 staffing vacancies, and many of those who are in post are over-stretched and facing burnout. Yet deep cuts are still being made.

New system, new cuts

In May, it was reported that integrated care systems will have to make average efficiency savings of almost 6 per cent to meet their financial requirements this year. According to the Health Service Journal, one integrated care board (ICB) said of its financial plan for 2023-24, “We do not have confidence that we can deliver it in full but are committed to trying.”

It is clear that the Government is simply not giving the NHS the necessary funding to meet the needs of patients.

If the Government continues to underfund the NHS, we can expect to see even longer waiting lists and increasing numbers of people paying, in desperation, for private treatment that they are entitled to receive on the NHS. The costs can be eye-watering.

Strategy behind the queues

The highly respected Professor Sir Michael Marmot recently said “If you had the hypothesis that the Government was seeking to destroy the National Health Service … if that was your hypothesis, all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised health care system, he referred back to this answer and added “I have no special insight into what motivates ministers, but they’re not behaving as if they want to preserve our NHS.”
Of course, evidence of Conservatives’ desire to privatise the NHS has been around for a very long time.

As far back as 1988, John Redwood and Oliver Letwin wrote a pamphlet, which has been seen by many as a blueprint for the privatisation of the NHS.

In 2008, Jeremy Hunt, now the Chancellor of the Exchequer, co-authored a book entitled Direct Democracy: an Agenda for a New Model Party, which included the line, “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain.”

The squeeze on NHS funding is a basic tool in the Conservative Party’s armoury when it comes to undermining the NHS as a comprehensive, universal public service and seeking to replace it with a privatised system.

One of the provisions of the Health and Social Care Act 2012 was to allow NHS Foundation Trusts to, in effect, earn 49 per cent of their income from treating private patients.

The Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships (ICPs) and so, play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent. The act is vague around who can sit on integrated care boards (ICBs), which exercise commissioning functions, as well as their committees and sub-committees. As a result, the new structures are riddled with opportunities for conflicts of interest and the pursuit of strategies that fly in the face of the founding principles of the NHS. This is contrary to what the public wants to see.

A political choice

People are quite rightly proud of the NHS; it’s our most treasured institution, but these major pieces of legislation, together with chronic underfunding, have actively undermined it as a comprehensive public service.

The Rational Policy-Maker’s Guide to the NHS, produced by The 99% Organisation in July of this year, sets out the average annual change in per capita health spending by UK governments since 1979, adjusted for demographic and population factors. The political differences are sharp.

Between 1997 and 2010 under Labour, there was an average annual increase in per capita health spending of 5.67 per cent. The Conservative-Liberal Democrat coalition government oversaw an average annual reduction of 0.07 per cent between 2010 and 2015, and under the Conservatives between 2015 and 2021, there was an average annual reduction of 0.03 per cent. The current Conservative Government’s committed spend, up to 2024, represents an average annual increase of 2.05 per cent.

Put simply, Labour governments have, on average, increased the per capita health spending in the UK markedly more than Conservative governments.

Public satisfaction levels have reflected the success of this approach; they were at their highest at 70 per cent in 2010, the year Labour left office. In 2022, overall satisfaction with the NHS fell to a record low of 29 per cent. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives being in power.

The Rational Policy-Maker’s Guide shows that, according to respected international data from the Commonwealth Fund from 2014, the UK NHS has often been the best-ranked healthcare system in the developed countries studied in terms of effectiveness, equity, and efficiency. This was before underfunding had made a significant impact on performance.

The report also asserts that “the fundamental business model of the UK NHS is better than that of any other in a high-income country,” and it puts forward the view that “the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time.” This makes a great deal of sense.

The next government

We all want the NHS to be there for us when we need it, but we are perilously close to losing it. If the needs of patients are to be met, the next government will have to provide the NHS with significant annual increases in funding. They should also put an end to NHS privatisation and commit to the delivery of a comprehensive universal public service.