Opinion: Look at what’s happening to the NHS in England and reject the continuing privatisation of NI health services
NHS Privatisation: What does the Evidence Say?
Speaking to councillors at the City Hall, Belfast earlier this year, Workers Party spokesperson, Lily Kerr, made a forceable argument against the outsourcing of healthcare in Belfast to private providers. Why, she asked, would anyone object to another hospital being built in South Belfast, before showing how harmful this private health concern will be for most of the people here.
According to those who champion outsourcing, it is an article of faith that private sector involvement improves performance through efficiencies derived from robust competition. The Workers Party and others argue that privatisation and outsourcing lead to cost cutting and poorer outcomes for patients. So, who’s correct?
Writing in the Lancet, two scholars from the Department of Social Policy and Intervention, University of Oxford, have looked at trends in the NHS in England, where privatisation and outsourcing have been ongoing for thirty years, to see if empirical evidence can show whether these measures have had beneficial or negative effects on patient outcomes. The results are shocking, if unsurprising.
Thirty Years of Privatisation
Since 1991 the NHS in England has operated a two-tier system, “a private health sector serving a minority of the population and the NHS serving the majority”. In addition, an internal market operates within the NHS purchasing services from for-profit and non-profit external providers. In the mid-2000s, reforms centred on a rhetoric of ‘patient choice’ introduced a consumer market with “increased ... use of private finance and independent sector treatment centres.” The 2012 Health and Social Care Act intensified pressures on the NHS in England to outsource service provision from state-owned providers to private for-profit providers. For example, provision of contracts seen to be favouring state providers was outlawed as ‘anti-competitive behaviour’.
Results
Analysing payments made by 173 NHS clinical commissioning groups (local bodies) in England between 2014 and 2020, the researchers found that “private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services”. Outsourcing was associated with 557 additional treatable deaths over a six-year period. In other words, during this period 557 patients died whose conditions could have been successfully treated.
Why did they die? Poorer Quality and Cream Skimming
What accounts for these significant increases in mortality in the fifth richest country in the world? One theory is that cost cutting behaviours by for-profit providers mean inferior services which will lead to worse health-care quality and health outcomes. “The private providers receiving NHS contracts could simply be delivering worse quality care, resulting in more health complications and deaths. For-profit providers tend to cut costs more than public providers; this can be through staff numbers and qualification levels” or nonadherence to guidelines for correct medical processes.
Similarly, in a process known as 'cream skimming', increased competition for contracts could result in private health-care providers prioritising easily quantified outcomes such as waiting times or relatively easy procedures such as cataract surgery, at the expense of quality of care and more complex, potentially life-threatening procedures, resulting in higher patient mortality. As another recent report indicates, the private for-profit sector is averse to risk and, therefore “unwilling to deliver full-scale emergency services or open-ended services for the chronically sick and elderly – unless a substantial premium payment is attached, to guarantee a profit.”[1] Lily Kerr noted, “the private sector is only interested in making a profit and cherry picking the cases they want to deal with: if it’s profitable it’s theirs, costly its ours. They don’t do serious complex health care needs because they deem them be too costly, which would eat into their bottom lines.”
Say ‘No’ Now!
The Oxford academics note that their findings, “suggest that these processes, manifesting in the outsourcing of health-care provision, are not associated with improvements in service provision, and instead have been associated with increased deaths among patients.” The people of Northern Ireland should look across the water and say a loud ‘no thanks’ to NHS privatisation and outsourcing everywhere in these islands.
B Goodair MSc, A Reeves PhD, Department of Social Policy and Intervention, University of Oxford, Oxford, UK, ‘Effects of outsourcing are contested. Improve additional competition. Cost cutting and poorer outcomes for patients’, Lancet Public Health 2022; 7 https://www.spi.ox.ac.uk/publication/1266459/hyrax
[1] The Rational Policy-maker’s Guide to the Private Sector, How the NHS should approach competition. https://99-percent.org/the-rational-policy-makers-guide-to-the-nhs/