Recent headlines about the NHS drawing up secret “sustainability and transformation plans” have led to speculation about widespread cuts to local services and allegations of an orchestrated attempt by the NHS to keep the public in the dark. For the record, indiscriminate closures are neither planned nor legal. But the need for a rational, national debate about how we secure a viable health and care system is urgent, and made more difficult by partisan and party-political arguments.
What’s more, and with this week’s autumn statement highly unlikely to offer anything other than jam tomorrow, we must shift the focus away from hospitals. I don’t know any NHS leaders who believe that more hospitals are the answer. Quite a few hospitals and services could do with shifting to where they’re most needed, but the NHS has no appetite for solutions reliant on more institutional settings.
Right now NHS leaders are calling for the priority to be social care. But with the country’s most publicly treasured institution facing unprecedented demand, exponential growth in high-cost complex care and a post-Brexit economic landscape that leaves little room for optimism, what are our political leaders talking about? The threat posed to the service by the private sector.
What was seen a decade or so ago as a sensible way of attracting investment, and what helped get average waiting times down from 18 months to 18 weeks, is now seen as a political no-go area, with the Tories and Labour locked in an arms race over who has used the private sector least while in office. This is a con trick, as in reality the private sector has been used for decades to help sustain a health service that is free at the point of use and available to all based on need and not ability to pay.
Currently, NHS leaders are working through how to bridge the quality, access and finance gaps in their areas, and it’s not unusual for these plans to be predicated on the need for multimillion-pound injections of capital. Across the country, funding requirements run into billions, and there will need to be significant private investment if plans for transforming the NHS care landscape are to be realised. This raises the spectre of the rightly discredited PFI schemes. Acknowledging and learning from their failure, rather than being paralysed by past events, is the way forward.
Independent-sector healthcare providers, which increase the system’s capacity to respond to demand, help meet waiting-time targets and enable investment to bring important benefits for patients – most of whom are relaxed about who provides their care, so long as it’s high-quality and free at the point of use. This is particularly important at a time of lengthening waiting times and unprecedented demand, and in advance of winter, which always adds to existing pressures.Examples of beneficial private sector involvement include quicker access to treatment through the use of private hospitals paid at NHS prices, more rapid discharge from hospital through well-established “recovery at home” services, and access to private sector community diagnostic facilities for scans, tests and examinations, again at NHS prices.
There will need to be significant private investment if plans for transforming the NHS care landscape are to be realised
We need to remember too that the public sector does not have a monopoly on caring. I have more than 40 years of public sector clinical and leadership experience, and in that time we have seen high-profile failures in the private, public and voluntary sectors. I don’t seek to deny the incidence of failure, but providing choice beyond a single, public option, introducing personal budgets and enabling different forms of independent sector provision has more often been a force for good, and improved people’s lives.
And this is still the NHS – free at the point of use, with strong safeguards over quality and safety.
So let’s stop pretending that private sector involvement in the NHS is a uniformly bad thing: it isn’t. Around 10 million NHS patients per year are treated by private sector organisations operating across nearly 2,000 sites. Patient feedback and Care Quality Commission inspection reports demonstrate that these services are generally safe, responsive and high-quality.
The political debate over the future of the NHS urgently needs refreshing, and portraying private sector healthcare organisations as bogeymen that should either be pushed out of the NHS or never spoken about simply serves to bind the hands of NHS leaders who want to bring about change in partnership with others.
As long as this political negativity exists, it will be patients who feel the consequences.
Private money is the NHS’s saviour, not its bogeyman | Stephen Dalton
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