Type NHS privatisation into Google and it returns 981,000 matches. Ever since the Government restructured the NHS, the row over “privatisation” has raged. The Coalition Government has stated very clearly that in its view competition and bringing in independent providers will enhance the NHS and drive up standards.
Privatisation is an immensely emotive word; the root of it “private” is anathema to the NHS, a state run service free at the point of delivery. It evokes images of Big Corporate Bastard Health companies whose only aim is to squeeze as much money as possible from the NHS in order to pay ever larger bonuses and dividends to its share holder whilst simultaneously providing a cheap, inadequate and probably dangerous service for patients.
However, the government never says private sector, it says “independent sector” by which it means private companies, social enterprises and charities. As someone who has spent 20 years working in and with the third sector, this makes me very uncomfortable. I do not like the face that in arguments about privatisation, charities like for examples MIND, diabetes UK, Arthritis care or whoever are lumped in with the likes of SERCO and Virgin Healthcare. Yes both are “independent providers” as in they are not N HS bodies but private companies which exist explicitly to make a profit for share holders should not be in the same category as charities.
I do wonder though, for people in the NHS is an NHS service provided by a charity more acceptable than one provided by a private company? I would genuinely be interested in knowing.
Most people I know in the charity sector do not agree with the changes to the NHS and do not want to see large profit making private companies providing NHS services either. However, they also have to be realistic. The income of charities is under huge pressure. A poll published by the Charities Aid Foundation and NCVO in December 2012. Showed that charitable donations in the UK dropped by 20% in 2011-12 £11bn to £9.3bn during 2011-12. As a result, two in five charities (40%) fear they face closure if the economic situation does not improve, while one in four has axed staff. Other sources of funding such as charitable trusts are under growing pressure at a time when their own income is at best flat-lining. In 2013, Social Enterprise UK published research that identified that 92% of charities wanted to increase their income from trading and 90% felt that income from grants and donations would continue to drop.
Presented with such a difficult funding climate, most charities in the health and social care field will look at opportunities in the NHS and face a real dilemma; should they go for contracts to run NHS services that will bring in additional income and offer patients more choice? Or should they let them pass by knowing that private companies will go for them and could of course win them?
Personally, I cannot see the clock being turned back on NHS services being put out to tender. Already some 200 contracts worth over 2.5 billion have been put out to the market. I would like to see far more NHS and third sector partnerships working together to bid for services. This is happening in some areas e.g. Bedfordshire musco skeletal services though even there Circle are the lead contractor. The NHS and the third sector together could be immensely powerful sharing many common goals and views about doing what is best for patients and that that definitely comes before profit. How can we make it happen more often?