The recent NHS reforms have been accompanied by the mantra that
services will continue to be free at the point of delivery. So
that's alright then, well actually no. The key ethos of the NHS is
that it is available to everyone when they need it. Being free at
the point of delivery is only the corollary of this ethos. I pay for
breakdown cover and, if my car packs up, I get towed home with no
payment. The service is free at the point of delivery, but I only
get the service I have paid for.
Introducing more private provision into the NHS weakens the
underlying ethos of care being available when needed, because the
driving force behind a company is to generate profit. There are
plenty of examples where private companies have not put their
customers first (insurance and pension mis-selling, Southern Cross
care homes, breast implants).
The biggest issue is not necessarily that things go wrong, public
organisations can provide poor service as well, but how quickly
issues are put right. Private companies will fight to protect their
profits (it's their reason for being after all), look at how long it
took for the insurance companies and banks to admit liability over
the mis-selling of various products. In the case of the breast
surgery the main providers of the PIP implants have refused to carry
out corrective surgery and the NHS has acted as the safety net. When
things go wrong in the public sector, the politicians have more power
to take corrective action.
The NHS is far from perfect and includes perverse incentives (too
many targets, an obsession with structural change), but the ethos is
that the patient should come first. For private companies that will
only be the case whilst the patient generates a profit. The argument
over how the NHS functions masks the real focus which should be on
why the NHS exists – to provide healthcare to all. The only
questions we should ask are:
- What is the best thing for the patient?
- How do we allow staff to deliver that care most effectively?
The market can generate innovation and necessary change, but it
cannot ensure everyone gets the healthcare they need, when they need
it.
