THE private versus public sector debate has bedevilled health policy for some time. It lies at the very core of the failure of politicians to provide the leadership the NHS needs. The ‘public good, private bad’ mindset which is held by many politicians on the left is equally matched by the ‘private good, public bad’ attitudes often prevalent on the right. Only in this country could this happen.
Even in these days of supposed consensus, these attitudes still prevail. Do any of these politicians think people care if they are treated privately or in an NHS hospital, if they get the treatment they want, where they want, when they want it?
Of course not. Yet people who use Bupa or other private health providers are made to feel as if they are somehow being elitist, rather than being praised for taking responsibility for their own healthcare and not burdening the NHS with their demands.
A ComRes poll in July 2014 showed that two in three people (67 per cent) say that they do not mind if health services are provided by a private company or the NHS as long as they remain free of charge.
Beveridge and Bevan never meant for the NHS to have to meet every single demand ever made of it. Two systems can work happily together as long as each respects the other.
For too long in this country, Labour politicians have seen private medicine as a class enemy and Tory politicians have viewed the NHS as something for other people to use, not them.
David Cameron makes great play out of the fact that he is a regular user of the NHS. He had a disabled son whose seizures made regular overnight stays in a local hospital a normal occurrence for him. His view was shaped by his experience. He put the NHS at the top of his agenda. He says his three priorities can be summed up in three letters: N.H.S.
One of Cameron’s first acts was to abolish the Tory policy of encouraging private sector healthcare. George Osborne said in opposition: “We are having no truck with ideas for some alternative funding mechanism like social insurance. Nor are we looking to help fund escape routes from public services for the few who can afford it, which is why we have moved away from the idea of the patients’ passport.”
All very well, but where are we going to get the extra capacity that the NHS needs if the private sector is not embraced in a way it hasn’t been before? Ministers in the last Labour government would freely admit they would not have been able to reduce waiting lists without utilising private sector capacity.
Let’s not pretend that private sector involvement in the provision of healthcare is anything new.
Most people use private sector dentists. GPs are effectively in the private sector, as are most osteopaths and physiotherapists. A lot of primary care is provided by the private sector – the out of hours service and 111 to name but two examples. Drugs are provided by private sector suppliers. Chemists and dispensaries have never been in the public sector and no one has ever suggested they should be.
It was recently reported with some horror in the Guardian that 70 per cent of NHS contracts are with the private sector. They put this down to the Lansley reforms, omitting to say that the private sector has always played a major role in health provision.
Opponents of the private sector also raise the spectre of the NHS introducing charges, conveniently forgetting that patients already pay prescription charges.
From time to time, the issues of charging for hospital food or GP visits are floated, but quickly ditched until the howl of public outrage subsides.
However, on radio phone-ins such as my own, the idea of charging for NHS services is quite popular in some areas. For example, people ask why the taxpayer should pay for the treatment of people who bring their own misfortune on themselves.
People who binge drink on a Friday night often end up in A&E. Why shouldn’t they be charged? People who regret getting a tattoo can apparently have it removed courtesy of the NHS. But where do you draw the line? Charge smokers for lung cancer treatment? Charge obese people for diabetes drugs? Another one for the too difficult box, I suspect.
Very few people have anything nice to say about the National Institute for Health and Care Excellence. And let me be no exception. It was set up by the Labour government with the best of intentions. Part of its mission was to end the variation in medical treatment across the country and ensure that if a drug was found to be effective, patients should not have to fight to get it.
Clearly there needs to be a body which licenses drugs, but there is a huge suspicion that too many drugs are still licensed through budgetary consideration rather than clinical need. And drugs which are available in some parts of the country are not in others – for much the same reason. And if a cancer patient should have the temerity to decide to use their life savings to fund their treatment using a drug which for budgetary reasons is not available via the NHS, what does the NHS do?
Instead of saying ‘thank you very much for helping us out and paying for your own drugs’, it refuses to continue any treatment for that patient. See? Public good, private bad. It’s the politics of socialist envy and says that just because everyone can’t have it, you can’t either. So people die. Is that really what should be happening? I don’t think so. It’s an example of the kind of dogma which has bedevilled our public-sector thinking over many decades.
I am surprised that no one has yet taken the NHS, or NICE, to the European Court of Human Rights over issues like this. I suspect it is a matter of time. Perhaps then the postcode lottery may be brought to an end.
No other country’s health system operates in such a bigoted and uncaring way. The sooner we eradicate this sort of thinking, the better. If we are to get anywhere in improving standards of healthcare and quality of outcomes, surely it is obvious that the public and private sector healthcare systems need to operate side by side and help each other where possible.
• Iain Dale is a political commentator, blogger and publisher. He is author of The NHS: Things That Need To Be Said which has been published by LBC Books, price £8.99.