You have to first follow the Tweet exchange on this issue between me and Martin McKee, who generally is a good public health academic. I don't think he works in the NHS directly in terms of provision of care or commissioning, but correct me if I'm wrong.
In response to my earlier blog he claimed that concerns about NHS privatisation were not unfounded. I think Cameron and Lansley have been clear they want charities, private sector, social enterprise and existing providers in the fray for NHS contracts, but so was Labour. At the moment the private sector does actually take NHS work - including a fair bit of the routine stuff. It isn't in that respect much change from NuLabour.
My view is that the public would see privatisation as taking away the tax payer funded guarantee of NHS treatment "from the cradle to the grave", which I don't believe will be on the cards in my lifetime at least. Martin McKee seems to differ, but he doesn't seem to quite admit that if the NHS using private providers is privatisation in his definition, then it is already privatised (under Labour).
So what is your definition:
1. Not privatised whoever provides care as long as paid for by taxation not the patient? (ie would only be called privatised if we take away the taxpayer funded service).
2. Currently already privatised because there are already (and have been for years) private providers providing tax payer funded care for NHS patients?
3. Would be privatised if 100% of care was provided by private providers, even if tax payer funded, free to the patient?
I think Martin must agree with point 2. I'm somewhere between 1 and 3. What are your views?
By the way - I think the important thing is that the commissioners need the freedom to make the right choices for their population. This can even involve overpaying to protect some services, and protection from cherry picking and fragmentation. That doesn't mean the private sector should be excluded, however.
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Dear Rachel,
Thanks for giving me the opportunity to respond in more than 140 characters! Why I responded to your original tweet, suggesting fears of "privatisation" were unfounded, was because so far I've been unable to get a response from the government about what they mean. It seems that they agree only with your definition 1 - i.e. even if 100% of delivery is private it is not "privatised" as long as care is still tax funded and free at point of use (I'll return in a minute to what "care" is). This is fine, as long as they make it very clear to the public that in future their local hospital could be run by a US corporation. However, you suggest (option 3) that you think this could be privatisation of the NHS. The two positions are not alternatives and we need absolute clarity.
There is the question of what "NHS care" actually includes. My reading of the bill suggests that consortia could define this in a way that excludes some (or even a lot) of what the public now consider to be included. Again, if this is intended we just need transparency.
Option 2 is a straw man. Some elements of NHS funded delivery are clearly privatised already, but the vast majority is not. I think most people want to know where the balance will lie in the future.
So, in summary, we need much more clarity about what the result of the Bill will actually be. Then we can begin to apply the evidence about what works and what doesn't.
Best wishes
Martin
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