The NHS – contracting out is not privatisation, and the left should stop shouting “squirrel”

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December 16, 2014 by Paul Goldsmith

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If you ever want to see a real Conservative in action, listen to someone from the left talk about the NHS. You would honestly think that there is absolutely no reason to change anything, that any change would bring catastrophe down upon all of us, and to even suggest other wise betrays revolutionary instincts that Che Guevara would shy away from.

I am, of course, being a little unfair. The motivation behind those on the left not wanting change to be brought to the NHS, particularly to the way it is funded or who delivers what come from a good place. That place is the protection of the fundamental ideal of it being free at the point of delivery for everyone. The NHS is something we should be proud of. That doesn’t, however mean that it is perfect, and doesn’t mean that everything should be done to try and provide those services free at the point of use as efficiently and as well as possible.

It is here where the left have a problem. They are like the dog character in the movie “UP”, who stops and shouts “Squirrel” right in the middle of sentences should he think he has seen one. The left stop and shout “Privatisation” in the middle of sentences whenever they think they have seen one. In the case of the NHS, if I may continue the dog analogy, they are crying wolf.

No government at any time, not Margaret Thatcher and certainly not David Cameron has suggested selling off the NHS to anyone. So there is no privatisation on the cards. Now has there ever been. What there has been is “contracting out”, where some services, which can be admin but can also be medical, have been put out to tender and private companies have been able to bid for them, or some private companies have been commissioned to do medical work. When the left see this, they shout “privatisation”, and if that doesn’t work, they shout “slippery slope”, and too often refuse to engage in a sensible discussion (like the one attempted by Newsnight on Wednesday night) about it.

A report was released recently where patients were asked to compare their well being before and after some medical procedures (hip and knee replacements) that had been performed by NHS hospitals and also by some private providers (both still free at the point of delivery). The report concluded that overall the experience and well being of those who had been treated by the private sector was higher. It used a dataset called ‘Proms’ which means ‘patient reported outcome measures’ and the results were proved to be statistically significant.

Statistically significant though they were, they don’t mean private provision is better than public provision. They mean, probably, that when a private provider specialises in a few elective procedures they may provide better outcomes for patients. They also reduce NHS waiting lists, which are dependent on supply of these types of operations. They are not life-saving, normally not complicated, and it is hard to see how there could be a problem with the contracting out of medical procedures such as these.

The response from those claiming to be ‘pro-NHS’. They stopped, mid-sentence, pointed at this data and shouted out “privatisation!” and then “slippery slope!”. That was it.

Well here it is. I am pro-NHS, and I believe in it being free at the point of use. But as an economist I know that something being free means that demand can exceed supply and I have no problem in a private provider being used in that case. We have an ageing population, making ever greater demands of our health service, and we need to look at all ways of dealing with that, instead of just stopping mid sentence and shouting “squirrel”.

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