NHS waiting lists are out of control. Around 7.5 million people are queueing for hospital treatment in the UK, around 6 million of them in England, where this is the highest number since records began in 2007. In Wales, more than a fifth of the population is waiting for treatment. There are differences in the policies adopted by the devolved administrations to reduce backlogs. In England, it is clear that an increased role for the private sector is the government’s plan.
The details of the recovery plan promised by ministers are still being finalised, with NHS bosses resisting what they regard as unrealistic targets. Finding a way to increase surgical capacity, so that more operations can happen more quickly, is the priority. The impact of delays is both social and economic: people waiting for cataracts can’t see properly; people who need joint replacements may struggle to walk. But there are worrying signs that any new contracts will tip the system’s overall balance further in favour of for-profit providers, and away from the NHS.
The unprecedented pressure that the NHS is under ought to lead the government to invest in it, not compel it to rely on businesses to do its work. Yet as with education, where the government chose to buy a package of pandemic catch-up tuition from outside partners rather than funding schools themselves, ministers are opting to meet the additional health needs of the population through the private sector. Earlier this month, Amanda Pritchard, the chief executive of NHS England, warned the health secretary, Sajid Javid, that she does not believe the latest three-month deal with private hospitals represents value for public money. She was overruled, with Mr Javid ordering her to accept it despite her warning that the NHS could end up paying for care that is not provided.
The role of the private sector in carrying out operations on behalf of NHS England is well established. Labour’s health spokesman, Wes Streeting, has said he would use private firms to reduce waiting lists. Outsourcing also happens in Northern Ireland, Scotland and Wales, although to a lesser extent. But by forcing NHS England to continue to rely on private sector backup, while refusing to commit to long-term workforce planning as advocated by the former health secretary Jeremy Hunt, among others, the government is deliberately expanding the role of the market.
New research from the Centre for Health and the Public Interest reveals that hundreds of NHS consultants have become shareholders in private ventures. MPs and regulators should examine the financial incentives and potential for conflicts of interests that such arrangements may create, and whether there is a risk of harm to NHS patients.
The number of staff absences due to illness has thankfully fallen sharply from the high of 46,000 earlier this month. But if the government sticks to plans to dismiss all those who remain unvaccinated, with letters due to go out next month, the staffing situation in some trusts is expected to get worse. Ministers should consider postponing the deadline, to give a further opportunity for trusts to address vaccine hesitancy in the workforce.
Additional NHS funding from higher national insurance should help ease pressures. But the problems in some areas are chronic, long predating the pandemic, and a worsening staffing crisis in the social care sector is already having knock-on effects. Of course, ministers continue to declare their support for the NHS, which they know is valued highly by a public that sees clearly how much worse people fare under for-profit healthcare systems such as in the US. But their actions in beefing up the role of private providers, while refusing to take the steps that would help to secure the NHS’s long-term future, speak louder than their words – or indeed their claps.
