Labour, the private sector and the NHS

Listen:
https://x.com/keepnhspublic/status/1934171933739728924?t=5jggU7O2-DPppwTjxQLVgQ&s=08 [4.44 mins]

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LBC News:             Health secretary Wes Streeting is defending private sector care in the NHS after figures suggest it is helping to cut waiting lists. Half a million patients have been treated by private doctors since January this year. Mr. Streeting has written in the Telegraph saying it would be foolish not to use the independent sector to support the NHS. Let’s talk with Dr John Puntis, Co-chair of Keep Our NHS Public, a retired consultant pediatrician. Very good morning to you, thank you for joining us. What do you make of all of this?

JP        Good morning, Sandy.

It sends out the very clear message that government would rather invest in the private sector than the NHS. I think in the long term that’s completely the wrong approach and the figures don’t really give the full story because the complete story has to include the adverse effect on the NHS of outsourcing to the private sector.

And ophthalmology is a brilliant example. This is one of the biggest outsourced specialties. You have a situation now where the private sector did not have spare capacity but because the NHS said it would send lots of patients to the private sector for cataract surgery you have something like 170 clinics that were opened. There are five big players in that market and in one year they made £169 million in profit – that’s a 32% profit margin. At the same time, they take low risk patients. They have direct referrals from opticians who send patients with very early cataracts that the NHS wouldn’t normally operate on and the result is that the number of patients operated on for cataract surgery goes up and there’s less money left for everything else which is left to the NHS units to manage.

So you have NHS units who used to subsidise their other work, including complex eye conditions which would end in loss of sight if not treated promptly, and also providing 24-hour emergency cover. They used to subsidise that from the money that they got from doing high volume cataract work. They now don’t get that.

It’s also having a terrible impact on training because cataract surgery is the bread and butter for training ophthalmologists and something like 7 out of 10 trainees in ophthalmology are now saying they’re not going to work in the NHS [when training is completed] because they could get a lot more money if they go and work in the private sector doing cataracts. So there’s all kinds of ramifications for this.

Another point I would make is that the private sector providers in ophthalmology are we’re actually servicing their debt the companies that bought up the cataract operations they are private equity companies and the money that the NHS pays them something like £69 million actually went on servicing the debt that they incurred in order to buy these companies in the first place.  

This is not a good use of taxpayers’ money.

LBC News:             You started by saying that the signal it’s sending is that the government would rather invest in private sector than NHS medicine. Is it not more the case though at the moment that they’re trying to ease the pressure on the NHS and therefore they’re trying to help the NHS while they can find the space to invest in the NHS?

JP        I think that’s their argument but I don’t think it stacks up. For example, they say the private sector has spare capacity and so it would be ludicrous not to use it. But it doesn’t really have spare capacity. It develops capacity if it’s given money and it takes staff from the NHS and if you look at the other big outsourced speciality of orthopedics, and hip and knee surgery, there’s been a very detailed study just published by Professor Allyson Pollock that showed as this policy over the years of sending patients to the private sector has rolled out – and this is its latest iteration – activity in the NHS went down, waiting times went up, overall numbers of operations went down, and the most disadvantaged 20% of the population were the ones who ended up waiting the longest, because they don’t get referred to the private hospitals – they stay in the NHS. So it’s a policy that actually increases health inequalities

LBC News:             Dr John Puntis thank you so much for joining us, Co-chair of Keep Our NHS Public, a retired consultant pediatrician

For a longer discussion see a new article by John Puntis and also KONP’s Labour and the NHS section on this website