Dr Tony O’Sullivan, co-chair of Keep Our NHS Public looks at the forms NHS privatisation takes and the impact on patients, staff and the NHS itself.
This article first appeared in the September-October issue of Public Sector Focus in the run up to Budget Day, 26 November.
For decades, governments have denied privatisation of healthcare in England. Ministers’ denials always rely on services still being free at the point of use. Now, the Government embraces privatisation, though evidence shows how it undermines the publicly provided national health service and damages patient safety.
Privatisation takes different forms, all with negative impact:
- Transfer of public funding to private companies: outsourcing of NHS clinical services for patients (such as cataract and joint replacement surgery) and outsourcing support services and ‘soft facilities’. NHS trusts have created separate private companies (‘SubCos’) – though there is pushback recently. Some have set up joint public-private companies (Synnovis, the £2.25bn pathology network in SE London).
- Rationing or withdrawal of some NHS services and charging for others like dentistry, driving more patients to the private sector.
- The PFI hospital building scandal from the Blair years returns in the form of PPP to fund new NHS building outlined in the 10 Year Health Plan for England.
- Ubiquitous private sector involvement in the management of the NHS: 15 years of cuts stripped out the skills, experience and organisational knowledge of NHS estates, procurement, public health planning, finances and HR, leaving trusts heavily reliant on private consultancies and corporate replacements for support services.
Privatisation of cataract surgery provides a dramatic case study. NHS patients with serious eye conditions – from glaucoma and macula degeneration to retinopathy of prematurity in babies – are at increased risk of losing their sight as a consequence of the massive outsourcing of cataract surgery to the private sector. Five private companies with NHS cataract contracts worth £536 million extracted 32% profits (£169 million) in 2023-24. The Royal College of Ophthalmology warned: ‘Investing so much scarce resource into treating cataracts – a reversible, relatively low-risk condition – in the independent sector has led to funding, workforce and infrastructure being diverted.’
However, the Government is no longer denying privatisation – the 10 Year Planmakes clear that it actively welcomes ‘partnership’ with the private sector – viewing it as the saviour of England’s stressed health service. Labour is relegating the NHS to the role of mere partner to corporate companies and plans to send more NHS funding to the private sector along with NHS patients, staff and ownership of buildings.
Alan Milburn has re-emerged to exert major influence on the plan. Now Wes Streeting’s main mentor, Milburn pushed hard as health secretary under Blair for NHS privatisation. His later career took him to Bridgepoint (venture capital) and in 2018 to Ribera Salud, the private accountable care organisation in Spain. In a recent interview with the Health Foundation, Milburn calls time on the NHS as the main provider of healthcare in England, and his views are clear:
“We’ve got to stop viewing the healthcare system in this country as being about a single institution that we happen to call the National Health Service, and instead see it as being an ecosystem of very different providers from tele cos, tech cos, of course private sector providers, at the margins, the public sector.”
This is a dramatic divergence from the principle of the NHS as a publicly provided universal service. Streeting’s plan will expand all forms of privatisation, in the face of evidence that a well-funded publicly provided NHS is the most cost-effective model, free of private involvement.
Privatisation in all its forms has a damaging impact on patients, staff, funding and NHS infrastructure. MPs must look at the evidence and challenge the direction of travel pursued. MPs were right to oppose the slashing of disability benefits a few months ago. Now is the moment for MPs to defend the publicly provided NHS with equal vigour.
Streeting’s plan relies on the private sector, playing an increasing role across the board, to boost productivity. He is captivated by apps, gadgets, private tech and data companies whilst cutting 100,000 NHS jobs that deliver – many will have to find work with the expanding private sector. Public-private partnerships – the new PFI – may fund new NHS community and hospital buildings but will create long-term indebtedness.
The WHO definition of privatisation is met:
“…a process in which non-government actors become increasingly involved in the financing and/or provision of health care services”
Private organisations already involved in the provision of NHS clinical and support services, financing, management and procurement have had a damaging impact on the NHS. Longterm, privatisation increases costs of services, patient safety is compromised, health inequalities widen and there is a negative impact on NHS staffing and training.
In 2022-23, at least 11.2% of the NHS budget went on private contracting of patient services. Add to this NHS trusts outsourcing cleaning, catering and other soft facilities, private SubCos owned by trusts, high street optometry, dentistry and corporate interests in primary care and pharmacies, and the costs of contracting, legal firms’ and consultancies’ fees.
Overwhelming evidence shows that privatisation costs more and patient care is compromised. We need health policy based on evidence.
The public trusts the NHS model and it remains a top three issue for voters. But waiting lists have risen in the two monthly reports and patients struggle to see their GP. For as long as the Government fails to deliver on its NHS promises, Labour’s days are numbered.
MPs, unions and those with political influence must demand a halt to the path to privatisation, a reversal of funding cuts threatening 100,000 jobs, and an urgent switch of investment from private sector companies to the NHS and care systems to allow them to provide health, care and security for the population once again.
Further information:
- Privatisation of the NHS – Briefing from Keep Our NHS Public https://bit.ly/4gXaIU9
- Ten Year Health Plan for England. DHSC July 2025 https://bit.ly/4qbgvd0
- How has the role of the private sector changed in UK health care? Nuffield Trust, 2024. https://bit.ly/4mMvqaF
there is si much evidence that privatisation has brouhgt about the demise of the NHS as well as g0venmemts using PFI to borrow money to build hospitals etc from the private sector who demanded enormous interest charges so much so that we can be paying for years to repay the debt and actually finally own the hospitals. There is so muc more to say from people with far more knowledge than me and many others but we do get the gist of it.If you want to change something rubbish it as much as you can and keep repeating the same old lies All this has to stop!