I find that the really popular part of the NHS that most voters wish us to protect and continue is the fact that most NHS service is free at the point of need , and all UK citizens are eligible for that treatment based on their need, not their means. All main political parties in the Commons – and I think UKIP – support this principle. The political debate is often about how a monopoly healthcare provider can deliver a good enough service without queues, without high rates of hospital infection and without bad treatment.
There is always, however, another foolish debate about whether Conservatives secretly plan to privatise the NHS, with most people rushing to condemn any such move. Successive Conservative and Coalition governments have remained wedded to the free at the point of use principle, and the next Conservative Manifesto will doubtless reaffirm it. Labour governments have also normally stayed true to this principle, though a former Labour government did break it by introducing prescription charges which have subsequently been accepted by all governments as a modification to the main principle. Many people are now exempted from these payments based on their own needs and resources.
There is however, another way of looking at the Labour concern about “privatisation”. Whilst no recent government has and no future government after the 2015 election will seek to introduce charges or want to change free at the point of use, not all NHS care is delivered in NHS owned establishments by directly appointed staff. Again the irony is that the accusers over privatisation, Labour, have in office bought in private sector care for NHS patients themselves, sometimes preferring a private sector contractor to their own in house staff. All major parties accept that it may be sensible to outsource catering, cleaning, legal work or even some clinical and medical services.
There is also one huge elephant in the room for those who claim to be against all private involvement in the NHS. That is the GP service. The primary care GPs were never nationalised in the first place. To this day they remain as a collection of small businesses, running their own practises, with payments from the NHS under contracts for services they provide.
As proof of their private sector status they can perform private sector work in their surgeries, offering holiday and travel advice and vaccinations, private consultations, work for legal cases and the like for fees and charges. The GPs arrange their own properties, finance their own practises and hire their own staff. They may run their own dispensing service to earn additional revenue.
The latest GP contract reminds us of their independent status, and of the controls and limits on their NHS work conduct imposed by government through the contract for services which the NHS buys. Few of those who claim to hate private involvement turn their attack on the GP model. No government has wanted to fully nationalise the GP service, and make all doctors state staff turning up for duty in NHS owned surgeries with no right to undertake private competitive medical business. Maybe this should give pause for thought when next the cries go up about the dangers and undesirability of private involvement, and remind people that it is the no fee and charge that people most like, not the details of how the service they receive is organised.