One of the most ill informed debates which Labour regularly makes us have is the debate about “privatising the NHS”. Labour, Conservative, Lib Dem and UKIP all say they will not privatise the NHS. I think what they all mean by this is we are all fully signed up to the proposition that health care should be available free at the point of need for UK citizens who want it from the NHS, a very popular principle.
In practice the private sector plays a large role in the NHS, and has done so since its foundation. It would be a good idea if we began the debate with a proper explanation of the current structure of the NHS. Labour, Conservative and coalition governments with the Lib Dems have all preserved the extensive use of the private sector inherited from the original NHS scheme, and have extended the role of the private sector in certain ways.
From the beginning it was decided to depend entirely on the private sector for the supply of drugs and other medical supplies. A very profitable competitive industry has grown on the back of NHS contracts and their equivalent elsewhere in the world. We still depend on large pharmaceutical and medical supplies companies for everything from pills to scanners, from bandages to beds.
From the beginning it was determined that most GPs would be private sector businesses, earning much of their living from NHS contract payments. So it has remained, with a majority of GPs today being private sector contractors working under the NHS banner. On average 95% of their income comes in NHS contract payments and 5% from private sector fees and charges. The typical GP partnership receives gross payments based on the size and composition of their list of patients registered, and based on particular services they provide which qualify for additional remuneration. Out of the gross payments they pay their practice costs and then receive the rest as personal remuneration. According to NHS England in 2011-12 the average GMP received £178,200 gross , which gave take home pay before personal tax of £106,100. I think it right that we seek to reward people with medical qualifications at good levels for their expertise and professional study.
In hospitals many years ago under the Conservatives it was decided in some cases to introduce private sector contractors to do the cleaning, to provide the meals and some of the other hotel services. Labour continued with this approach. Labour also added some limited use of private sector medical services, bought in to relieve shortages of capacity in particular specialities or to improve the patient outturns and reduce the waiting lists. In office Labour argued that the essence of the NHS was to offer good quality care free at the point of use. Sometimes, they said, this could be done more quickly and more cheaply and better by buying in service from the private sector and paying for it with NHS funds for patients.
It is therefore curious that today Labour wish to maker a political issue out of the “threat” of privatisation. As far as I can see there is absolutely no threat from any political party to the idea that the NHS should be free at the point of need to those who want it. Nor do I see any likelihood that Labour, who used the private sector extensively in power to help deliver NHS services, would want to nationalise doctors and drug companies were it to get back back into office.