A Helping Hand

The following editorial is a step in the direction of privatization recommended by the Galen Institute in a letter to The Times last summer.

The Times of London, Editorial
November, 1, 2000

The NHS concordat shows a welcome lack of dogma Yesterday was an historic occasion for the National Health Service. Alan Milburn, the Health Secretary, shook hands on a deal which could put an end to decades of antagonism and uncertain relationships between the public and private healthcare sectors.

But, after generations of enmity, will any long-term benefits to patients result? The new “concordat”, announced in the NHS Plan in July and formally signed yesterday, will allow patients to be treated at NHS expense in the private sector when no spare room can be found elsewhere. While the concordat is far from a full solution to the winter pressures already being felt in some hospitals, the agreement will make essential slack available. Unlike Britain which appears uniquely wedded to public provision, other European countries like France and Germany already use private beds to stave off peaks in demand. It is only sensible that we should follow suit.

Relationships between health authorities and private companies are presently at best vague and at worst non-existent. Both sides have historically been discouraged from co-operating. This mistrust will take time to dissipate. But formalizing the existing patchy arrangements between sectors may help NHS managers plan ahead more effectively. Health authorities could finally have the freedom to co-ordinate provision locally. If this reduces the cancellation of routine operations and prevents the horrific spectacle of patients having to travel miles for emergency care, it will have served a useful purpose.

The agreement is symbolic in its admission that a reciprocal, though often unpredictable, relationship exists with the private sector. The life and death nature of health politics has often meant that expediency has triumphed over long-term planning. This winter, the Government’s immediate priority is to find more beds and more doctors and nurses to staff them. In the short-term, the Government needs rapid improvements to convince voters that its manifesto pledge to “save the NHS” has been achieved. In this climate, the concordat may be interpreted as a face-saving measure – no more than a contingency plan to ward off a damaging winter crisis in the NHS.

The deal certainly raises more questions than it answers about the Government’s relationship with private medicine and its vision of the future NHS. Is the private sector only a short-term winter expedient or will ministers eventually overturn the Labour left’s historic aversion to private healthcare by placing greater reliance on the private sector? For now, the concordat will simply make use of existing beds rather than building up additional capacity. Nor, of course, will it find the cash required to fulfil the Prime Minister’s aspiration of bringing UK health spending up to the European average. Funding this increase in spending will require similar pragmatism to that now being applied to provision.

The concordat is a welcome signal that the Government is willing to take a longer-term, less ideological approach to meeting the public’s rising demand for healthcare. It shows a desire to even out the cyclical boom and bust in NHS capacity. Nick Harvey, the Liberal Democrat health spokesman said yesterday: “In any rational system, this sort of co-operation would not be regarded as an ideological revolution.” This is a small step towards a more rational approach to healthcare by Labour ministers. If it at last convinces the rank and file that the private sector must play a larger role in healthcare provision it will be historic indeed.

Grace-Marie Arnett is president of the Galen Institute, a health policy research organization based in Alexandria, VA. Readers may write her at galen@galen.org, or P.O. Box 19080, Alexandria, VA, 22320.

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