A recent study –  the first to look at the impact on NHS provision of diverting NHS funds to the private sector – shows that private sector contracts are associated with a decrease in NHS provision and an increase in treatment inequalities.

This finding brings home the urgent need for the NHS Reinstatement Bill, which was
successfully reintroduced to the House of Commons by Labour MP Margaret Greenwood on 13 July, with support from Labour, Green, and Lib Dem MPs.

Drafted by barrister Peter Roderick and Public Health Professor Allyson Pollock, the Bill proposes to fully restore the NHS as an accountable public service by reversing 25 years of marketisation, abolishing the purchaser-provider split, ending contracting, and re-establishing public bodies and public services accountable to local communities.

The impact of private sector contracts on NHS provision and treatment inequalities

Patient choice and the use of the private sector for hip surgery in Scotland has been found to be associated with a decrease in NHS provision and may have contributed to an increase in age-related and socio-economic treatment inequalities. This confirms concerns that the policy in England of contracting with private providers for NHS care, combined with NHS expenditure cuts, will accelerate the closure of local NHS hospitals and services and worsen health inequalities.

The new study compared rates of hip surgery carried out by NHS and private
providers. It suggests that the more contracting undertaken by NHS boards in Scotland with the private sector, the greater the reduction in NHS provision.

This evidence undermines the claim made by NHS Scotland’s 2003 white paper, that the additional use of the private sector would provide ‘sustainable local solutions to long waits’ for elective hip replacement. The involvement of the private sector was supposed to provide extra capacity to tackle long waiting times, so in theory NHS treatments should have stayed at the same level or increased. Instead the level of NHS treatments went down during a period of high private sector activity.

Those NHS boards with the greatest use of the private sector for elective surgery experienced the largest reductions in direct NHS provision. Those of Fife, Grampian and Lothian had not recovered 2006/07 levels of in-area provision by 2012/13.

The study also suggests that inequalities have been exacerbated, with lower increases in treatment rates for the oldest (over 85) compared to, for instance, 75-79 year olds, and for the most deprived social groups compared to the least deprived.

The 2010 UK-wide Equality Act legislated for public bodies such as the NHS to tackle inequalities in the delivery of care by a range of factors including age, sex and socio-economic deprivation. These results are therefore concerning and complement other studies that have shown that the private sector is risk averse and more likely to select out healthier and less poor patients.

It is current Scottish government policy to eliminate the use of the private sector for elective surgical NHS care, although concerns are being raised over increasing use of the private sector in the past few years. In contrast, England is now dismantling its NHS and accelerating privatisation. Indeed, it has been estimated that since April 2013 in England £5.5 billion worth of clinical contracts have been won by private sector companies, in addition to the continuing £5 billion Independent Sector Treatment Centre programme.

In Calderdale, there was a forecast overtrade with the private sector of £1.1m for acute services in 2015/16

Kirkwood G, Pollock AM. Patient choice and private provision decreased public provision
and increased inequalities in Scotland: a case study of elective hip arthroplasty.
Journal of Public Health 2016.