25 May 2008

Privatising the NHS

Dr Grumble has told you about his friend, Philip, who just does not believe that the NHS is being privatised. Dr Grumble has another friend, Sarah, who realises what is happening (her own work is going out to tender) but doesn't seem to think it matters. So, working in the NHS, we have a group of doctors who cannot open their eyes and a group of doctors whose eyes are looking through rose-tinted spectacles. And, presumably, there is a third group which thinks that privatisation is heading our way and may not be such a good thing.

Probably, if regular readers have not given up on the cautious Dr Grumble, you will think that he takes the view that privatisation is happening and is bad, bad, bad. But Dr Grumble is a physician and brought up on the grey case. Nothing is black and white. He happens to think that in Sarah's area of work (sorry to have to avoid just what this is) it might not be too damaging to privatise the service. One thing is certain: Sarah, as a highly skilled consultant, will get more money if the service is thrown into private hands. Less skilled people are likely to get less. That's the way markets work. Those in short supply cost a lot and those that are plentiful are cheap. Dr Grumble already does a small amount of work for a private company. If he worked for them full time he would be on a top barrister's salary not a doctor's. Are such changes bad? You can decide. Dr Grumble's point is only that he wants you to know that, if he is opposed to some of what is happening, it is not because of the consequences to his personal finances. What does worry Dr Grumble is the potential cost to the taxpayer. Because, if one thing is important in the world of ever-more-costly medical care, it is keeping the lid on expenditure without damaging the patient.

So the key question is: will privatising the health service cost us more? The arguments about this are there in the Grumble head waiting to get out. One day Dr G may enumerate them. To cut to the bottom line, some of what is proposed is so obviously a bad deal for the taxpayer that he cannot believe that government does not realise the folly of its ways. But governments do not necessarily do what is sensible. And they do not necessarily see what is obvious. Here's an example from Andrew Marr's excellent History of Modern Britain:

The problems with selling off an elderly, loss-making railway system on which millions of people depend, are obvious. If your first aim is to raise money, then you have to accept that fares will rise briskly, and services may be cut, as the new owners try to make a profit. This will make you less popular. If, however, your aim is to increase competition, just how do you do that? Different train companies can hardly compete directly, racing each other up and down the same track.

Very similar arguments apply to the health service. But this will not stop the government privatising the NHS. There are powerful forces at work driving this. Some think they are unstoppable. Dr Grumble does not agree.

And for Philip, who does not think the NHS is being privatised, here (pdf) is some recommended reading.


Witch Doctor said...

The Newchurch Document will surely be an eye-opener for those who care to read it, Dr G.

I've skimmed through it and I think it will be my bedtime reading for the next couple of nights.


Anonymous said...

"So the key question is: will privatising the health service cost us more?" I think you oversimplify. My key question is will I get a better health service by paying more money or by having a better structured/run service?

Or do I want a cheaper NHS delivering the same standard of service?

Dr Grumble said...

You will get a better health service by paying more money. But whether you will get more healthcare per buck by privatising it is quite another matter.