4 April 2022

The Government’s latest U-turn shows the ideological purity of the NHS matters more than patients


Every time. Every time one thinks that surely the Government’s will couldn’t get any weaker, the gulf between its notional majority and its will to act any wider, it finds a way to surprise you.

Last week we saw the Government not only retreat from onshore wind and its plans to overhaul judicial review, although each of those was disappointing enough. It also junked plans to involve the private healthcare sector in efforts to clear the Covid-19 backlog.

According to The Daily Telegraph, a health minister tabled an amendment to the Health and Care Bill to ban private providers from the new elective care boards being set up in the latest round of reforms.

This followed a defeat in the House of Lords, where Labour tacked on an amendment barring those who had ‘conflicts of interest’ from commissioning service. 

And the Opposition have been quick to jump on the retreat, with a shadow health minister crowing: ‘We see a dramatic shift that is most welcome. We may start to get back to a public service model.’

It really is enough to turn the stomach. The pandemic saw huge disruption to the normal operation of the Health Service, causing delays which prolonged preventable suffering and, in many tragic cases, cost lives which might ordinarily have been saved.

Those delays haven’t gone away; in fact, they could continue to get even worse. The word ‘backlog’ stands in for more suffering and, potentially, more death. Clearing it is rightly an urgent priority.

Unfortunately, some things are more important even than that. The private sector may have the capacity to take on patients, perform operations, and help get the system back on track. But that would sully the purity of ‘Our NHS’. 

Better to have patients suffer nobly queuing for the public option than ‘relying on the private sector’ – apparently an insupportable evil, even when the state is picking up the tab and there is no challenge to the principle of free at the point of use.

The progressive priorities which saw The Guardian write that ‘the only serious black mark against the NHS was its poor record on keeping people alive’ are still with us. 

What makes this U-turn stand out (in an increasingly crowded field) is the speed of it. At least on planning the Prime Minister is jettisoning plans made in the distant days of 2019, before the pandemic and internal ructions destroyed the Government’s sense of purpose.

Javid’s plan to clear the NHS backlog, on the other hand, was only published in February. The life-cycle of the Government’s bids to apply right-wing values in practice can now be measured in weeks.

Again, this is a government elected just over two years ago with an overall majority of 80. Just think what Thatcher, or Blair, would have done with that sort of muscle.

This insistence on maintaining a strict firewall between the NHS and private healthcare hurts patients. One source quoted by The Daily Telegraph nails it when they say it ‘will send a message that the capacity and investment which they bring will be better targeted at supporting the growing numbers of patients choosing to pay privately for care’.

Because private healthcare will still exist. It will just be siloed off, with no means of contributing to a joined-up, mutually-supportive healthcare system.

In a world where the purity of the model mattered a little less, it would be relatively straightforward to establish ways in which private healthcare could bring extra resources into the system and subsidise the less well-off. This is indeed a feature of some of the mixed social insurance systems we see on the continent.

Imagine if NHS Trusts could treat private patients, with the profits put back into the trust to fund better public care? Given those private patients are going to exist either way – Labour is not talking about banning the private sector, after all – surely supporters of the NHS should prefer their cash to support it, rather than the balance sheets of profit-making providers?

Remarkably, no. Ever since NUPE went on strike to drive pay beds out of NHS hospitals in the 1970s, the preference has been for ideological purity. Even as the NHS continues to consume an increasingly unsustainable share of public spending, its most committed supporters cling to a Shangri-La where it is ‘properly funded’, rather than deigning to tap tainted funding streams which actually exist.

We might have expected better from a Conservative government with the largest Commons majority since 1987. But at this point, that would admittedly be very naïve.

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Henry Hill is Deputy Editor of ConservativeHome.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.