Introduction

Whether you believe the NHS is being privatised depends on your view of the founding principles of the NHS. Do your beliefs hinge on the fact the service should be tax funded and largely free at the point of use? If that is all that the NHS amounts to—one of the world's biggest and most comprehensive health insurance systems—then the NHS could, at least in theory, be entirely privately provided. It would, however, remain recognisably the NHS because patients would not pay. That, broadly, is what Tony Blair, Alan Milburn, John Reid, and now Patricia Hewitt, the current health secretary, have all come to believe. The alternative view is that the founding principles include the proposition that the NHS should also be largely publicly provided.1

Waiting times for cataract surgery have fallen sharply since treatment centres were launched

Credit: PASCAL GOETGHELUCK/SPL

Public or private?

Those who hold the view that the NHS should be publicly provided are faced with the challenge that the 30% or so of the NHS budget that does not go on paying staff has always ended up in the private sector through £10bn ($18bn, €15bn) a year of pharmaceuticals plus beds, drips, files, computers, and much else. Indeed, of the 70% that is spent on pay, a considerable sum goes to general practitioners, most of whom have always been, and remain, independent contractors not salaried employees.

Added to that, the NHS has long bought some operations from the private sector. And it has long contracted out care for some of its most vulnerable patients, including people who require medium secure accommodation and who are compulsorily detained under the mental health acts, as well as those …