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Feature NHS Reforms

How attractive is the NHS to private providers?

BMJ 2011; 343 doi: (Published 30 November 2011) Cite this as: BMJ 2011;343:d7682
  1. Philip Carter, journalist
  1. 1London, UK
  1. pc{at}

Have reports of the death of the NHS been greatly exaggerated? Philip Carter reports on the ambitions—and reservations—of the private companies poised for greater involvement in healthcare delivery

The Health and Social Care Bill sets out a landscape that has few boundaries for private sector involvement. In a speech this September, the English health minister Earl Howe said there are “huge opportunities” for the private sector within the current health service reforms.1 To critics this was the articulation of their long held fears: that the reforms are little more than privatisation by the back door. But what is mere rhetoric and what is fact? What is the current extent of the role of the private sector and is this set to expand rapidly and irreversibly as critics maintain?

“People have simply not appreciated the magnitude of the changes the bill proposes,” says Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine. “There is nothing in the bill to stop the entirety of NHS services being provided by private sector firms in a few years’ time. There is no brake and no restraint to the role of the private sector within the reforms.”

But Jill Watts, chair of NHS Partners Network, a body that represents private sector NHS providers, points to a different reality. “I’m afraid there has been a ridiculous amount of scaremongering in the debate over the NHS reforms and specifically about what the role of the private sector might be as a result of this,” she says.

Private sector reach

Underpinning the debate has been the belief that the vast bulk of NHS services are currently provided directly by NHS bodies. According to NHS Partners Network, about 5% of NHS services are provided by independent organisations—both commercial and not for profit organisations. Yet, …

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