Intended for healthcare professionals

Observations Future of the NHS

Mutual ownership: privatisation under a different name?

BMJ 2014; 349 doi: (Published 21 August 2014) Cite this as: BMJ 2014;349:g5150
  1. Martin McKee, professor of European public health, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  1. martin.mckee{at}

Will taking NHS providers out of state ownership and giving them to their employees to manage be a charger to the rescue, or a Trojan horse for private equity?

What is to be done with the NHS in England? By common consent, the coalition government’s reforms have failed to achieve their stated objectives—perhaps because their complex, largely incomprehensible design made it impossible for them to succeed.1 True, GPs were supposed to be in the driving seat, but in reality they are driving away from the NHS to an early retirement as they leave in droves.2 So what is the answer?

The latest “solution” to appear on the scene is mutualisation. This is the idea that NHS providers would be privatised (although its advocates seem reluctant to use that word) by being taken out of state ownership and managed by their employees. Politicians, such as the Cabinet Office minister Francis Maude, are promoting them enthusiastically,3 dropping hints that this could be the future of all current NHS provision after a Conservative victory in 2015. They draw encouragement from a recent report chaired by Chris Ham, of the King’s Fund, that reviews …

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