Five ways Westminster's NHS privatisation plans will hurt Scotland's health service

Private health providers are bidding for a bigger share of the NHS in England - and health secretary Wes Streeting has said “Labour will be holding the door open” to more private involvement. There was a significant increase in NHS funding in the next budget - but it is an open question how much of that money will end up as profit for private businesses? 

The Independent Healthcare Providers Network (IHPN), which represents private hospitals and groups such as Bupa, has offered more than £1 billion of private sector capacity to NHS England. If accepted, that will signal a huge expansion of the role of the private sector. 

This is being sold as a smart way to get waiting lists down - but it is a long-term threat to the future of the NHS. This is just one example of creeping privatisation in England’s NHS - others include private firms taking over community services and a deal over weight loss jabs for the unemployed. Plans for ‘patient passports’ are also causing concern. 

The UK government expanding the role of the private sector will have knock-on effects for Scotland. Here are five key points. 

1 - Westminster is empowered to reverse or undermine devolution 

Currently, Scotland’s health service is performing better than others in the UK in a number of ways 

After Brexit, Westminster pushed through the Internal Markets Act, which has the specific goal of ensuring that any international trade deals automatically cover Scotland. It can also be used to prevent any Scotland-only changes. 

That means that any deals the UK government does with international pharmaceutical firms or other healthcare industries can affect Scotland. Currently, Wes Streeting is talking about experimenting with expensive weight-loss drugs as a way to get people back to work. There are also concerns over using commercial firms to lead the process of digitising patient records - ‘patient passports’. Holyrood has only limited powers to prevent these deals from including Scotland. 

2 - Using the private sector to clear waiting lists could add pressure for Scotland to do the same

It is certainly likely that expanding the role of the private sector could lead to waiting lists falling in England and Wales compared to Scotland. No doubt this comparison will be made by Unionist politicians and there will be pressure for Scotland to go down the same road. But the downside of using private health providers to clear waiting lists is that they: 

  • Charge more
  • Poach NHS staff, 
  • Cherrypick easier cases 
  • Serve wealthier areas
  • Send patients with complications back to A and E. 

An example of this is when the Labour government under Tony Blair used the private sector to clear orthopaedic waiting lists. The BMA reported that they charged 11%, treated mostly patients in wealthier areas and left the NHS to “pick up the pieces” when things went wrong.

There is evidence that where private health care is used, people from poorer areas or marginalised communities are much less likely to get access to it. So too are people with more complex health needs. 

But it will be hard to resist this pressure, particularly because increasing the role of the private sector will affect the way Westminster funds Scotland’s NHS. 

3 - Scotland is still paying for the cost of private involvement in the NHS in the past 

The Private Finance Initiative (PFI) – where public sector bodies pay private corporations to build and manage new facilities, such as schools or hospitals – was first introduced by the UK Tory government in 1990.

This was continued by Labour and was used in Scotland - leaving a £30 billion repayment bill to be footed by Scottish taxpayers. That represents many times more than the original cost of the projects. The repayments were linked to inflation and last year they went up by £1 million a week. There is still about £15 billion outstanding. That money could have been used to fund more health care. 

4 - Political choices made at Westminster impact the budget for Scotland’s NHS

Although Holyrood is supposed to be in charge of the NHS, Westminster still controls the purse strings. It very much depends on the terms of the deal they do with the private sector what the implications are for the Scottish budget, both on a day-to-day operational basis and in terms of the capital investment.

Any deal with the private sector is likely to involve signing up for long-term contracts. That often means the provider offers apparent savings up front - but stacks up costs further down the line - as with PFI. A deal like that could mean LESS money for Scotland’s NHS coming through the block grant. Westminster also gets to decide how to account for its projects - and sometimes this is clearly inequitable.  

In terms of the capital budget, private providers own the premises - so increasing the amount of health care they provide means England will spend less on building its own facilities. That could end up cutting what Scotland can spend on infrastructure. The Scottish government does not have the power to borrow money for capital investment. 

5 - More privatised health care in England could lead to a brain drain of Scottish medics

Scotland currently has more GPs per head than England - but it has particular problems getting doctors to commit to living and working in rural areas. 

Expanding private health care in England could create a more profit-based ethos within the profession that will add to the pressures on Scotland. 

The NHS trains the majority of doctors and nurses in the UK in a UK-wide process that means young medics have little control over where they are placed. Scotland’s young doctors often spend part of their training in the south of England.

Scotland is rethinking how vets are trained - the SRUC is creating pathways for young people from rural areas to train while remaining connected to their local areas. But there is no pathway like that in medicine, where the BMA reserves the right to send medical students across the UK. The system is not turning out the right mix of graduates that is required to serve and to connect with Scotland’s rural communities. Letting Scotland’s medics get their training in a country with a system with a different balance between private and public is not likely to address this.

Conclusion

The Labour government has close links to private health care and is likely to expand the private sector’s share of the NHS. That may look like a sensible way to increase capacity - but the costs are likely to mount over the long term. 

Under devolution, Westminster holds the purse strings. It set the tone and direction of the NHS. With England set on going down the road of greater privatisation, Scotland’s government can only offer limited protection to our NHS.

Only as an independent country can Scotland have the power to make decisions and then act on them in the best interests of Scotland’s people.

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