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It’s starting to worry me.
I am not the only one. My in-box is always a very good indicator of what’s on your mind.
You pointed out two important stories that emerged over the weekend. Seriously, they make no sense.
One in the Financial Times, the other in the nursing press.
The FT, as you know, is £walled. You’ll have to take my word that I’ve produced a fair summary…
… the headline says it all; ‘The NHS Should Exploit Private Healthcare, to Get Back on Track'. The story is about how Labour will ‘save the NHS’.
I’m not sure the private sector will be too keen to ‘be exploited’.
Silly-Boy tells us Alan Milburn (health secretary 25 years ago) and Paul Corrigan (former Labour policy advisor, of the same vintage) are ‘rolling up their sleeves’ to help. Whatever that means.
What it has meant in the past?
When Milburn was Labour’s health secretary (and you could buy a pint for less than two quid), the NHS was required to tender for just about everything.
From buying by-passes to running bunion clinics. The upshot was a huge increase in bureaucracy, very high transaction-costs and no evidence of a reduction in operational costs or an improvement in quality.
In 2012, the Health and Social Care Act reinforced the NHS’s use of the private sector but that was mostly lost in the chaos of the Lansley Reforms, the world banking-crisis and Covid.
More recent legislation has freed-up the NHS to make more pragmatic decisions on how it ‘buys-in’ services.
I think I’m right in saying the NHS has more contracts for services with the private sector now, than at any time since well before Covid.
Most contracts with the private sector are set at or around the NHS tariff…
…usually well below the price private suppliers might charge a fee-paying or insured patient. As waiting lists are so long, there’s been an expansion in self-pay customers.
Private providers are doing nice business at a premium and some are non-too-keen to work for the NHS at cheaper rates.
Self-pay has nearly doubled since 2019.
There are only 2,400 private hosptials in the whole of the UK. The geographical distribution mirrors demographics. Mostly in wealthy areas… 28 in London.
High deprivation areas are where the waiting lists are longest.
Most private hosptials don’t have ITUs. If something goes wrong, they ring for an ambulance and wait… like the rest of us.
Last year there were 6,000 transfers of care, from the private sector to the NHS.
Hence, they only do the simple stuff which depletes NHS income, of which a large chunk will be used to cross-subsidise more complex and time consuming treatments.
Let’s not forget… the private companies don’t grow their own doctors. They just provide the facillities for NHS consultants to work outside their contracted NHS hours. Usually the evenings and weekends.
It’s a tiny workforce. Of the 23,000 consultants in the NHS, only 16,000 do some private practice.
In the NHS there are 3,000 operating theatres carrying out more than 10m operations a year. One NHS hospital is likely to do more operations in a year than the whole of the private sector.
Working with the private sector is the mustard on the side of the plate. The meat and two veg are provided by the the NHS. It is not a policy, it’s a token. Milburn and Corrigan (sorry gentlemen) are way out of date.
The second item?
The (gullible?) Nursing Times (? £walled) who published a schmaltzy piece from Streeting, to showcase his plan to ‘train thousands more district nurses’.
Since 2010 the number of district nurses have halved.
‘We will train thousands more district nurses as part of the biggest expansion of NHS staff in history’… he boasts.
Good luck with that.
Trainees need, already, to be a registered nurse and go on to do degree level, specialist practitioner training. Transferring from nursing to district nursing can often result in ‘down-banding’ on the Agenda-for-Change pay-scale.
It’s a five year, if not six, roll-out. Beyond the life of the next parliament.
Frenzied promises and an auction of old ideas is not a way to make policy. And, promises are not policy. Neither are they practical, or deliverable.
That's what Streeting is missing. Real-time, doable and deliverable ideas that will make things better.
Streeting would do well to bare-in-mind; people are remembered for what they do, not what they say they’ll do.
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