Originally published in healthmatters issue 44, Spring 2001, Editorial

Hooray, they’re back! The party that created the health service has won a historic second term. So why are we – along with almost everyone else – still worried about the future of the NHS? Because, in contrast to Mrs Thatcher’s famous certainty, Tony Blair doesn’t seem at all sure that the NHS is safe in his hands.

Of course, there were strong warnings of trouble ahead even before the election. There was the leaked draft IPPR report which argued that the question of who owned the assets used by the public services was ‘increasingly a second order issue’, while Labour’s manifesto reiterated support for its private sector concordat, where the NHS makes use of empty beds in private hospitals to treat public sector patients. And the manifesto went out of its way to point out that the management of new fast track surgical units might well be provided by the private sector.

The government seems genuinely to believe that public ownership of public services isn’t really very important, arguing that so long as the state pays then health care remains free at the point of use, and the founding principles of the NHS remain intact. Bevan can sleep peacefully in his grave.

But to believe that this is the case is to wilfully ignore both evidence and experience. There are clear and strong arguments – economic, political and social – why the continuing public ownership of the public services matters very much indeed.

First, the economic: services run by commercial providers will cost more, and offer less. The idea that the private sector can run schools or hospitals more efficiently than the public sector is a myth, unsupported by evidence. Sure, it can run cheaper hospitals: it simply pays staff less and refuses to treat the sickest patients. No mystery there.

And, of course, at the same time as being less efficient, private providers take our tax resources and redistribute a slice of them as dividends to already wealthy shareholders. The sight of Railtrack letting the rail network slip into disrepair while taking its public subsidy – tax we paid – and continuing to hand out large amounts of it to private shareholders has been unedifying, to say the least. We can’t have hospitals and health centres doing the same.

Second, the political: privatising public services risks losing any effective democratic control over how services are provided. Rather than handing health care over to private providers (with their magic spell ‘commercial confidentiality’ with which they make themselves invisible whenever questions of freedom of information come up), the NHS, like many other parts of the public sector, should be exploring ways to enhance local democratic control and public accountability, not end it forever. The responsiveness of the NHS to local communities is tenuous at best, and even electing an MP on an NHS ticket, as in Wyre Forest, may not be enough to gain any real influence over service planning. Let’s not make matters even worse.

And thirdly, social: allowing commercial organisations to take over the NHS changes our relationship to the health and social care which each of us, at some point, is likely to need. While we may retain our entitlement to use the service, we lose our stake in it. Health care is no longer the tangible expression of human values and social solidarity. We cease to be citizens, and become only customers.

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