By Andrew Morrison

This blog will consider the impact that the privatisation of the NHS is having on patient care and staff wellbeing within the context of the current strikes.

“Today, we strike for fairness. We strike for the future of our NHS. We strike because it’s our right – and our duty – to stand up for fair pay and for patient safety.” Pat Cullen - Royal College Nursing General Secretary & Chief Executive – 15 December 2022

The nurses are on strike. 100,000 NHS nurses have gone on strike due to low pay driving ‘chronic understaffing that puts patients at risk and leaves nursing staff overworked, underpaid and undervalued’. Alongside the nurses first strike in over a century, junior doctors, ambulance staff, blood collection workers, healthcare assistants, cleaners and porters are all striking to demand better pay and conditions for patients all happening in a context of other public sector strikes. This has led to the highest loss of working days since 1989 after Margaret Thatcher unleashed her free market ideology onto the UK leading to privatisation of many public services. At the time she declared “Economics are the method; the object is to change the heart and soul’.  Has creeping privatisation of the NHS changed the heart and soul of an organisation built on principles of care for all? If so, what does a soulless care organisation feel like for staff and patients?

Private companies have always been part of the NHS but since the 2012 Health and Social Care Act which allowed bidding for NHS contracts, a third have gone to private companies. Alongside the tendering of contracts, the introduction of Private Finance Initiatives (PFI’s) in 1992 by John Major and then advanced by the new Labour government were used to reduce immediate public spending on the building of new hospitals via receiving loans from private companies. However, the interest on the repayments will end up costing the NHS £80bn after an initial investment of just £13bn. Alongside PFI’s and not a direct attempt at privatisation, the impact of austerity has reduced NHS spending from a 3.7% yearly average from its conception to just 1.4% from 2009-2019 Alongside the COVID-19 pandemic this has led to record waiting times and lists leading to unparalleled public dissatisfaction. As a result half a million members of the public took out health insurance in 2022.

Privatisation leaves the public with a stark choice, cough up for private cover or face a gamble with your health and potentially your life. A study published in the Lancet found ‘private sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of health-care services’ (Goodair & Reeves,2022). Leading us to the frightening position of a two-tier health service with those who cannot afford private healthcare facing an inadequate system.

As we are seeing from the current strikes NHS staff are also struggling, according to a Kings Fund study ‘NHS staff were 50% more likely to experience high levels of work-related stress compared with the general working population’ and a 2019 NHS staff survey  found that 40.3% of respondents reported feeling unwell because of work-related stress or burnout. Alongside significant vacancies burnout leads to “performance protection” which are ‘strategies to maintain high priority clinical tasks and neglect low priority secondary tasks such as reassuring patients’. A study of NHS patient  feedback found that patients valued effective treatment highly, but positive/negative ratings for staff correlated with their interpersonal skills such as empathy and patience. Due to this NHS patients requested that commissioning decisions around NHS funding do not result in demotivated and rushed staff.

A significant factor in the current NHS crisis has been caused by the role of privatisation, leading to burnt out staff and anxious patients battling against a shattered system. So, has this ‘changed the heart and soul’ as Thatcher hoped? Perhaps, but with the recent news of an increased pay offer resulting from staff strikes a united and a collective voice may give us hope that our National Health Service can be resuscitated.  

About the author:

Andrew Morrison has recently left the NHS after eight years working in mental health care and is currently studying BA (Hons) Politics, Economics and Philosophy with the Open University.  

References:

Goodair, B. and Reeves, A. (2022) “Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: An observational study of NHS privatisation,” The Lancet Public Health, 7(7). Available at: https://doi.org/10.1016/s2468-2667(22)00133-5.