I have the great good fortune to live in a country with an excellent national healthcare system. I’m talking about the UK’s National Health Service (NHS).

Perhaps surprisingly the UK also has a thriving private health care market which is usually backed by private insurance paid either by individuals or by companies on behalf of their employees. The primary advantages of private care over the NHS are (in my opinion) that under private care there are shorter waiting lists to see a consultant or to undergo an operation and hospitals and other facilities are more comfortable. Some might suggest that medical care is better under a private scheme - but I rather doubt that.

I’ve been given medical treatment by the NHS at various times over the years and I’ve contributed to its funding through my taxes. I have not analysed it, but I expect that I’ve contributed more towards my medical care through my taxes than I would have paid if I’d only been covered by some form of commercial medical insurance. This is a good thing. I’ve been in reasonably well paid jobs and in good health for most of my working life and it is right that I should have have contributed more in tax than lower paid people.

Several years ago I had to spend a couple of weeks in an NHS hospital. As far as I can tell the medical care was excellent but it was quite obvious that the nursing staff were badly stretched and struggling to care for the number of patients on the wards. Also the food was almost comically poor - a portion of shepherd’s pie which looked more like a fresh cow-pat springs to mind, though it didn’t taste as bad as you might imagine. Suffice to say they sorted out my problem and I was glad to leave in much better health than when I arrived.

A few years later I needed a minor ‘day-procedure’ operation. The NHS offered me a choice of consultants at various hospitals including two private hospitals in the area. I opted for one of the private hospitals and got an evening appointment (so it did not interfere with my work commitments) for the initial consultation. The consultant offered me a wide choice of dates to have the procedure done and we agreed on a date which suited me. I arrived at the agreed time, was shown into a private room, and was attended by several nurses who made sure everything was ready and then took me down to the operating theatre. When I woke from the anaesthetic I was returned to the private room and was directly supervised until I was able to get up and move around. Mid afternoon, I was offered a meal and was able to choose from an attractive menu with many options. I was given cups of decent tea and checked regularly by the nursing staff and was finally given the OK to leave by the consultant.

To be fair, I’m sure it’s easier to provide decent catering at a small private hospital rather than at an enormous facility like my local NHS hospital… however, I expect it is also much more expensive per meal.

So finally we approach the point: I’m reasonably sure that the clinical care I received at the private hospital but paid for by the NHS was equal to the care I would have received at an NHS hospital. However, I believe the private hospital was able to provide better nursing care and support, better catering and more flexibility in timing than the NHS. So why did the NHS contract this procedure out to a private hospital? Reasons for this sort of outsourcing might include a short-term lack of capacity in the NHS or that the private hospital could do the work more cost-effectively.

If the NHS is paying to outsource medical procedures to private companies and those companies are providing equivalent medical expertise, better nursing support, better catering, better flexibility on timing and still making a profit, then why can’t the NHS do it themselves?

I don’t believe a private hospital is using cheaper operating theatre staff or nurses or caterers or cleaners. I don’t think they keep poorer records. I don’t believe they carry less negligence insurance cover. I don’t believe they take more shortcuts or excessive risks. I do believe that a private hospital makes a profit on this work and that the NHS outsources in this way because it is cheaper to do so than to do it themselves… So why the hell can’t the NHS do this work to the same standard for the same cost minus the private company’s profit?

So here’s the point:

I think the only explanation must be bloated management layers within the NHS. The surgeons, anaesthetists, doctors, nurses, diagnostic service staff, caterers, cleaners and so on are equally qualified and experienced and should be equally well paid in the NHS as in the private sector - though actually I suspect many are less well paid in the NHS and wish to move into the private sector as a result of this. The private hospitals are definitely well managed and served by accountants (they make a profit). I’m sure the NHS requires equivalent levels of administrative record keeping from the private hospital for the work that they contract out to them. So why was that money that went into the private hospital’s profits not retained and spent directly on clinical services within the NHS? I blame the management.

Update 10-Feb-2016: In the US Republican Party nomination debates to select the party’s candidate for the US Presidential election 2016, Senator Ted Cruz is reported to have stated: “Socialised medicine in other countries doesn’t work and leads to rationing”.

Hmmm. Think about it. Is medicine rationed in the UK or US or both? Yes, both. Of course it is. In the US people buy medical insurance and that will pay out up to a certain limits if they need medical treatment. If they choose to do so they can buy minimal insurance which will not cover everything that more expensive and comprehensive insurance will. Before President Obama’s reforms, people could ‘choose’ not to buy any medical insurance at all (usually only because they could not afford it). In the UK much essential medical treatment is available on the NHS and paid for through people’s taxes - but if people want to they can buy extra medical insurance or pay directly to avoid delays or to cover elective or other non-NHS treatment. Either way medical treatment is rationed by the available money.

Even so, let’s not allow the facts to get in the way of a good story.

Update 25-Aug-2016: An article describing how Jeremy Corbyn, at the time of writing the leader of the Opposition UK Labour Party, plans to ‘renationalise’ the NHS when/if his party forms a government under his leadership.

In the article there’s the following paragraph:

The private sector is also used for routine operations when NHS hospitals are struggling to see patients quickly enough. Again NHS provision could certainly be increased, but there is a balance between having slack in the system and leaving facilities idle unless you are prepared to make patients wait longer.

OK, that makes sense - a three way balancing act: Facility utilisation, provisioning and waiting times.

Well, actually no. Adequate facilities to meet peak demand can be and have been provided - initially paid for by the private sector - who make money out of these facilities and maximise their utilisation by accepting work from the NHS. So why can’t the NHS provide these facilities for themselves instead? Where the private sector scores is by responding to the changes in demand from their customers and clients (insurance companies, private patients and the NHS) in a timely manner. This responsiveness is lead by their management who are responsible to their company owners (shareholders) to make a profit. We need to see the same responsiveness in NHS management. While such skills in NHS management could not and should not be measured by profit, it should be measured in terms of cost (funds spent) to ‘get the job done’. If the NHS is paying an outside agency to do some work and that agency is making a profit - then the NHS should be able to do it to the same standard, but cheaper, by themselves.