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Private sector in the NHS

There seem to have been a number of examples recently of increasing private sector involvement in the health services.  For instance, American company Palantir is said to be in the running to provide the overarching NHS Federated Data Platform, apparently with no public consultation.  Then someone alerted me to Optum UK, part of the giant, U.S. based UnitedHealth group, taking over the EMIS group, one of the largest providers of systems software for GP practices.

Should we be worried?  To answer that would require a blog that I haven’t the time, or probably the expertise, to write, but here are some immediate thoughts.

First, it’s not as simple as ‘private sector – bad’, ‘public sector – good’, or vice versa.  There’s a huge variety in each.

Secondly, how you judge, depends what you are judging.  What’s most important to you, efficiency, corporate social responsibility, benefit to customers / patients, the wellbeing of staff, risk, inequality, etc.

Thirdly, there probably are ‘tendencies’, such as profit driven firms driving out inefficiency, public sector firms having to catch up based on private sector experience, examples of greed and inequality in the private sector and amazing examples of effort and commitment in parts of the public sector, such as the NHS.  These tend to drive the debate and are important, but they are not absolutes, definitive in all cases.

Fourth, a large part of the argument for use of the private sector relies on the efficiency of markets, but many of the cases of concern are where the sort of free markets that could guarantee optimum efficiency (but not equity) do not exist anyway.  Also, one of the ways markets work is by some firms going bust leaving ‘the best’ to survive.  If your work relies on a private firm and it goes into administration, or possibly just cuts costs, it could have a big impact on your service.


My conclusion?  The public sector can be as efficient and more caring than the private sector.  Skimming off profits from activity which is for the collective good (like health) seems wrong and not worth the likely improvement in efficiency it might bring.  So, we should keep those services public and put our efforts into reducing the risks of things going wrong, whether from occasional scandals or day to day lack of efficiency or poor service, and build on what it is best at, like caring, commitment and co-operation.

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