Recently the Department of Health announced its plans to reduce the overall size of contracts with private sector firms providing surgical treatments and diagnostic services to NHS patients. This decision generated more than its fair share of headlines. However, it also led some commentators – from both the left and the right of the political spectrum – to claim that the government had signalled the death knell for private sector involvement in the NHS.
As someone who, as well as being the general secretary of the Royal College of Nursing (RCN), is a trained nurse and a former NHS Trust chief executive, that’s a claim with which I’d have to disagree. In fact, to paraphrase Mark Twain’s famous riposte to the premature publication of his obituary, I believe the death of the private sector’s role is greatly exaggerated.
Yes, there has undoubtedly been a shift of emphasis. However, as the secretary of state for health stated, the government’s decision was made because of value for money reasons, not because of a dogmatic opposition to the private sector. In other words, their approach is one of pragmatism, rather than ideology.
In truth, that’s an approach which echoes the RCN’s position on this issue. So, when it comes to the ways in which a public service such as health is delivered, the RCN believes that the answer to the question ‘what’s best?’ should simply be this: ‘what’s best is what works’.
On one level our pragmatism reflects the fact that well over a quarter of our nearly 400,000 members work in the private, independent and voluntary sectors. Consequently, we know that these nurses make every bit as valuable a contribution to public service as their colleagues in the NHS.
On another level our pragmatism recognises what, for those who oppose any and all private sector involvement, is an inconvenient truth – namely that there is a long history of partnership between healthcare providers in this sector and the NHS. For instance, we entrust the care of the most vulnerable people in society, including older people, people with disabilities and mentally ill people, to private and voluntary providers. Moreover, our GPs have been private contractors to the NHS since the day it opened its doors for business in 1948.
The RCN believes in the NHS, its core values and its track record of success. If it did not exist then it would have to be invented. None the less, while we would always oppose the whole-scale privatisation of the NHS, we acknowledge, and accept, a legitimate role for the private, independent and voluntary sectors within the health service. However, in order to play that role, we would argue that they must meet a number of crucial tests.
For example, they must deliver high-quality care for patients along with high-quality terms and conditions for staff; they must provide additional capacity for service users and value for money for taxpayers; they must subject themselves to democratic scrutiny and robust regulation; and they must abide by NHS principles of universal provision, equity of access and care free at the point of delivery.
Public service is not some vague notion. It’s real, it’s meaningful and it matters. Ultimately it’s the civilising force that binds our society together. But the ethos of public service stretches well beyond the narrow confines of our public sector. That’s why, in the final analysis, the ‘public versus private’ arguments are academic at best and redundant at worst. Patients, like all service users, know there is but one genuine yardstick by which to judge – the best system of service delivery is the system that works.