In the past week, in what is becoming rather a theme in Labour’s leadership race, Jeremy Corbyn and Owen Smith announced the same plan. And this time it was rather radical: a “fully public” NHS.
Smith got there first, calling last week for “a public NHS, publicly funded, 100% publicly funded”. “Private provision in the NHS” he said, is “an absolute red line”. And yesterday, amid some irritating questions involving trains, Corbyn pledged the same: a “fully publicly provided” NHS, put “back into public hands”.
Consensus and conviction. But is it a good idea?
Well, it is certainly a different one. Britain’s NHS has never been 100% public. Nor has the health system of any other western economy. Even France’s public health service - seen as particularly socialist - has a great deal of help from the private sector. There is therefore no road map, and no proof it can be done effectively.
This matters because a nationalised NHS would require a vast unpicking of the fabric of the country’s health system. Most general practices are privately provided, not to mention hospital CT scanners, buildings, beds, bandages, and bog-roll... and all medicines. An almost impossibly huge task.
Of course, Corbyn and Smith could simply mean that they want to stop outsourcing - giving contracts to companies to run NHS services. This takes up around 7% of the NHS budget. Doing away with this would be easier, relatively speaking. But it would cost. And more than that 7%.
Right now, the private sector does around half a million NHS operations a year. Patients are often offered a choice to go private, for free, or to stay with the NHS. (This costs the taxpayer the same). Various other services - like cancer diagnosis - are also outsourced. Sometimes, private companies might merely run an otherwise NHS building (filled with NHS doctors and services).
For these privileges the NHS pays companies a one-off fee. Do away with this option, as Corbyn and Smith suggest, and they would not find the same for their money in the NHS. They would have to start from scratch - building entire hospitals and fleets of operating theatres. This would mean a great deal of capital investment, which would mean a great deal of borrowing. And while all this was going on, waiting times would shoot up.
True, some areas of the NHS would suffer more than others. The change would hit mental health (a third of mental health hospital beds and over half the beds for people eating disorders are provided privately). It would also damage community services (meaning, for example, that people couldn’t get NHS-priced hearing aids at Specsavers), and diagnostics (like mobile breast-cancer units).
But all waiting times would go up too. Private hospitals step in when emergencies arise: during the winter, for example, when the NHS has used up its bed-space. They also step in on the regular for things like hips and knee operations. In the 1990s, the average waiting time for hip replacements was 18 months. Now, with 15% of them done privately, the target is 18 weeks.
And what of charities? They are private institutions, so a truly renationalised NHS would not tolerate them. Yet charities run most hospice care; not-for-profit organisations run district nursing, physiotherapy, and midwifery.
Getting rid of private services in the NHS would also get rid of a lot of patient choice. Britain’s health divide - between those who can afford to go private, and those who can not - used to be far wider. If private services were pushed out of the NHS, it would not be the rich who would suffer.
And as long as they get treatment free at the point of use, do voters even care who they get it from? There is some evidence they don’t. A wide ranging NatCen poll found Brits had no strong preference about who provides their care - whether public or private. Just over half those polled by Ashcroft in the run up to the 2015 election thought the government should consider using more private companies in the NHS “when they can provide high quality services more cheaply”.
Indeed, as David Hare, Chief Executive of the NHS Partners Network, puts it, “the BBC does not cease to be a public broadcaster because it commissions programmes from production companies”. Voters may be smarter than Labour’s leadership contenders are giving them credit for. The NHS’s private partners do not threaten free healthcare. And the public knows it.