No Wes Streeting, private practice damages the NHS

Dave Kellaway responds to shadow Health Secretary, Wes Streeting’s argument that paying private hospitals for treating NHS patients is a good thing and that it is only middle class ‘lefties’ who object to it.


Poor Wes Streeting, one of his advisors must have not checked this week’s media carefully enough. His team missed the fact that on the Monday following his pro-private care speech the BBC would  broadcast an excellent Panorama programme specifically criticising the quality of care provided  by one of the biggest private Health corporations, Spire Healthcare, which runs 39 hospitals.

Some of the patient cases examined by the programme were being paid for by the NHS. Since 2021, Spire Healthcare has treated more than half a million NHS patients. Last year its profits rose by more than 30% to £126m.

What had Streeting said?

We will also use spare capacity in the private sector to cut the waiting lists. (…) Middle-class lefties cry ‘betrayal’. The real betrayal is the two-tier system that sees people like them treated faster – while working families like mine are left waiting for longer.   

He tries to express outrage at a two tier system but by agreeing to ramp up NHS payments to the private sector he is effectively consolidating and growing these hospitals.  Parading his working class background as a substitute for logical argument he denounces middle class leftwingers, some of whom may have paid for private care, for being the real villains.  He wants us to believe these people want to stop honest workers like him having access to private health care funded by the NHS.

It is a bad faith argument. Nobody on the left who objects to private health as a system leeching on the NHS is saying a Labour government committed to improving the NHS should on day one of power stop all these treatments.  It is like saying we will take back the water companies into common ownership in weeks, chucking out all the managers.  We would want a Labour government to close all the food banks and set up a decent welfare system but nobody is saying this happens in the first week either.

No, those people who care about protecting and improving the historic gain for working people that the NHS represents are merely saying there is a better way of using public resources than boosting the profits of these private health companies. 

Nowhere in Streeting’s speeches in there any analysis or condemnation of the two tier system he supposedly abhors.  He seems to think we can overcome this inequality by tipping NHS cash into the private sector to bring down the waiting list.

Streeting’s fantasy middle class lefties

Our shadow Health Secretary sneeringly implies middle class left wing people are paying for private healthcare while trying to stop working people getting it through an NHS bung to the private sector.  I have not seen or heard even one left wing person talk in these terms.  Most people on the left accept that both working class and middle class people have been forced at times to pay for private health given the absolute crisis in the system. Many do this while maintaining an opposition to private health care and support for a better NHS. 

Streeting is probably wrong too to make this neat division between ‘middle class’ paying private patients and NHS assigned ‘working class patients’.  Many working people on average salaries are forced to choose private care and middle class patients also benefit from the NHS paying for private care. I have a (middle class!) relative who got one hip paid privately and the other via the NHS in a private hospital.

Neither does Streeting’s proposals produce a fairer waiting list since, as the Panorama programmes exposes, private hospitals generally do not take people for the routine operations who are high risk or have complex conditions that even a simple operation could aggravate. Consequently working class patients with those conditions will not benefit from the scheme, they stay on the NHS list.

Private medicine is a parasite on the NHS

Streeting does not address the fundamental issue – private medicine is only financially viable if they offer a limited service. They cherry pick routine operations that do not require the complex resources, specialists and equipment that the NHS has.

How much more money would private capital have to invest to provide the same service as the NHS?  Doctors and nurses are educated and trained in publicly resourced universities and hospitals. This huge cost is not met by private healthcare.

Ambulance services are also key to any comprehensive health system – private hospitals need them when they have to ferry patients with complications back to the NHS. Private health does not do accident or emergency and does not have to deal with geriatric patients holding down beds because the social care system in in crisis. If you factored all these costs the financial model would require high insurance premiums and function only for the well off.

When Nye Bevan led the creation of the NHS in 1948 he said that he had to ‘stuff the doctors’ mouths with gold’.  Given the ferocious opposition of the doctors associations he had to allow the persistence of private practice which meant NHS-trained and paid doctors could still do hours in private healthcare. Today doctors can work both in the NHS and the private hospitals.  This facility makes it easy for the private sector to recruit. 

Bevan’s historic compromise allowed the private health care to survive and grow, particularly in recent years.  Statista’s Consumer Insights say 22% of UK adults now have private healthcare, which has doubled since 2019.

Research by YouGov has shown that one in eight British people have used private healthcare within the last year for themselves or a member of their immediate family. Huge amounts are being spent on TV advertising these services. The NHS does not waste money advertising for what should be a basic right in a decent society.

Some are also simply coerced into private care because the NHS fails to provide. With some trans people put on half a century waiting lists, private or partially-private care (so-called shared care) is required if they want medical access whatsoever to life-saving transition services. The mental health crisis is partly perpetuated by a woefully inadequate provision at every level of need, and to secure therapeutic services many pay more than they can afford. Streeting’s language makes a mockery of such people on the margins.

Panorama exposes limitations of private healthcare

Apart from the systemic contradictions in organising health resources in this way the Panorama programme showed three ways in which Spire Healthcare badly failed patients paid for by the NHS. 

  • First, when patients going in for a routine operation suffer complications there is no Intensive Care Unit (ITU) in the private hospital.
  • Second, staff at Spire, particularly at night, were not always led by consultants, but often less qualified staff working longer hours than permitted in the NHS.
  • Third, ambulance transfer facilities were inadequate in emergencies.

The programme showed that coroners judged at least three patients to have died unnecessarily as a result of these failings. Two of them had been paid for by the NHS.

An alternative vision

What should Streeting be saying rather than inventing a false picture of middle class lefties wanting to stop working class patients getting decent care?

A real alternative requires a massive injection of resources into the NHS, paid for by a more progressive tax regime and a wealth tax. A plan needs drawing up after an assessment of all the current healthcare resources – public and private. Health workers and their unions should lead on this. Private hospitals could be incorporated into the NHS to increase and rationalise overall health care. 

Bevan did some of this in 1948, but it was not a revolutionary act. Preventative care in the community and via the educational system would need to be hugely ramped up.  Active programmes against inequality by improving pay and benefits are essential too. Companies – like food, supermarkets, fast food or drinks – would be fiercely regulated.

Marginalised communities need to be brought in drawing on coproductive models of health care provision. This means embedding various communities into developing the forms of provision that are being provided: disabled people (whether they have physical or mental health disabilities), trans people, and other structurally oppressed communities who face particular health challenges (such as Black women who face inadequate maternity care with often deadly consequences).

However, implicitly or explicitly, the Labour leadership has already ruled any of this out.  Reeves, the shadow chancellor, on breakfast TV today swiftly quashed any idea she would take up Gordon Brown and other ex-Labour ministers’ good idea of re-establishing Surestart family centres. So we need to keep the debate going with activists inside and outside Labour about the NHS we need today.

The coming general election period provides us with the potential of a wider political discussion and campaign. The aim would be to build a movement that could force change under a future Labour government. Do not expect Wes Streeting to support such a movement.

An excellent campaign that leads on this is

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Dave Kellaway is on the Editorial Board of Anti*Capitalist Resistance, a member of Socialist Resistance, and Hackney and Stoke Newington Labour Party, a contributor to International Viewpoint and Europe Solidaire Sans Frontieres.

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