The NHS was established to provide healthcare free at the point of use, so that people with high healthcare needs and low income are not denied adequate care. The cost is shared by everyone. I believe that most people support that principle, but some Conservative politicians do not, although they are reluctant to admit that publicly.
The question is, if the NHS is publicly funded, what should the balance of public versus private provision. This should surely be decided on the basis of overall value for money. There are three reasons why I believe that private provision should be very limited:
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Private providers expect to make very large profits. Why should the public purse pay these?
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Private provision involves complex contracts. Not only must these be fair to the public sector but they need to be managed by the public sector to ensure that the private sector pays when it fails to perform. Experience suggests that public servants lack the skills either to negotiate fair contracts or to manage them. In fact often the public sector does not seem to understand the necessity of actively managing them. If the public sector were to manage contracts properly that would be a substantial cost, though probably not as much as not managing them
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Private providers offer worse employment terms to their employees than does the NHS, but if these terms mean employees have to seek benefits, this goes back on the public purse.
So if value for money analysis were conducted properly, I believe it would show the the scope for private provision would be very limited. But does trade law allow this? My concern about this goes back to the Marakech agreement of 1994 and in particular the General Agreement on Trade in Services (GATS). Under this treaty if a nation allows private provision of a public service, it may not change its mind. Whether the UK ever committed itself to signing onto that in relation to the NHS is something that subsequent governments have been very reluctant to clarify.
In the noughties multilateral trade negotiations conducted through the WTO ran into trouble because African and Asian nations realised they were being shafted and would not play any longer. The US then focussed on trying to get so called bilateral deals. In reality they are trilateral deals, corporations being the third party. The terms of such deals are biassed in favour of corporations and against sovereign nations, especially those that believe that extensive public services should be provided.
Not only that but Liam Fox seems desperate to get any deal with as little interference from Parliament as possible. This actually weakens the UKs negotiating position. The constitutional position appears to be a hang over from the 19th century when diplomats were happy to screw ‘lesser breeds without the law’. The boot is now on the other foot. The Constitutional and Governance Reform Act 2010 was billed as putting the Ponsonby Rule onto a statutory basis. It changes very little. Our constitution is now a major threat to the British people.
David Smith
