NHS privatisation has been one of the most hotly debated issues in the lead up to the Election this May, whether it be through political discourse, or the interest ramp-up on social media. There are many commentators that believe the health service is under increasing threat from outsourcing to the private sector and this issue is likely to be key to whose health argument wins over voters in May.

The fact that our health services are generating such heated debate and interest is welcome. After all, the NHS budget in 2014/15 is set at a massive £113bn, health spending is worth 9.3% of our GDP and the funding gap facing the NHS by 2020/21 is £30bn (if no improved productivity/efficiency is achieved) and £65bn by 2030[1]. Whatever the result of the Election, it will be very interesting to see how the relationship between the public and private sectors evolves within the health sector.

We take a look below at two of the key health battle grounds we are keeping an eye on in the coming months to give you a flavour of the initial shots across the bow.

Pledges

The Labour Party recently launched its pivotal election pledge in which it has promised 20,000 more nurses, 8,000 more GPs, 3,000 more midwives and 5,000 new care workers. It is actually one of the shared themes between the political parties that more investment in personnel is required but there remains disagreement as how much investment is required and how it would be funded. As Mark Porter, Chair of the BMA Council noted, “while the promise of more frontline staff, better joined-up care and improvements in mental health services are important steps in the right direction, these will take time to deliver and must be backed up with the necessary long-term funding to make them a reality”. At the core of Labour’s NHS 10 year plan is the concept of a Labour’s Zero-Based review of all government spending, i.e. this is explained as realising better value for the taxpayer across all public services. One example given is in relation to NHS cancer patients in England being guaranteed to see a doctor within one week to receive their test results; this would be funded by a levy on tobacco firms and would reportedly help spot problems at a much earlier stage whilst still achieving annual savings of £210m. Andy Burnham has outlined that Labour’s health manifesto promotes a health system of prevention. Put simply, Labour consider charging for basic care to be counter intuitive since if people then refuse to pay, they can often develop more serious (and more expensive) conditions. A major tenet of this idea is the challenges of an ageing society and the problems associated with social care. Labour have advanced the idea that the NHS and social care should not be on divergent paths but should be integrated more efficiently; this concept is driven by Labour’s belief that changing the primary care setting in some scenarios from the hospital to a patient’s home can help drive savings and a prevention culture across our healthcare system.

The Liberal Democrats have also pledged more funding on the NHS front line services, heading their manifesto with a promise to fund an extra £8billion into the NHS until 2020. One of their core principles is in the area of mental health and breaking down further stigmatisms attached to it. Among their pledges in this area are to establish more choice for mental healthcare and the investment of £400million in evidence-based psychological therapies and £54million in improving access to mental health care for children. Such pledges are even more interesting when viewed in the context of a tight election race since they give a flavour of the most important principles held by a party that has been and could once be given another opportunity in the event of a hung parliament.

The Conservatives have been placed on the back foot in recent months as the incumbent and, as such, an easy target for the other parties. The main argument put forward by David Cameron is that a Conservative government will ring-fence the NHS from budget cuts from 2015-30 if elected. Health secretary Jeremy Hunt has also announced plans for seven-days-a-week access to GP services by 2020 and noted the government’s position that “securing the NHS budget is not about an extra billion here or there”. Mr Hunt added that any increase in spending had to be accompanied by reform, which included greater use of the independent sector whilst not going as far as privatisation as Labour have claimed.

The most talked-about party of the moment, UKIP, have introduced a manifesto with eye-catching issues that will certainly spark debate in the coming months, including dementia funding of £130million per annum (a figure UKIP claim to be double the Conservatives pledge) and scrapping hospital parking charges through tackling health tourism (which it claims costs up to £2bn per year).

Competition and procurement

As Clinical Commissioning Groups (CCGs) become more accustomed to buying NHS services for patients in England, the debate as to whether this is appropriate for the NHS will continue in the background. As a reminder, CCGs now hold the responsibility for commissioning services from ‘any qualified provider’, i.e. including private companies. Those who oppose this format point to the fact that greater competition for such services means more regulation of the market created, and this, it is claimed, all comes with a regulation price tag.

Andy Burnham, the Shadow Health Secretary has also claimed in recent days that the Government is trying to sneak through legislation aimed at accelerating the privatisation of NHS services. Mr Burnham pointed out that recent regulations tabled in Parliament on 6 February would result in all contracts worth more than £625,050 to be put out to tender. The new regulations, to which he referred, apply to CCGs and NHS England from April 2016, albeit NHS Trusts will be required to comply with the rules from 26 February 2015. The regulations will require NHS bodies to publish all service contract opportunities above £25,000 on Contracts Finder and, for contracts above £625,050, also in the OJEU through a PIN or contract notice. Labour claim that any contract that is let by an NHS Trust will therefore be opened up to competition. The Department of Health, however, responded by stating that the new regulations would not lead to every contract worth over £625,050 going out to tender, but rather, “the €750,000 threshold is about notification when a decision has been made to go to the market, not about a requirement to go to the market for anything at or over the value”.

The obligation to run a ‘fair, open and transparent processes’ is nothing new: all such opportunities, involving cross border interest, were subject to the Treaty on the Functioning of the European Union and whenever a public body decided to go to market it was obliged to ensure it did not breach the fundamental principles (e.g. non-discrimination on grounds of nationality, freedom of establishment, freedom to provide services etc. as well as the principles derived from such fundamental rights). This position remains unchanged. However, the new regime and the new obligations will certainly provide for greater regulation of the method in which such contracts are let (including for health, social and related contracts valued at between £25,000 and £625,050, which must now under the Regulations be published on Contracts Finder) as well as introducing more wide ranging remedies for aggrieved tenderers.

Conclusion

The arguments about our healthcare system will rage on long after election night in May. The NHS has been providing “free at point” care for 66 years and is widely praised by international communities. However, it faces a long list of obstacles in the coming years from an aging and expanding population and a demand for a wider range of drugs. Given the huge rise in demand and pressure on the NHS, privatisation of some form will certainly be at the forefront of these dialogues since it is at the core of how the NHS moves forward and finds a way to bridge the funding gap that is ever-widening. We hope that whatever the outcome, the political parties can find a more constructive and co-operative approach to lead us forward in the long term.