Do you notice anything different about your GP practice? A bit more bling? Trip Advisor type questions asking you to rate your last visit or consultation with a GP or nurse practitioner? If you don’t, there’s now a handy, downloadable map pinpointing independent care providers for the NHS. It has been put together with the help of the public, and research by EveryDoctor – the doctors’ campaign to raise public awareness of the negative impact on us and staff of the privatisation of the NHS.
Research by the University of Oxford published in the Lancet found that “private-sector outsourcing corresponded with significantly increased rates of treatable mortality”, and a postcode lottery was taking its toll.
Some of the problems are historical and well known. But it is unclear whether lessons have been learned. The map highlights the diverse range of private provision, encompassing also some 111 records of private prison healthcare, including 33 by G4S, a company investigated by the government’s Serious Fraud Office (SFO) for overcharging on contracts in 2013. G4S then provided services to around 200 hospitals and healthcare centres in the UK. In 2020, G4S Care and Justice Services (UK) Ltd agreed a ‘deferred prosecution agreement’ (DPA) with the SFO.
The pandemic has also affected the balance between public and private health care. Only this week, the role of Dido Harding in the covid test and trace programme has come under renewed scrutiny. And contracts for PPE have long been criticised as opaque. Meanwhile, Rishi Sunak and Liz Truss have floated the idea of fining patients for missing appointments, something EveryDoctor has criticised as likely to impact those without private transport the most. Back to the postcode lottery for accessing healthcare?
So what does the map reveal?
Click and check
EveryDoctor has just published its second report showing creeping privatisation. You can find your GP and MP on its new interactive map, as well as charities and not-for-profit organisations services providing health care. The GPs listed on the map are recorded in NHS England’s provider directory and registers of licensed healthcare providers, under the ‘independent providers’ document.
The map shows over 40 privatised services in Hull and over 30 in Sheffield. It pinpoints some 600 privatised GP surgeries in England, including 40 run by AT Medics, a firm recently bought by Operose Health. Operose Health is a subsidiary of the US-healthcare firm Centene. Many other firms are perhaps more familiar and known private providers in Yorkshire – Spire, for example, in Elland. Others are less familiar, and the map shows who provides a range of services, including alcohol liaison (Wakefield), drug and alcohol services (York), vasectomy (Redcar) and dialysis (Rotherham, Scarborough and North Ormesby). If you click on the map, the name of the care provider is shown.
Does your MP know?
EveryDoctor has run a campaign to inform MPs, with letter-writing input from the public. But the new report suggests that many MPs are still not aware of the extent of privatisation. And there’s a degree of disingenuousness in statements like ‘NHS services will always be free at the point of use’ according to EveryDoctor. While the NHS is mainly funded from general taxation and our National Insurance contributions, evidence is growing that independent providers (sometimes foreign-owned or foreign-based companies) are fragmenting and buying up the NHS. This means that profits go to private shareholders, often outside the UK.
Dr Julia Patterson, EveryDoctor’s chief executive says that much of the public and NHS staff are unaware of the level of NHS privatisation and outsourcing. “With the NHS currently on its knees, people deserve to know where public money is going, and who’s really providing our nation’s healthcare.”
She hopes that the EveryDoctor map will make all this transparent.
Murkier and murkier – confusing stats
The map shows that the independent sector earns almost £2bn a year treating patients with psychiatric conditions, making profit margins of 15–20%. That’s the equivalent of 13.5% of NHS England’s entire mental health budget. Overall, according to the Kings Fund, 7.2% of spending is on private providers.
Spending on the private sector by the NHS is higher and in 2019 was closer to 26%, if primary care services, GPs, pharmacies, optical and dental services are included, according to research by the London School of Economics. It suggested that following its comprehensive six-year review of Department of Health and Social Care accounts, the presentation of the data is “seriously flawed and requires revision”. Confusion results.
Data from NHS Improvement showed that NHS providers spent £1.5bn in 2019–20 on outsourced services, including the private sector. However, the LSE report criticised the way figures were recorded. It said that when asked to provide a definition in Parliament of the ‘independent sector’ for the purpose of these accounts, the government was unable to do so. Instead, it gave examples of the kind of companies in this category that ranged from small nursing homes to large multinational private hospitals.
The true magnitude of NHS privatisation is obscured
It went on to show how easily it is for MPs to be confused. Payments the NHS makes to local authorities worth £8.2bn in 2018 went, in fact, to independent providers, commissioned ‘funded nursing care’ or ‘continuing health care’. It also noted that the definition of ‘voluntary sector’ is confusing. Some major providers – like BUPA and Nuffield Health – it claimed, are not-for-profit companies. In the care home sector, such companies “often turn a relatively healthy profit … a large number of private hospitals are often registered as charities”.
More confusingly still, various items of NHS expenditure weren’t clearly shown, including elective care bought from the independent sector. Equally problematic, was the exclusion of the amount the NHS spent in 2018–19 on social care, mainly provided by the independent sector.
The author of the report, David Rowland, Director of the Centre for Health and the Public Interest, concluded that, “Healthcare in England is now very much less directly provided by the NHS than most people think”.
And that was nearly three years ago. The EveryDoctor report and the living map not only confirm continuing disruption of the NHS through privatisation. They reveal how extensive systemic privatisation has become and show precisely where you may find evidence of it in Yorkshire and the rest of England.
