The NHS and its use of the private sector

As election day draws closer, we're taking a look at how the public sees the NHS, and specifically at some of the underlying narratives around the NHS that are featuring in the debates. 

Here we look at the role of the private sector in providing NHS care (previously we looked at immigration and the NHS). In this election campaign, Labour have set out a plan to use the private sector to bring down waiting lists. However, this has been controversial - the SNP has attacked this policy as “creeping privatisation” and the Green Party leaders have pledged to end outsourcing. At the other end of the spectrum, Reform UK have offered to give out vouchers for private healthcare to patients waiting too long to be seen. So what does the public think?

The public thinks that NHS use of the private sector is on the rise – half (48%) think that the NHS’s use of the private sector has increased in the last five years, as opposed to a quarter (25%) who think it has stayed about the same and 6% who think it has decreased. This reflects the reality to some extent. It’s true that when it comes to elective care, NHS Trusts are now spending more of their budgets on private providers, and that the private sector provides a greater share of hospital care than five years ago. However, spending on the private sector as a share of the overall health and social care budget has not changed much, and is currently 6% compared to 7% in 2018/19.

But how do the public feel about the use of private companies to help the NHS treat more patients? 

They could be said to be lukewarm – but still overall in favour. Nearly three times as many people were in support of the practice than those against (46% vs. 17%).  However, neither view was supported by a majority, with a third of people neutral or uncertain; and few people (13%) strongly in support. This may reflect a view that the NHS is currently in crisis (with nine in ten people concerned about the pressure NHS services are under) and the public know this is one of the tools available to tackle it. 

We also asked what kinds of services the public think it appropriate for private companies to provide, giving five services as examples. While none of the options were chosen by a majority, nearly three-quarters of respondents selected at least one of them. The most commonly chosen service was cancer treatment, with half (50%) of respondents supporting this being provided by the private sector, while the least was accident and emergency services (27%). Interestingly, fewer than half of the public want to see private-sector provision of GP and dental services (31% and 42% respectively) – yet ever since the NHS was founded most GPs and dentists have been private practices contracted to the NHS.  

We would need to do further research to understand how this applies to a greater range of services, and people’s reasons behind this. Their choices broadly feel intuitive and may relate to the difference between ‘front door’ and specialist services, which are more defined and ‘self-contained’. Or perhaps the public are more comfortable with private sector involvement where they perceive there are choices to be made about treatment, and the problem may be acute, but not an emergency. Perceptions of where there is already private sector involvement may also play a part.

Furthermore, our research consistently shows that whilst the public think the NHS needs some big changes, they strongly want to stick to its founding principles. Our recent work on the future of the NHS confirmed this; there is strong opposition to an alternative system that is not free at the point of use or in which there is heavier influence from profit-making companies (such as the US system).

So, while the British public are strongly against privatisation, there is some support for the NHS using private companies to ease the pressure on the service. Time will tell whether this support is simply a by-product of the record levels of dissatisfaction with the NHS we are seeing, rather than genuine comfort with private sector involvement in the NHS. And if one option for the next government is greater reliance on private companies, even just to ease waiting lists, the public will want to ensure that it doesn’t change their relationship with the NHS.