Will using the private sector to cut NHS waiting lists actually work?

The impetus to reduce waiting times is in part political, but whether it will improve anything for patients or the Tory party is open to question, writes Sean O’Grady

The government has announced plans to expand private sector involvement in the health service (PA Archive)

Concerned that NHS waiting lists are likely to rise before decreasing, the government has announced that further use will be made of private sector reserves in an effort to cut waiting times. Downing Street has said that 13 new community diagnostic centres will be opened across England to carry out an additional 742,000 scans, checks and tests per year, in a bid to reduce the intense pressure on NHS hospitals.

Despite some improvement in reducing times for those waiting the longest, and the claimed virtual elimination of those who have been waiting for treatment for two years or more, the situation remains serious. One health minister, Maria Caulfield, has admitted that the number of patients in line for treatment, which currently stands at 7.47 million, is expected to climb further in the coming months before reaching a peak.

Politically it is also a grave matter, because in January Rishi Sunak made it one of his five “people’s priorities” and promised: “NHS waiting lists will fall and people will get the care they need more quickly.” Vague as it is, the target is in permanent jeopardy due to of a number of other factors: the lack of staffing; the continuing strike action by junior doctors, consultants and radiographers; and the possibility of a winter crisis.

How much difference will the private sector make?

It’s hard to say. The shortage of skilled staff pervades the healthcare sector, even though independent providers seem to be better at paying and retaining staff than the NHS trusts. So there is still a capacity restraint, even when everything is taken into account – something that became clear in the admittedly extreme conditions of the pandemic.

But even with caveats, ministers seem optimistic about the potential for good, and the Labour front bench is supportive of the initiative. That said, the UK’s private medical sector is relatively small, and the NHS will continue to struggle with industrial action. Junior doctors are currently preparing for another four-day strike starting on 11 August in their ongoing argument with the government over pay, with consultants set to walk out for 48 hours on 24 August.

What are the objections to private clinics helping out?

A mixture of historical, traditional and ideological, and largely on the left. There is an understandable distaste, dating back to the days before free healthcare was a right, for the idea that anyone should have to suffer pain because they cannot afford treatment, and a revulsion at the idea of profiting from misery.

Many people across the political spectrum are particularly distressed about the quiet, unannounced part-privatisation of NHS dentistry and social care; despite these two enormous societal changes having been delivered by almost imperceptible increments in recent decades, neither has ever been subject to a national debate. Also relevant is the wider socialist argument that some of the public funds that will be pumped into private medicine will make their way into the pockets of private shareholders.

On the other hand, the private sector has always been intimately enmeshed in the NHS, most obviously in the supply of anything from drugs to ambulances and ventilators to bedpans, all of which come from private firms making profits. Many consultants still supplement their NHS earnings with private practice (and the other way round), and Big Pharma pays for much valuable research. “Privatisation”, in other words, has always been part of the NHS experience, and has rarely been objected to as such.

Is Labour opposed to the idea?

There are mixed messages, but generally it is not, and a consensus of sorts has emerged. Albeit now largely forgotten, the Blair government maintained the NHS “internal market”, and freely used the private sector to demolish waiting lists after 1997. Now, since the end of the Corbyn era, the pragmatists are in charge once again, and there is none more flexible than Wes Streeting.

Since last year, Streeting has been pushing the case for putting patient care ahead of ideology, and has argued that 331,000 patients waiting for NHS care could have been treated since January 2022: “The Conservatives are failing to make use of private sector capacity, and patients are paying the price. No one should be waiting in pain while hospital beds that could be used lie empty. The next Labour government will use spare capacity in the private sector to get patients seen faster.”

What’s the benefit for the Tories even if they succeed in reducing waiting times?

Directly, there is very little for them in the issue itself, which has historically been “owned” by the Labour Party – which after all set up the NHS in 1948, and has always enjoyed a lead on it over the Conservatives. In the slightly cheesy words of Keir Starmer, “For them, it’s a cost, not a cause, and from that mindset springs the well of their neglect ... £200bn a year – that doesn’t square with their small-state vision of Britain.”

The Conservatives counter that they’ve spent more than any previous government, are pledged to recruit many more staff under the long-term staffing plan, and are building 40 “new” hospitals, including upgrades and the like.

Still, all the Tories can usually do on the issue is engage in damage limitation. If Sunak did succeed in reducing waiting lists, it would give him a line to use at PMQs and in the next election campaign. The more important point it would make is that, caring or not, the Conservatives are at least competent to deliver on a promise.

What’s likely to happen?

As always, the various stats on waiting lists, waiting times and variants thereof will probably end up pointing in different directions – which means the prime minister’s scorecard will be hard to mark – and subject to inevitable wrangling.

If Sunak does fail on his targets, partially or completely, the BMA, the Royal College of Nursing and the other health unions will have handed him a handy alibi, so that he can claim, as he did in June, that he would have reduced the backlog of patients waiting to get better if the unions hadn’t been so irresponsible.

Even there, though, Sunak has to contend with the fact that public opinion rates NHS carers higher than it does Conservative politicians, and blames ministers for the fact that the strikes are happening in the first place. The brutal fact is that no one votes Conservative because they’re worried about the NHS.