For all the pre-election pledges to protect its funding, the NHS is clearly threatened by major cuts. Yet one area of English health policy has remained apparently immune from the debate on cost savings – the main parties all still cling to the dogma that efficiency in healthcare is best achieved by promoting competition and encouraging the private sector to provide services. As practitioners of medicine and supporters of the NHS, we believe this consensus must be challenged.
The NHS is spending £350m a year on external management consultants – often at the expense of its own, internal expertise. Repayments to companies profiting from PFI in the NHS are costing the taxpayer billions. There are many examples of independent sector treatment centres failing to carry out the volume of procedures for which they have been paid. GP-led health centres – often imposed on communities despite a lack of local demand as part of the costly drive to increase commercial involvement in primary care – are struggling to attract patients.
Such examples of public money being wasted are particularly galling to those frontline workers who are being told to gear up for cuts. Moreover, the purchaser-provider split has facilitated the diversion of NHS funding to a plurality of competing interests, and resulted in disincentives for doctors in primary and secondary care to work together to improve services for patients. The experience of other health systems indicates that the creation of a market results in a significant proportion of funding being absorbed by transaction costs.
A recent survey by the Economist Intelligence Unit – hardly known for its hostility to business – found that less than a quarter of the UK population believes the NHS would be improved by a greater role for private providers.
We share the commitment of our patients to a health service that is publicly provided as well as publicly funded. It is time for politicians in all parties to rethink their policies on the role of the market in the NHS in England.
Dr Hamish Meldrum, chairman of council, British Medical Association
Prof Jonathan Brostoff, professor emeritus of allergy and environmental health, Kings College London
Sir Iain Chalmers, editor, James Lind Library and co-founder, Cochrane Collaboration
Prof Anne Chamberlain, emeritus professor of rehabilitation medicine, University of Leeds
Prof Kennedy Cruickshank, professor of cardiovascular medicine & clinical epidemiology, University of Manchester
Prof John Dickinson, former professor of medicine, St Bartholomew’s Hospital Medical School
Dr Nina Essex, consultant physician (retired)
Prof Nick Finer, hon. professor, Dept of. Medicine, University College London
Dr Peter Fisher, president, NHS Consultants Association
Prof Stephen Franks, professor of reproductive endocrinology, Imperial College London
Prof John Garrow, emeritus professor of clinical nutrition, University of London
Prof Andrew Hattersley, professor of molecular medicine and consultant physician, Peninsula Medical School
Prof Allan House, director, Leeds Institute of Health Sciences
Prof Alan A Jackson, professor of human nutrition, University of Southampton
Prof Brian Jarman, emeritus professor, Imperial College London
Prof John Jarrett, emeritus professor of clinical epidemiology
Prof Harry Keen, emeritus professor of human metabolism, consultant physician, King’s College London and president, NHS Support Federation
Sandy Macara, former chairman of council, British Medical Association
Prof Vincent Marks, emeritus professor of clinical biochemistry
Prof DR Owens, professor and consultant diabetologist, University Hospital Llandough
Prof Allyson Pollock, director, Centre for International Public Health policy, University of Edinburgh
Prof John Rees, dean of undergraduate education, King’s College London School of Medicine
Prof Wendy Savage, hon professor, Department of Health and Social Science Middlesex University, and co-chair, Keep our NHS Public
Dr Robin Stott, co-chair, Climate and Health Council
Dr Julian Tudor Hart, research fellow, Swansea University Medical School
Prof John D Ward, past vice president, Royal College of Physicians
Prof Malcolm Weller, emeritus consultant psychiatrist