The privatisation of the NHS

This is an interesting discussion on privatised medicine – something that many commentators are writing about. There is no doubt that the recent NHS reforms has opened the door to private companies in a way that is unprecedented. Under the guise of efficiency and competition, private providers are being given contracts for huge aspects of NHS provision. I think it is important that we don’t loose sight of the fundamental values of the NHS. The government claims that so long as care remains free at the point of delivery then it matters little as to who delivers that care. I beg to differ and will expand on that in a separate blog.   In the meantime, read this interesting letter which was published in the BMJ.

Private medicine’s real manifesto

BMJ 2013; 347 doi: (Published 1 July 2013)

Cite this as: BMJ 2013;347:f4188

  1. Liam Farrell, retired general practitioner, Crossmaglen, County Armagh

Historians may one day look back and say that there was a time, in the 20th century, when people actually cared about each other. That once the world was more than just a jungle—full of monsters rising on all sides to smite us, where the strong prosper and the weak are devoured.

But that time is passing, as our health minister perfects the trick of throwing up his hands in horror while simultaneously washing them, like a little Tory Pontius Pilate. And as the NHS is slowly eroded, private medicine is blossoming. It even has a conference now: Private Practice 2013 is “for clinicians looking to launch or expand their private practice” and who “want to start a private practice and offer a higher quality service.” So it’s timely to present the real manifesto for private medicine.

  • 1) Always remember that you are a client, not a patient. Your main purpose is for us to generate income. Our doctors will be professional, I’m sure, but if you do happen to get better, that’s just a bonus.
  • 2) Health is a commodity, disease the product line, and doctors the sales force. We’ll obfuscate with weasel words like “providing a better service,” but remember point 1.
  • 3) We do things to you; that’s what we do. There is money in procedures. Sitting you in a bed and watching you for a few days is not a big earner. Masterly inactivity will not launch us into the million dollar club.
  • 4) Old, chronically ill, or mentally ill people are unsuitable for our services.
  • 5) Private health screens are the whores of medicine. They make even us a bit ashamed.
  • 6) “Robes and furred gowns hide all / Plate sin with gold, / And the strong lance of justice hurtless breaks.” * We disguise our mendacity with a veneer of luxury. The waiting room has carpet and ferns; the whorehouse parlour look is quite deliberate, and you won’t have to share it with the riff raff. In contrast, the NHS has always been the Ryanair health service—austere, without frills, it doesn’t aim to give you what you want but what you need.
  • 7) Of course, if the worst happens and you get really sick (or unprofitable) you will be turfed back to the NHS. Looking after sick people: that’s what it’s for, isn’t it?

*  [Had to Ixquick/google this one, but you likely remember your King Lear much better than me.


About Aneez Esmail

I am a Professor of General Practice at the University of Manchester and was an Associate Vice-President responsible for Social Responsibility from 2005-2013. I no longer work in University management. I am a practising general practitioner working in an inner city practice, and a teacher of both undergraduate and postgraduate students. I am also a Health Services Researcher and my research interests include patient safety in primary care, public health, racism in medicine and medical education. I am an active trade unionist.
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