Opinion: People don’t care who provides their healthcare

nhs sign lrgThe publication of a new poll by ICM for Civitas on the NHS should give encouragement to those in the Lib Dems who believe that we should not be bound by a single provider approach to the NHS.  The poll shows that people are proud of the NHS but not concerned by who provides their healthcare.

The key question is:

“It shouldn’t matter whether hospitals or surgeries are run by the government, not-for-profit organisations or the private sector, provided that everyone including the least well-off has access to care”.

83% o agreed with this – 56% strongly , while only 14% disagreed, 10% strongly.  These figures are the same as those which the identical question received in 2006 and are consistent across all ages, classes and regions.

These findings should encourage the Coalition Government to be bold and look for reform and greater efficiency in the NHS wherever it to be found.

Scandals like mid Staffs show the way in which producer led healthcare can lead to systematic abuse of patients, but what is in many ways as  worrying is the way the NHS is falling behind other universal healthcare systems.  A recent study in the Lancet found that “the UK performed significantly worse than the EU15+ [15 members of the EU plus Australia, Canada and the US] for age-standardised death rates, age-standardised YLL [years of life lost]  rates, and life expectancy in 1990, and its relative position had worsened by 2010” and that “The performance of the UK in terms of premature mortality is persistently and significantly below the mean of EU15+ and requires additional concerted action”

None of this means that Liberal Democrats should not be committed to a free, well funded NHS.   But if the NHS is to be affordable in the long term, it has to be more efficient.  There is much to learn from other countries (one of the more effective Labour and union lies has been that the only alternative is the US) – the message from the poll is that the public has the good sense to realise that it is what is provided that is important, not how it is provided.

* Simon McGrath is a councillor in Wimbledon and a member of the board of Liberal Reform.

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  • One of the most interesting points is that people also didn’t care back in 2006. This isn’t some sort of new miraculous faith that’s emerged in alternate providers; the British public have always simply wanted the best healthcare possible with no prejudice for provider.

    Labour recognised this, hence why they began the process of bringing the private sector in where it proved useful, it’s only now that they’re in opposition that they cry on about “7 days to save the NHS”, etc.

  • Agree with this entirely. As long as it is free at the point of use and a top service is provided I don’t care at all who runs the hospital/doctors’ surgery.

  • Peter Hayes 19th Mar '13 - 7:21pm

    The problem is you move simple surgery into the private sector which does no training so how do specialist surgeons get trained. Also what about intensive care? My neighbour went private for a simple operation, came home and a blood clot moved, you do not have to guess where he ended up.

  • Foregone Conclusion 19th Mar '13 - 8:24pm

    The problem with this position is that it is an intellectual cop-out. As you say, almost everyone agrees the basic principle. In that way, it’s like the harm principle – who else but a fascist, a Stalinist or a theocrat could disagree with the idea that someone should be allowed to do something as long as it doesn’t harm others? The problem is that the idea of harm can mean a lot of different things to a lot of different people, stretching so far as the harm that parents do to their children by not feeding them properly, or the harm caused to society at large by income inequality. The same is true here: the principle of ‘best possible provider’ is a good one in principle, but seeks to neatly side-step the question of what exactly the costs and benefits of private sector involvement really are.

    The question that should be asked is: does the British public want a mainly publicly owned and operated health service with private involvement at the margins to relieve demand in certain areas or provide specialist functions, and based on the principles of co-operation? Or does it want a model where the majority of health care is provided by profit-making organisations competing against one another, commissioned by unelected general practitioners and overseen by Whitehall and a raft of quangos? This question was, of course, not asked at the last General Election. If proponents of greater private involvement and internal competition really cared about democratic legitimacy, they might want to be honest with the electorate in 2015 about their plans for the future of our public services and put their proposals forward forthrightly and without evasion.

  • The criticism that is coming the NHS way is part of a PR blitz by Jeremy Hunt and by those who wish to privatise the NHS. It is the old story of emphasising the bad so they can open the NHS out. It is criticism from a standpoint of wanting to criticise to undermine to legitimise the proposed changes of the NHS. The tragedy and hypocrisy is that the replacement organisations or coming privatisation will not provide a remedy to problems or be more open. It seems that public service is being held to a higher standard of scrutiny and openess then the equivalent private organisations.

    There is emphasis on lambasting the NHS while poor private practice in health and social care provision is being roundly ignored. Existing Social care outsourcing can be very poor but we don’t hear a mass campaign about that. Look at the cruelty shown at Winterbourne House for those with Adult and Learning Difficulties.


    I refer you to this article in the Guardian.

    The opening out of competition and the regulations created by Jeremy Hunt is a disaster for the NHS. At a time that the NHS is struggling to cut costs, commissioning groups will have to run expensive tendering processes and risk court challenges over their decisions. The change in advice from Jeremy Hunt does not change this. It is privatisation by the back door. I thought Shirley Williams and the Liberal Democrats said that this was not be happening, but it is happening.

    This is how it may work. Harmoni in Hackney out of hours GP cover was found to run a dangerous lack of cover. A not for profit group supported by the Commissioning group wanted to take over control but were unable to due to fear of litigation from Harmoni lawyers. Harmoni had their contract extended.

    This is the new NHS that you the Liberal Democrats are enabling the Conservatives to create. It is not going to be better, choice of providers will not be given to the new commissioning groups. The corporate lawyers will run riot and there will be massively escalating costs in the tendering process. The legal challenge and threat of litigation will become the driver of the process and not choice or quality of the provider.

    Add in the conflict of interests between the commissioning groups and their business groups. The whole system is a horrible mess and will not better. The current problems that the NHS are facing and being highly criticised about will not be put right by the changes that are happening.

    The Liberal Democrats have latterly showed some spirit in not allowing everything through the Conservatives wanted. If they do no stop Hunts regulations, the Liberal Democrats will pay a heavy price at the next election. A 340,000 signature shows the concern. The Liberal Democrats ignore this issue at their peril.

    I find it worrying that the contributions on this thread choose not to recognise any of the problems.

    When this comes out to play and NHS health care is severly rationed because of the costs of the competitive process has shredded the money that should be used for health care the electorate will not forgive. It is not just about the who provides the care.

  • So we are ruled by opinion polls are we? But did the LibDems or their Conservative colleagues put their plans for NHS commercialisation to the electorate? The answer of course is No. The LibDems (along with the Conservatives) had no mandate whatsoever for what they have done to the NHS. And well they know it, for it is a very very sensitive subject in the LibDem Party. I, for one, am a democrat. If you, as a political party want to make massive (yes massive) changes to the way the NHS is run then fair enough – put it to the electorate for their approval, get the voters’ approval and then go ahead with your plans. But the LibDems didn’t do that; prior to the 2010 they promised voters that there would be no upheaval in the health service. Post-election LibDem MPs suddenly became keen converts to the thoughts of the rather idiosyncratic Mr Andrew Lansley. The voters and the LibDem party members didn’t get a look in. If this is an inaccurate account of what happened I am sure someone will put the record straight for me!

  • Simon McGrath 19th Mar '13 - 10:21pm

    @Peter – not actually a slam dunk case against private providers is it? Part of the contracts could include training. There is an issue about small hospitals needed to move people to intensive care sometimes but that happens with NHS as well.
    @Foregone Conclusion – you appear to have reached one already .

    @Jack Timms – you are right , there are sometimes problems with private providers. But i don’t see how that is an argument against private provision in toto any more than the many scandals in public sector provision is against public provision.

  • Simon, if you think this Tory lead government will require basic treatments be run by a University lead teaching hospital or equivalent I think you are deluded.

  • Tom Papworth 19th Mar '13 - 10:53pm


    To describe “The criticism that is coming the NHS way [as] part of a PR blitz by Jeremy Hunt” ignores the fact that the NHS has consistently under performed the most of the developed world (not just the US) for decades. The fact that you rely upon extracts from a newspaper while Simon cites The Lancet is significant.

    Relying on private providers while the government guarantees equality of access has made (socialist) France and Sweden one of the leading nations in the world for healthcare outcomes, while the (Anglo-Saxon Capitalist) UK languishes in the lower-middle of the league table.

    Dogma aside, we need to learn from our OECD and European neighbours if we want to improve health outcomes in the UK.

  • Andrew Suffield 20th Mar '13 - 12:20am

    The problem is you move simple surgery into the private sector which does no training so how do specialist surgeons get trained.

    Well we never moved GPs out of the private sector, so how does that work exactly?

    Perhaps you might want to find out. People who don’t know how it’s actually working today probably don’t have a whole lot to contribute on this subject.

  • I think Simon the point that I am making is that there Hunt and those that want to destruct the NHS are looking for anything they can to undermine the NHS and the public sector. Very poor provision of services other than NHS, trains, care homes, energy market etc, are virtually ignored by the Conservatives and the right wing media.

    It is ideological. The Conservatives given the opportunity would remove public sector provision completely. The Conservatives did not gain a majority as people did not trust them on things such as this. The electorate that voted for Liberal Democrats were voted for to moderate the conservatives ideological dogma.

    There is no disputing that the NHS can improve but are the current changes going to achieve that ?

    I am specifically talking about the clause that Hunt is putting up that opens up the NHS to competition law. You mention the Lancet but 360,000 signatures with many, many senior health figures against the privatisation of the NHS, which this clause enables. Commissioning GPs will be prevented from choosing the best provider, which may be non profit, Charity or NHS provider by challenges from corporate lawyers. The whole process will become hugely more expensive, taking money aware from patient care and into the tendering process.

    It is a disaster for the NHS.

    This is not what the Liberal Democrats were voted into do. If the Liberal Democrats allow it, it will not be forgotten at the next election.

    The achievements of the French and Swedish systems are built on a higher level of spend (%GDP). It is acknowledged that the NHS does very well on the money that it gets. Do you really think that the system being foistered on the country, carefully takes the best of other systems ?

    Tom. I am interested that you raise the US system where a large amount of people have no access to health care and there are spiralling premiums and insurance costs; with someone with a clipboard making decisions around whether you get access to health care is a better system. The American system is a disaster for a large portion of Americans. Do you think that the US system is better than the NHS ?

  • Yellow Bill 20th Mar '13 - 1:16am

    Anyone who seriously believes that noone cares about the NHS being privatised need only look here


    Personally I would rather believe 38 Degrees than a propaganda survey carried out for a right wing think tank.

  • Simon. How do you deal with the argument about private vested interests who are just out to make money. Also issues of Communication, Co-ordination and Accountability??

  • Matthew Huntbach 20th Mar '13 - 10:31am

    Simon McGrath

    These findings should encourage the Coalition Government to be bold and look for reform and greater efficiency in the NHS wherever it to be found.

    Yes, but this was the argument for PFI. There is some magic fairy dust called “private sector know-how”. You sprinkle it around on things, and they all get much better. My local hospital was built under PFI. Now it is costing hugely more than it would have done had this system of financing it not been used, there’s a massive outrage about it locally because to help pay the extra costs they are part closing down another hospital in the area. Or consider the privatisation of gas and electricity? If you asked people when it was done would they have answered they didn’t care so long as the lights and heating came on? Now they are paying big bills for the inflated salaries and bonuses those who run these things demand, and to pay shareholders’ dividends. Ask people now whether privatisation was a good thing. I think you would get a different answer.

    I remember when this PFI thing came out, it seemed to me to be madness, because it was locking us into a long-term deal which might seem good at the start, but how would we know it would still seem good 10 or 20 years later? And so it has turned out – the private companies could afford better lawyers and investigation than we could, and they had it all planned out so that it started off looking good so they got it, and ended up in them making a massive profit.

    Where do these efficiency savings come from? It’s magic fairy dust, Simon. It doesn’t actually work. Experience suggests that loss of democratic control ends the close scrutiny of standards we used to have. The dog-eat-dog mentality of competition to provide the lowest bid does NOT result in higher quality. It results in something that looks good to start with, but is achieved by cutting corners with bad long-term consequences. Sack the staff that know what they are doing, employ cheapo ask-no-questions staff to do the job instead, run it all by a regime of fear where those who care dare not speak out at all that is going wrong, at all the poor standards resulting from having to meet the headline cost-cutting figure, for fear that if they do they will be thrown out and never work again. A side effect of all this is the rise in cases of depression. The way you want things to be run, Simon, is leading to great unhappiness and misery.

    Look at the finance industry. Look at the run of scandals, the PPIs and endowment mortgages, poor quality products which people took on because they seemed good at the time and the gabby salesmen who sold them were so pushy. Wasn’t that all free market? Wasn’t that all fair competition? So why did it lead to people paying for products so poor that the banks are being made to pay compensation to those who bought them? THAT, Simon McGrath, is what your supposed efficiency due to competition really leads to. We are not talking about apples sold off a barrow in a real market. We have seen enough of your sort of dog-eat-dog competition in so many areas now to know it tends to drive quality DOWN and costs UP in the long term.

  • Matthew Green 20th Mar '13 - 11:25am

    Matthew, I’m old enough to remember what BT and British Gas were like before they were privatised – and I thought you were too! There was clear evidence of the fairy dust working there. And do you really believe that rising energy costs are to do with privatisation, and not rising world energy prices, and the pound sinking as North sea oil and gas runs out?

    What privatisation can do is break the hold of vested interests that prevent services from modernising as responding to consumer needs. There is plenty of evidence of that in the NHS. It may not be dog eat dog competition, but it is just as ugly. There is also the view that the NHS has to move to providing less care in hospitals and more in the community – and surely that implies a bigger private sector involvement?

    While we are engaging in theological arguments about ownership, the real issue is not being addressed properly. And that is developing effective commissioning systems that can hold health service providers to account properly. There is a danger that the Tories prevent the CCGs from being effective enough in this role.

  • Jonathan Hunt 20th Mar '13 - 11:52am

    People still want healthcare free at the point of delivery. That is the idea Liberal MP William Beveredege advanced in his famous wartime report, and what then Labour stole and stood on in the 1945 election. As a result, they were the only junior partner in colaition government ever to win the succeeding general election.

    As we all know, they swept the country and sent craven Liberals into obscurity. Unless we stand up for that principle now, we shall suffer the same fate again. People using private healthcare plans usually end up paying for some extra or other.

    A one-time colleague was told to use the company provider, and ended up having to personally pay what would now be a four-figure sum for dressings to be removed and after-care. This is the next step on the road to an Americam system that most US citizens want to end.

    The idealogical purpose of the Tories is to provide additional markets for the private sector to profit from. In time, that will lead to us all paying more, and the PFI example will seem like a minor pinprick in comparison. The Tories created individual health trusts, each responsible for their budgets just like a private company.

    But as soon as paying the cost of private finance arisis, people in south-east London lose an A&E service, which puts pressure on others, such as King’s College, my local hospital where the A&E is already hard pressed. It is like Teso and Sainbury’s having to cough up because Asda has failed. But that would never happen.

    The shame of it all is that it is Liberal Democrat MPs and peers who have allowed this to happen.

  • Alan Marshall 20th Mar '13 - 12:04pm

    I’m not sure the poll question shows what you state it does. It’s a very convoluted and leading question. It lumps in NGOs confusing the issue and comes up with a question that is difficult for anyone to clearly disagree with. It’s also seriously at odds with many other opinion polls on the NHS and Social Care bill where the issue was hotly disputed and usually significant majorities were against it.

    The Lancet study talks a lot about lifestyles and diet being major factors. As well as a need for more preventative work to be done. This will of course involve the state intervening to change our habits. The study suggests changes or reform in the NHS. It doesn’t prove any case for more private takeovers of health services, just that changes are needed.

  • Geoffrey Payne 20th Mar '13 - 12:44pm

    Matthew Green – rising energy prices are a lot to do with privatisation on top of world energy prices. The British government should have done what Norway did and take into account that oil is a finite commodity whose price will go up and it therefore need to be consumed slowly. Instead Margaret Thatcher allowed the oil corporations to exploit the reserves as they please and which they did. That helped the British economy out of the Tory inspired recession in the 1980s and the corporations made big profits. However now we have passed peak oil, unlike Norway. Now we import more oil than we export and paradoxically the oil corporations are not making as much profit as they would have done if they copied Norway.
    We think about free markets as an efficient way to maximise profits, but they do not take into account the advantage they would have in forsaking short term profits in order to make long term ones.

  • Matthew Green 20th Mar '13 - 12:50pm

    Jonathan. I don’t think the problem was turning NHS hospitals into trusts. That just is the health service equivalent of local management of schools – a policy invented by the Liberals and now adopted across the politcal spectrum. It can be corrupted into privatisation, but that wasn’t its purpose. Surely the real culprits are New Labour with their “Payment by Results” and Foundation Trust policies – which they show no sign of retreating from.

    In fact privatising hospitals is a bit of a red herring. They are fast becoming local monopolies only allowing people a choice at the boundaries. The problem is that techological changes are making many District Generals obsolete, so there will be fewer of these hospitals – and the level of monopoly will increase. Franchsing these to the private sector seems to have gone out of fashion. Private provision is much more about community services, where the NHS in-house record isn’t that strong, though the private sector one probably isn’t any better. The real issue is quality management, whoever owns them.

  • Matthew Green 20th Mar '13 - 1:05pm

    I’m sorry Geoffrey, I don’t understand how adopting the Norwegian policy would have reduced energy costs for the British public – I thought they charged world prices. I don’t disagree that the Norwegian policy towards the North Sea was more sensible than Mrs Thatcher’s – but that’s not the point at issue. What I do remember was thet British Gas before privatisation was one of the most inefficient and unresponsive organisations in the British economy, and that privatising it has been of enormous benefit. Whether we could have turned it into a Statoil, which is relatively efficient, I have strong reason to doubt. I also doubt whether Statoil’s commercial behaviour is all that different from that of a regulated private sector entity.

  • Geoffrey Payne 20th Mar '13 - 1:28pm

    I am ok with a well regulated private sector, but this government does not believe in regulation and that is what makes privatisation and marketisation so toxic. Look at how the elderly are treated by our so called caring services.

  • Matthew Huntbach 20th Mar '13 - 2:22pm

    Matthew Green

    Matthew, I’m old enough to remember what BT and British Gas were like before they were privatised – and I thought you were too! There was clear evidence of the fairy dust working there. And do you really believe that rising energy costs are to do with privatisation, and not rising world energy prices, and the pound sinking as North sea oil and gas runs out?

    No. I wasn’t saying that. I was saying the extra money paid to executives and shareholders is a factor, not that it is the only factor. I’ve had huge problems with privatised BT and another telecoms company, so I’m not particularly convinced there has been a massive improvement, once one takes the technology changes out. On British Gas, I pay the quarterly bill now as always. What’s the difference?

  • Matthew Huntbach 20th Mar '13 - 2:51pm

    Matthew Green

    What privatisation can do is break the hold of vested interests

    Er, so there are no vested interests in the private sector? Everyone who works in the private sector is motivated solely by altruism? Matthew, this is just fairy dust sloganising, this is Tory talk. Why is it that in LibDem Voice these days all the people who have the LibDem symbol coming up under their names seem to be pure 1980s Tories in what they write?

    I’m not engaged in any sort of “theological” argument. I’m concerned solely with what works. I have friends and relatives who work in health and social care, and I have my own experience working in higher education and local government, what I say is based on that, not on spouting slogans. I think Margaret Thatcher got it quite right in that much misquoted phrase “there is no such thing as society”. The point underneath she was trying to make was that underneath it comes down to individual people and what motivates them. So too I would like to say “There is no such thing as the market. There are individual men and women, and there are companies”.

    The biggest vested interest in this issue is those who make money from all the extra administration putting this under private ownership with a market mechanism creates, all those lawyers and accountants and bankers. The “finance industry” is really just the bureaucracy of capitalism. We all need some bureaucracy, decent administration that gets the rest of us working together, but come on now, isn’t it the case that bureaucrats get too big for their boots and seem to go on and on expanding in numbers and thinking themselves indispensable and inventing more and more schemes to justify their existence and expanding pay? And isn’t it the case now that this vested interest is pumping huge amounts of money into various outfits promoting its case, thinks tanks, the right-wing press, donations to political parties and the like?

    I’m happy to listen to the points they make. I surprised people in LDV some time back by saying how much I admire Hayek’s “The Road to Serfdom” and think it an essential liberal text. But we’ve seen enough of these arguments taken, filleted out for those bits which justify the vested interests and other aspects thrown away when they don’t, and used to the exclusion of all else. I think we need to move on. Above all, I think we need to think in human terms, not empty slogans, which sorry, but what you wrote consisted of nothing but.

  • Matthew Green 20th Mar '13 - 2:55pm

    Matthew, at the risk of going off-topic. Before privatisation there was a waiting list to get a phone put in. I remember what a nightmare it was when I moved into a flat without one in 1981.That sorted itself out in no time after privatisation. BT (and the others) are still horrid to deal with, but at least the country has more or less kept up with technological advances. British Gas were notoriously bad at sorting out problems; they (and the others) are much better at that now. The extra bonuses and dividends are paid for by efficiency improvements that would have been almost impossible to acheive otherwise – or no nearly so quickly, anyway.

  • Matthew Huntbach 20th Mar '13 - 3:14pm

    Matthew Green

    In fact privatising hospitals is a bit of a red herring. They are fast becoming local monopolies only allowing people a choice at the boundaries.

    Don’t you people get it?

    I don’t WANT to feel I have to make a choice of hospitals. It’s not like choosing which restaurant to eat in or which clothes to buy. It isn’t a fun thing. I’m not a medical expert, and I don’t go to hospital on a regular basis, so how am I supposed to know which are the good ones and which are the bad ones? When I’m ill, I don’t WANT the added stress of having to do research on what hospital I should go to, and feel I’m a mug if I don’t get it right. I don’t WANT to play the wheeler-dealer in this and every other aspect of my life. What I want is the reassurance that I can go to my local hospital and they will give me the best standards of service and there are other people doing all the quality testing and the like that guarantees that, maybe people I have chosen myself to do that job for me through the ballot box.

  • Matthew Huntbach 20th Mar '13 - 3:26pm

    Matthew Green

    Before privatisation there was a waiting list to get a phone put in. I remember what a nightmare it was when I moved into a flat without one in 1981.

    On telecoms, I think there is a tendency to confuse the effects of privatisation with the effects of general technological advance. As it happens, I recall the first phone I had installed in a place of my own, done by BT, quickly and efficiently. I can also give you a couple of horror stories of bad behaviour from private telecoms firms.

    The point is that now we’ve had two or three decades of experience of privatisation, people have enough experience not to believe the simplistic slogans you were putting out, as if it’s the automatic answer to everything, magic private dust that can be sprinkled to improve efficiency.

    Could the improvements you observe in BT have been made by putting in place better management and more investment without the privatisation route? How did that alone work in human terms to improve things? I’m not being theological about this, I’m just being sceptical. As I said, I was right with PFI – the arguments put forward for it really were “this is magic fairy dust”.

  • Andrew Tennant 20th Mar '13 - 6:37pm

    That’s certainly my position Simon – completely provider agnostic, simply prioritising the best health outcomes available at the most manageable cost.

    You’d get a very different impression of public opinion from the media, the Labour Party, or the vested interests amongst the current monopoly providers.

  • Foregone Conclusion 20th Mar '13 - 7:05pm

    @Jack Timms

    “The criticism that is coming the NHS way is part of a PR blitz by Jeremy Hunt and by those who wish to privatise the NHS. It is the old story of emphasising the bad so they can open the NHS out. It is criticism from a standpoint of wanting to criticise to undermine to legitimise the proposed changes of the NHS.”

    …and this is why I also dislike the other position on the health service (let’s call it the ‘Brownite position’, because I remember Gordon Brown rumbling on about the sin of ‘doing down’ the NHS many a time). Any criticism of the NHS, and – holy smokes, Batman, get out the Batmobile! Someone’s saying nasty things about the NHS – it’s an evil plot to destroy the NHS! Whereas it is an institution that isn’t perfect and sometimes lets people down catastrophically. It’s overcentralised and overly bureaucratic. That doesn’t mean marketisation is the solution, but shutting down the debate with ‘you’re doing down the NHS to sell it off!’ is the counterpoint to ‘let’s be pragmatic about this’ in the let’s not have a debate-debate about the NHS.

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