Renationalising the National Health Service

This week was Jeremy Corbyn’s opportunity to talk about renationalising another important industry, other than the full-to-bursting railways. But how do you renationalise the National Health Service, as he put it? A free public service paid for by the taxpayer, in which 92% of services are delivered by the NHS itself, doesn’t scream privatisation, depending on which political narrative you listen to.

Corbyn’s suggestion of “taking back public ownership” of the NHS seems a touch dramatic and aimed at highlighting his fellow leadership contestant Owen Smith’s policy career at Pfizer, where he advocated for patient choice. Smith has since backtracked and turned his own guns on Labour’s introduction of patient choice and involvement of the independent sector in delivering NHS services, as he attempts to out-Corbyn Corbyn to win over the party faithful.

Listening to Corbyn and Smith’s recent speeches on the subject transports us back in time to May 2015, when the party’s anti-NHS privatisation rhetoric formed a key part of their electoral strategy. That failed to cut through with voters, and little seems to have changed since then to suggest an overhaul in public perceptions. So will going back to the anti-privatisation mantra actually get Labour anywhere? Throughout recent years, the British Attitudes Survey has shown that the majority (43% of respondents at last poll) of people in the UK do not mind whether the provider delivering their care is NHS or non-NHS, if they had to choose between one or the other. When put to people in this way, most take the pragmatic view that quality of care is what counts, not the nature of the provider.

The King’s Fund estimates that the increase in independent sector provision within the NHS has been gradual since before the Health and Social Care Act was introduced, and that competition between providers has been of overall benefit to patients. There are still some longer term questions if the independent sector were to ever grow to match the size of the NHS’s share of the market, such as the burden of training and how to link emergency services with the rest of the health network. But at 8% of the total share of NHS spending, according to the most recent Department of Health figures, it seems the independent sector is some way of reaching that tipping point.

The key point Smith and Corbyn have missed, isn’t who ‘owns’ the NHS or who is delivering care, but rather what does the quality of that care look like. The NHS is a relatively lean and high quality service, yet its biggest challenges are ahead. Pioneering technology means we are entering an era of personalised medicine, where a cure for a whole range of diseases will be at our disposal, yet at great cost. In a system that struggles to pay for medicines already available, will the NHS fall behind international standards and can it remain universally free otherwise? These questions seem bigger than the gradual but small increases in private sector involvement currently obsessing both leadership candidates.

The reality is that from now until September, both men are increasing their rhetoric to appeal to the party base, who overwhelmingly see private sector involvement in the NHS as a threat to its existence. If Labour wants to appeal beyond this demographic, they must start talking more seriously about the real threats average voters perceive – can they book a GP appointment, will their relatives have access to up-to-date medicines, how long before they can get a knee replacement, can their parents afford to pay for their own social care? Attacking the private sector is safe ground for Labour, it needs to start talking about transforming the service all voters value.