If it was decided to move to an all public NHS in England with health boards then what would be the advantages and what would be the cost of making the transition?
So far this change has been argued for as an end in itself, stopping any private involvement in the NHS, but nothing has been said about how it could be brought about, what the benefits are for patients or the costs to be met.
The Welsh NHS has virtually no private provision of health care. It is structured through local health boards based on defined geographical areas and responsible for all healthcare services. This means that the NHS in Wales is an example of what some wish to see in England.
Despite appalling politically motivated attacks on the Welsh NHS by Tory politicians the actual evidence shows that on almost all important measures there is little difference between the performance of the two different systems. There is also relatively little difference in the funding levels and it is certainly not true that Wales has an advantage in having much lower management and administration costs. There is no evidence that either system is better in terms of efficiency; technical or allocative.
Perhaps the biggest difference is that political and administrative accountability in Wales is far clearer and Wales is better placed to be able to develop more integrated solutions and to reconfigure services should such changes be agreed. Although there is no thought of greater involvement of private providers or of moving to a market structure there are critics of the Welsh structure just as there are in England.
Both systems currently face similar major challenges especially the growing gap between expectations and the funding available. Although Wales is probably better placed in terms of its social care and further down the road of integration there is still a different system altogether for social care with some private provision.
In England private (for profit) providers of healthcare account for around £7bn (6%) of the NHS budget. The % is rising but in line with a well-established trend. The Health & Social Care Act did not accelerate the increase. And in England rather than health boards there is a hugely complex set up with hundreds of organisations, a split between commissioners and providers and multiple regulators.
There is little doubt that making the change in structure from English to Welsh would be complex, take time and managerial effort and would have significant costs. The last major reorganisation cost at least £3bn and the change to health boards would be far bigger and far harder to complete. Buying out private provision would also be costed in £billions.
So the transition would be costly and disruptive but, if we compare with Wales, the immediate gains to patients and to the exchequer would be minimal. Many would agree the Welsh structure is better in many ways but in itself changing structures solves none of the current problems both countries face.
So why would we do it?
One original claim – that taking out the market would save £billions – has been disputed and anyway the Welsh experience (and in Scotland) says it can’t be true.
That leaves only the claim that this is the only (or the best) way to stop privatisation. This claim too has been disputed with alternatives not requiring major reorganisation put forward instead. It is also obvious that the only way to stop privatisation is to elect a government that does not do it.
It would be very helpful to our debates if someone could set out the answer with some explanation of how change would be brought about, how long it would take, some evidence to support the claims made, and a few numbers – instead of just making assertions.