“Despite private sector involvement, there have been some spectacular failures in the NHS”

Roy Lilley is a former NHS Trust chairman turned independent health policy analyst and commentator. Ahead of Thursday’s UK general election, Lilley speaks to Equal Times about the pivotal issue of the ‘stealth privatisation’ and dismantling of the National Health Service.

What has been the impact of the Health and Social Care Act of 2012 on the UK’s National Health Service (NHS)?

Before the [Conservative-Liberal Democrat coalition] government was elected they promised that there would be no major reorganisation of the health service, but the moment they got in power almost every one of the existing NHS structures was demolished and changed.

For the last three to four years, the NHS has really struggled with the consequences of that. Now, it is a much more market-driven health service.

We are now facing a general election where the Conservative Party, which introduced the Health and Social Care Act have not mentioned it at all in their manifesto and most of the other parties have said that they would repeal the Act, so it has not been successful.


What is your view on the position of the various political parties with regards to the future of the NHS?

The major difficulty facing the health sector, that whichever party that is elected will have to face, is the question of money. The NHS is facing a black hole in its finances of about £30 billion.

Simon Stevens, the Chief Executive of the National Health Service, says he thinks he can recover about £22 billion of debt through internal reorganisation with the remaining £8 billion coming from taxation.

The Conservative Party, and all the other minor parties, has said it would commit to the £8 billion. But Labour has rather surprisingly said that it won’t. Instead it is talking about further restructuring and making savings by merging health services into local government.

Now, while all of the parties have said that they will meet the funding commitment in one way or another, they have all taken the view that £8 billion will be sufficient to plug the black hole in NHS finances – buying resources, hiring more doctors and nurses, for example – and it won’t


What can you tell us about what Labour Party leader Ed Miliband called the ‘stealth privatisation’ of the NHS in recent years?

In the last four years, private sector involvement has gone up by about 15 per cent to £10 billion. And yet there have been some spectacular failures. There was one private company that took charge of an entire hospital, ran up about £7 million in debt and then pulled out.

We had another major international company, Serco, which pulled out from all of its clinical facilities contracts simply because it couldn’t make any money. But there is really no prospect of the private sector making any kind of serious money in providing NHS services.


What are the risks represented by Transatlantic Trade and Investment Partnership (TTIP) for the NHS?

The threat of TTIP is that the whole country would be obliged to tend health services to the private sector whether they wanted to or not. The latest we know from the European Trade Organisation is that governments do not have to submit health services to TTIP if they do not want to.

Labour has said that it won’t, but the Tory [Conservative] Party hasn’t given any real assurances on whether it would or not, so we are really in a kind of a limbo in terms of what the interpretation of TTIP really is.


Given the current context, is it possible to keep the NHS public and efficient?

The Commonwealth Fund, an American think tank, recently produced a survey which showed that in terms of value for money, the NHS is the best performing health service in the world.

Its management costs are around 2.3 per cent and its margins are about 7.7 per cent, whereas southern European health systems are running at costs of over 9 per cent. For the private sector to come in, take over services and be more efficient than the NHS is a big ask.