Understanding ‘NHS privatisation’: from competition to integration and beyond in the English NHS

Abstract

References to National Health Service (NHS) ‘privatisation’ can be found in UK parliamentary debates since the early 1980s, but it remains not well understood as a concept and can certainly be distinguished from the standard definition of ‘privatisation’, meaning taking into private ownership. Nevertheless, it is possible to say that the characteristics of ‘NHS privatisation’ include clear links with the evolving interaction between the NHS and private healthcare, a relationship which can be traced back to the inception of the NHS in 1948.By juxtaposing primarily the debates of the Health and Social Care Act 2012 (HSCA 2012) and the Health and Care Act 2022 (HCA 2022), it becomes possible to gain at least two insights into ‘NHS privatisation’ in the English NHS. Firstly, it enables us to understand whether, and if so, how, ‘NHS privatisation’ may be changing with the reversal of the controversial HSCA 2012 competition reforms by the shift to integration now enshrined by the HCA 2022. Secondly, we gain a greater understanding of how ‘NHS privatisation’ has developed as a criticism capable of being invoked by diverse political parties and thus able to shape the development and implementation of NHS reforms. Thirdly, ‘NHS privatisation’ may operate to inhibit more radical NHS reform in opposing directions by reference to the NHS Bill and the NHS (Co-funding and Co-payment) Bill. Finally, ‘NHS privatisation’ can be understood in terms of questions of accountability and the dynamic between market and state.