The line dividing the public sector from the private has been fragmenting for decades.
With the election looming I sense this process is facing a new period of instability, a bit like the earthquake fault lines which bring uncertainty to so many parts of the world.
The NHS has always used the private sector, just as doctors and other health professionals have long been good Bupa customers and state school teachers often send their own kids elsewhere
Typical was a Financial Times interview this week in which the CBI’s new “outsourcing tsar” (you see, it is not just the NHS and Russia that have tsars), a chap called Adrian Ringrose, suggested every form of public service - except maybe the army - should be opened up to market based competition.
Young Adrian runs a support firm engaged in providing military logistics and says US provision is outsourced “virtually to the finger on the trigger”.
He is being a bit coy there because huge private US security firms like Blackwater have been controversially squeezing triggers in Iraq for years; one reason for its recent name change to Xe Services LLC, I suspect.
All in all, a sinister trend. What has this to do with the NHS? Lots. Outsourcing is already worth £80bn a year, 6 per cent of UK GDP, and employs almost as many people as the NHS. The squeeze on public spending will force the government - whoever wins - to go further, especially if economic recovery is weaker than Alistair Darling hopes.
Think Royal Mail, where (says me) the posties’ militant strategy seems as reckless as the miners in 1984 or Fleet Street printers at Wapping in 1986. Don’t do it! It blocks unavoidable reform, as the printers/miners did. Now there is too much opportunism about, private firms circling your core business.
The NHS knows this. Rare is the edition of Private Eye (certainly not this week) which does not include an attack on the financial burden to weaker NHS trusts of servicing private finance initiative debts to the private sector. I remain to be persuaded that - overall - the initiative is a bad thing, but when I see the Daily Mail complain that health trusts are backing the Commissioning Support Appraisals service’s efforts to ensure that the National Institute for Health and Clinical Excellence “rations” what the Mail calls “lifesaving” cancer drugs, I smell a commercial rat dressed up as a pro-consumer mouse: the pharma lobby at work, Blackwater in scrubs.
Which leads us to Norman Lamb’s much trumpeted Freedom of Information discovery that since 2006 the NHS has spent £1.5m getting 3,337 staff private treatment - notably for physiotherapy, mental health counselling and other Cinderella services.
When I spoke to the Lib Dem health spokesman, nice bloke that he is, “Norfolk Lamb” said he “wouldn’t criticise any employer wanting to get his staff back to work. But it is a stark demonstration that in certain areas waiting lists still exist - despite the dramatic improvement in access where there have been targets”.
Of course, the truth is less stark. The NHS has always used the private sector, just as doctors and other health professionals have long been good Bupa customers and state school teachers often send their own kids elsewhere.
Indeed, a lot of trade unionists have private health insurance; for many years the Manor House hospital in north London existed to look after union members. Hypocrisy? Some people say so. I think not, unless those who use such services in private publicly campaign for their abolition without acknowledging that they don’t practice what they preach.
Norfolk Lamb fears the public/private fault line will soon become a San Andreas fault for Andrew Lansley if (Lamb is one of those who says “if”) he becomes health secretary in May. He may be a very reassuring figure, but the pressure from the restless right to privatise services will be on the Richter scale.