Tuesday, May 19, 1998 Published at 22:12 GMT 23:12 UK
The size and role of private medicine
Bupa nurse checks pulse of expanding private sector
Britain's ageing population and the ever-increasing cost of funding a modern health service have brought the private and public sector together in a very complex relationship.
The trend began in the 1970s, but was given real impetus under the Conservatives. And Labour, with its adherence to Conservative spending levels, appears to be toeing the private/public partnership line.
Latest figures show:
There has been some crossover between the public and private sectors since the foundation of the NHS. Hospitals have been able to have 'pay beds' for private patients. Consultants have also been able to hold part-time contracts with the NHS so they can practice privately as well. Patients have always had the right to receive private medical treatment, either paid for out of private healthcare insurance or directly.
But the private sector remained dominated by charitable hospitals and NHS 'pay beds' until the 1970s, when the number of private consultants began to increase. The 1974-9 Labour administration tried to phase out 'pay beds' in the NHS. This actually stimulated the development of private, profit-making hospitals. After a decline in 'pay beds' in the late 1970s, there are now around 1,500 private beds in NHS hospitals, roughly the same number as in the early 1970s.
When the Conservatives came to power, they introduced new consultant contracts which allowed full-time NHS consultants to do up to a tenth of their work in the private sector. The Health Services Act of 1980 also stimulated an increase in private provision.
Conservative policies, such as contracting out some services, the growth of private healthcare firms operating in the internal health market and the introduction of the Private Finance Initiative in 1992, led to fears about creeping privatisation of the NHS. PFI allows private firms to put up much of the capital for new developments, such as hospitals.
It is too early to say what the impact of Labour's election pledges on reducing waiting lists and abolishing the internal market will be for the private healthcare sector. One area the government is currently tackling is that of full-time or mainly full-time NHS consultants who work in the private sector. There is talk, for example, of introducing a 'naming and shaming' policy for so-called 'fat cat' consultants who make a lot of money out of private work. But it is likely to face opposition from the British Medical Association, which is calling for consultants to be allowed to do as much work in the private sector as they like.
Whatever the government's policy on hospital care, the private sector's influence in primary and continuing care is likely to increase into the millennium.
Most of the government's new health initiatives include stipulations that the public sector work in partnership with business as well as voluntary organisations. And private healthcare insurance, particularly for long-term care, is also under discussion as part of a review of the needs of Britain's ageing population.