Retain UK healthcare as a primarily publicly funded service, argues leading doctor

A growing proportion of public monies are not going into front-line healthcare, but into profit margins, warns Neena Modi, Professor of Neonatal Medicine and President of the Royal College of Paediatrics and Child Health.

In The BMJ today, she argues that a mixed public-private healthcare system "ultimately reduces the effectiveness of healthcare for everyone" and says "it makes sense on grounds of equity, effectiveness and cost-efficiency to retain UK healthcare as a primarily publicly funded, delivered and accountable service."

Professor Modi points to figures from the NHS Confederation showing that, in addition to NHS (publicly owned) providers, some 853 for-profit and other independent sector organisations now also provide healthcare services in England.

Yet there is no evidence that healthcare is better when delivered by non-NHS providers, she says. "Indeed evidence to-date indicates care is compromised when organisations with no prior experience of local contexts take over from NHS providers."

Some say the growth in private for-profit healthcare will take the pressure off the NHS, but Modi argues that in the UK "the overwhelming majority of doctors work in the NHS; take them away and the NHS, already reeling from the adverse impact of Brexit on migrant workers, suffers further."

The NHS doesn't need to be discarded, nor does it need to go back in time; it needs to evolve, she writes.

She calls for "visionary leadership" to translate its founding principles into 21st century , and "investment coupled with equitable cost-containment" for example through further development of pioneering mechanisms initiated by the National Institute of Health and Care Excellence.

The UK has also long punched above its weight in biomedical and life sciences research "but now needs to address its weakness in exploiting this for public gain," she argues.

And wiser public-private partnerships than the NHS has hitherto seen "could stimulate innovation directed primarily at health and wellbeing from infancy into old age, rather than disease and profit."

Government must be honest, the media must explain, the public must protest, and the professions must speak out, she concludes. "If we do not, future generations pondering upon the demise of the NHS, will be legitimate in asking whether our silence reflected ignorance, denial, fear, or self-interest."

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