Private and public sectors should face same rules

Two publications from the King's Fund have called for all healthcare systems in the United Kingdom to be subject to the same system of state regulation regardless of whether they are provided by the NHS, the private sector, or voluntary bodies.

In a report, Public-Private Relations in Health Care, academics have warned that the grand idea of improving the health service through public-private partnerships will work only if the government learns from experience and addresses certain difficult questions head on.

Justin Keen, professor of health politics and information management at the Nuffield Institute for Health at the University of Leeds and one of the report's authors, said there were already many public- private partnerships in the NHS, some of which had worked and some of which had not, but that no new partnerships should be forged without solving some existing problems.

“The independent contractor status of GPs is an example of a public-private partnership, and it has basically worked, while dentistry is one that hasn't,” said Professor Keen.

If new public-private partnership services are to be introduced the government must ensure that they are subject to the same regulations and patients' complaints procedures as those in the NHS.

Launching the report and a policy paper, Julia Neuberger, chief executive of the King's Fund, said: “If the government is determined to bring more public-private partnerships into the NHS, it will have to take greater responsibility for regulating the work of private companies. It is simply illogical to have two separate systems of regulation when more and more NHS patients are getting treated in non-NHS facilities. Instead of reducing the scope of the public sector, [public- private partnerships] could actually increase it, albeit it in a new, regulatory form.”

The policy paper, Developing the Public Role in a Mixed Economy, argues that NHS managers need more evidence that public-private partnership can benefit patients and should be able to choose between publicly and privately provided services.

According to Professor Keen, some of the existing public-private partnerships are unfair. “Access to treatment is based on ability to pay, and the government has to ask itself, how much discrepancy is the public happy to live with? For example, will NHS patients happily wait four times as long as those with private insurance for an operation—or is a wait that's twice as long more acceptable?

“These are difficult areas of public policy to tackle, and I have every sympathy with the government, but they have to be addressed if public-private partnerships are to go ahead and to be successful,” he said.