1st Southwest Medical Debate Report: Should the NHS be
privatised?
Authors: K Naguleswaran, T Tribedi, J Fenn and S Patel
Background
The inaugural southwest medical debate took place on December 3rd 2015, in
Exeter, between representatives of Plymouth and Exeter medical schools.
Plymouth proposed the motion ‘This house believes the NHS should be
privatised’ in light of the 2015 general elections igniting an increased level of
interest in the matter. This event was unique in nature, being one of very few
occasions where by those who debated were all involved in the medical
profession encompassing various roles (including clinical medicine, education,
health policy, ethics and economics). The debate was overseen by a panel of
prestigious judges comprising of Professor Salman Rawaf (Director of the
WHO Collaborating Centre for Public Health), Professor Robin Williamson
(past-president of the Royal Society of Medicine) and Professor Walter
Holland (Emeritus Professor of Public Health at LSE).
Is the NHS already privatised?
Plymouth opened the debate by illustrating how the NHS was already partprivatised. General practices, for example, were described as private
partnerships, which are owned by the doctors working in the practice. Yet,
primary health care was still free at point of delivery. Hence, Plymouth stated
that privatization could still abide by the founding principles of the NHS.
Plymouth went on to talk about patient owned co-operatives such as the
Seattle based healthcare provider Group Health. Group Health comprised of a
board of trustees consisting of patients and a service helping 600,000 in
Washington. The patient-centered private company was able to provide easily
accessible healthcare lead by the very people it was formed to help.
Can healthcare be ethical if financially incentivized?
Exeter started by opposing the motion on ethical grounds, codes of conduct,
efficiency and accessibility. Privatization would, by its very nature, be
financially motivated. How could we base our healthcare system on
economically status as opposed to medical need? In addition, Exeter outlined
the evidence in a variety of studies showing that making patients pay for
healthcare deters the most socio-economically deprived from accessing said
care. Hence, by privatizing the NHS, we would betray our evidence-based
medical system and ignore evidence in favor of financial incentives.
Exeter went on to describe how privatization would result in medical
professionals capitalizing on patient’s ill health and suffering. The ethical
ramifications of this notion are huge. Could an individual be trusted to perform
solely in the patient’s best interest if their pay was dependent on other
factors? Evidence in healthcare systems abroad unanimously say no.
Does privatatisation make sense economically?
Plymouth applied to the economically minded by stating that competition in
any market increases the quality of service. They highlighted the effectiveness
of such competition using the evolution of the smartphone. Couldn’t such a
revolution occur if healthcare was opened up to private providers? They would
undercut each other’s prices and the public would stand to benefit.
Exeter rebutted this point by clarifying that healthcare and smartphones are
incomparable. The variety of smartphones makes for a more successful
market. A variety of healthcare providers, Exeter argued, would merely
complicate the matter for the patient, making it difficult to make an informed
decision. Therefore, this multitude of providers could detrimentally affect
healthcare delivery to those in most need.
Closing Remarks
Plymouth concluded by highlighting, to the medical professional and students
in attendance, that the current health service would increasingly lack in
resources. In addition, professionals will have less autonomy over their dayto-day practice due to bureaucratic inference and be paid less than European
counterparts. Exeter concluded the event by adamantly defending the
foundations principles of Aneurin Bevan. They cited partial privatization as the
cause of the NHS woes brought up by Plymouth. Therefore, complete
privatization would only make the situation worse.
Conclusion
The judges (a 2-to-1 split decision) and audience swing vote decided that
Exeter had made the most convincing arguments. The NHS founding
principles along with new evidence from the Commonwealth report (rating the
NHS 1st in various aspects of healthcare) was effectively used by Exeter. The
audience was not convinced by Plymouth’s argument that privatization could
increase the quality of healthcare while remaining easily accessible by all.
However, Plymouth was praised for considering aspects of foreign health
systems, which worked well and highlighting how the NHS could be improved
in various areas such as waiting times. Both teams appealed to ethical
considerations. However, Exeter excelled by highlighting the lack of
healthcare available (unethically) to millions in the US where a private
healthcare system is utilised.
ACKNOWLEDGEMENTS
Chair:
Professor Robert Sneyd (Dean and Professor of Anaesthesia at PUPSMD)
Judges:
Professor Salman Rawaf (Director of the WHO Collaborating Centre for Public
Health)
Professor Robin Williamson (past-president of the Royal Society of Medicine)
Professor Walter Holland (Emeritus Professor of Public Health at LSE)
Debaters:
Sir Denis Pereira Gray (Exeter)
Professor Brian Kirby (Exeter)
Professor Stuart Logan (Exeter)
Professor Rod Sheaff (Plymouth)
Professor Sheena Asthana (Plymouth)
Professor Poorna Gunasekera (Plymouth)
(NB: sides were randomly allocated to be for or against the motion)
Any finally we would like to thank the Institute of Medical Ethics for
sponsoring the event. We subsequently were able to not charge for
attendance.