Should the NHS be in bed with the private sector?

David Hinchcliffe and Barry Hassell debate the issue

David Hinchcliffe and Barry Hassell debate the issue

DAVID HINCHLIFFE The concordat was a retrograde step for a government that has shown a strong commitment to restoring the NHS to its principles of equity and treatment on the basis of need. Sadly, private medicine, through the loophole of NHS consultants' part-time contracts, has undermined those principles since the inception of the service, by enabling queue jumping.

BARRY HASSELL Equity is precisely what the concordat is about. It gives patients funded by the NHS access to treatment in independent hospitals and homes when they need it. It's now acceptable for NHS patients to receive surgery in independent acute hospitals. It is now acceptable for NHS patients to have access to independent-sector intensive-care and high-dependency beds. And it's acceptable that they should move from NHS hospitals to receive more appropriate high-quality, best-value rehabilitation and care services in nursing and residential care homes.

DH During the health select committee's inquiry into NHS consultants' contracts, a number of witnesses drew our attention to the correlation between certain consultants' lengthy NHS waiting lists and their very healthy private practice. It was felt that NHS waiting lists were deliberately allowed to grow to create demand for private consultations and treatment. I welcome the Government's determination to renegotiate doctors' contracts to include a set period of work in the NHS after training. Last week's agreement runs totally counter to the Government's previously professed aim of encouraging part-time NHS consultants to cut private work and spend more time treating purely on the basis of clinical need.

BH The independent sector prides itself on high-quality standards. It is regulated by health authorities and welcomes a new regulator, in the form of the National Care Standards Commission. This sector employs 750,000 nurses, doctors and care staff, and it does a vast amount of training. More than a third of post-qualification nursing courses are in the independent sector. Thousands of NHS staff have clinical placements for training in independent hospitals, and we want to do more.

DH Two health committee inquiries established that the NHS frequently loses experienced staff to the private sector - which rarely trains its own staff and relies on the NHS to supply doctors and nurses. The fact that the concordat will result in private-sector staff treating NHS patients directly adds to the difficulties local NHS hospitals face in retaining staff.

BH With billions of extra pounds going into the NHS, Alan Milburn is right to point out that money is not the problem it was. But capacity is. He is right to point out how unacceptable it is to have surgeons who cannot operate on NHS patients, because NHS operating theatres and wards are full - while capacity may be available with a local independent provider. The independent sector does a million surgical procedures a year and provides more than 150 million bed-nights of long-term care in more than 15,000 nursing and residential care homes. Already, it is a partner in the UK's health and social care system.

DH Rather than helping the NHS, this deal will retard the development of additional capacity within the service, and breathe new life into a private healthcare sector which has been struggling. The inability of the NHS to offer appropriate care for all patients' needs is not simply a result of the lack of physical capacity. The problem is frequently the inability to staff beds, either through personnel shortages or lack of funding. This can lead to NHS bed closures. If payments to private-sector providers come from existing budgets, scarce resources will be redirected from the NHS to the private sector. There may be considerable distance between the Government's concordat and Tory policy of forcing patients to pay for certain treatments, but for many the clear distinction which existed between the two main parties on health will have become more blurred.

BH Opponents should accept that no one sector has a monopoly on doing everything in UK health and care. As winter pressures loom, it is right that the independent sector is mobilised for the benefit of NHS patients. It is vital that we move away from the politics and dogma that can so easily cause unnecessary suffering, and develop meaningful partnerships for those who really matter - patients.

David Hinchliffe, Labour MP, is chair of the Commons health select committee. Barry Hassell is chief executive of the Independent Healthcare Association.