Q: (from earlier)..."Whilst reluctant to get into the middle of this hate-fest... as long as the principle remains that healthcare is free at the point of need (prescription charges excluded), does it matter if it's provided by a private company?"
Well, yes it does, as it's an issue of accountability. Many in the general public have no idea how good the NHS is because they've never worked with any other system. Those of us who have, shudder.
I will cite my example. I worked for many years in Australia, as an radiographer. I worked (as a backpacker) in a typical 'practice', which is to say on a local high street. I was directly employed by a group of radiologists (Xray doctors) who rented the buildings and equipment. The patients were all local GP referrals. Although the radiologists could have charged a 'gap fee' (the difference between what their NHS would remunerate per examination and what the market might bear) they didn't because they knew the patients would simply seek out the free or cheapest option.
Well, of the 12 'radiographers' who worked there, only TWO of us were actually properly qualified. Two. The rest had 3rd world qualifications. Genuinely! If you came to us, as a lay-person, you'd actually have no idea how suboptimal your imaging was. You'd have no idea how heavily irradiated you'd been as that 'radiographer' attempted to produce something diagnostic. OK, you say, the radiologists wouldn't accept such 3rd rate work. Yes they would because their report would say 'Imaging was obtained as requested, however, we recommend you patient should have an ultrasound/CT scan/MRI scan..' which we also provided, funnily enough. 'Please refer'. There's no way they'd waste any time or money on repeat imaging when there was $$ still to be made on more expensive imaging. Basic views commanded one fee, 'additional' and 'functional views' more. So guess what? Everyone got all 3 whatever their clinical history as that meant the radiologists could tick 3 boxes in their Medicare (NHS) claim. They formed one of the wealthiest professional groups in Australia as a result of rorting Medicare so summarily. The patient (you) meanwhile remained blissfully unaware of how you were being exploited -in fact, you were telling your mates how thorough they were. Because, naturally, you knew no better.
You say 'That couldn't happen here'... Well, ever wondered how qualified, to British standards, that Eastern European person who did your 'NHS sub-contracted' MRI scan in the back of a van is?? Quite. At my current NHS place of work, due to demand, some MRI scanning is sub-contracted. That private company are sent a bunch of request forms. They choose which they want to scan and send back to us the ones that might be tricky, or take a bit of time, for us to do. They get paid, not only per scan but per reject, too! THEN they have the temerity to send us many of their scans to re-report because the subcontracted South African did such a poor job!
In the NHS we have to meet dozens of standards, our qualifications have to verified and we have to show proof of continuing learning. Many eyes are upon us, all the time.
Watch how soon the private companies bidding for NHS work 'persuade' the government to allow them to drop the onerous and expensive task of hand-checking every worker, ensuring every worker is properly qualified to UK standards: watch how soon these companies are threatening the government with discrimination when a Congolese qualification is questioned as being equal to a UK university one. The government will capitulate because it cannot afford not to.
There are so many ways the NHS could save money now. But the idea that a semi-vegetative elderly person in the end-stages of their lives in the midst of a busy general ward could have the quality of their care 'driven upwards' by spending less money defies logic.