WES 2025: Does private healthcare undermine or uplift the NHS?

There’s a near-universal consensus that the NHS is underperforming. The waiting list for consultant-led non-elected care is currently at roughly 7.5 million – far exceeding pre-pandemic levels. A&E and ambulance times have risen dramatically too. All of this has undermined public confidence in the NHS — only 28% of Britons believe it’s “providing a good service nationally”.

Enter the Labour Party. Having assumed power last July after battering the Tories at the polls, nursing the NHS back to health is not just a key priority but a political necessity for this government. Keir Starmer’s government have pledged that 92% of patients should wait no longer than 18 weeks for treatment by the end of this Parliament – up from the current 59%. To achieve that, they are leaning heavily on the private sector.

In a speech earlier this year, Starmer announced the government would embark on “a new agreement” with the private sector to increase NHS capacity. The Prime Minister suggested he was aiming to make “the spaces, the facilities and resources of private hospitals more readily available to the NHS”. More broadly, Starmer and Health Secretary Wes Streeting have heavily emphasised that bringing down waiting lists will require a partnership between the NHS and private healthcare providers.

What’s notable is how aggressively the government has characterised criticism of this approach. Last year, Streeting branded opponents of private healthcare as “middle-class lefties” that are prioritising ideological purity over improving patient outcomes. Starmer, during his speech, argued that efforts to improve the NHS must be “totally unburdened by dogma”. The implication of both statements is clear: greater partnership with the private sector will improve the NHS, and you’re an inflexible ideologue if you disagree.

All the panellists made nuanced, substantive critiques of private provision – albeit to varying degrees

Others might beg to differ. At WES 2025, I attended a panel discussion titled ‘Healthcare in Crisis: The Role of Nationalisation and Government in Pandemic Response’. Focusing on the relationship between the NHS and the private sector, all the panellists made nuanced, substantive critiques of private provision – albeit to varying degrees.

The panel reflected on what was arguably the NHS’s greatest challenge ever: the pandemic. Professor Nora Colton, the Director of the UCL Global Business School of Health, criticised contracts negotiated by the government with private providers during the pandemic. She noted that private firms were guaranteed taxpayer-funded compensation regardless of the volume of patients they treated, discouraging good performance.

David Rowland, Director of the Centre for Health and the Public Interest, echoed these concerns. He highlighted how NHS contracts with private providers incentivised them to treat fee-paying patients. Highlighting the case of hip operations specifically, he highlighted that ¼ of pandemic-era hip operations were paid for by patients. Rowland argued that this undermines the “basic principle” of the NHS: healthcare should be allocated on the basis of need, not ability to pay.

Private providers have played a long-standing role in the NHS, with the service being marked by “creeping privatisation and marketisation”. A classic example of this was private finance initiatives (PFI) – historically undertaken by both Conservative and Labour governments, where the financing, design, building, and maintaining of public infrastructure projects was undertaken by private firms. In the context of the NHS, PFI contracts generally involve private financing of new hospital buildings alongside services like cleaning and catering.

By “forgoing” some of their work in public healthcare to “fill their pockets” in private practice, NHS consultants may be aggravating labour shortages in the public sector

When queried by The Boar, Rowland noted that PFI was a “very interesting” case study about how the government interacts with private providers. Noting that he’d been studying PFI for the past 25 years, he argued that it was hard to negotiate the “perfect contract” that prevents the private sector from gaming the public sector. He also noted that governments “heavily reliant” on the private sector will be vulnerable to imbalances of power with private providers “once contracts are up and running”. Providers often wield this power in ways that drive up healthcare costs, such as by demanding additional public subsidies to complete projects. Rowland warned that, in general, naivety colours governments’ approach to private providers, providing them ample opportunities to “strip out millions and millions of pounds in profit”.

Besides concerns about value for money, Dr Rocco Friebel, an Associate Professor of Health Policy at LSE, cited the lack of transparency from private providers. He noted that they were generally unwilling to disclose information surrounding the quality of care being provided – what he described as a “black box”. To resolve this problem, he argued for “routine assessment” of providers by the government to ascertain just how well they are performing.

Whilst the panel was defined by broad consensus on a range of issues – there were areas of divergence too. One was whether private providers are ‘crowding out’ public healthcare provision, reducing the NHS’ capacity to treat patients. Professor Colton argued this was not the case. In fact, private provision has done the opposite, by carrying out elective surgeries the NHS would otherwise have had to provide. Dr Friebel argued the opposite. He highlighted that “the private sector draws on the same labour market as the public sector”. As such, by “forgoing” some of their work in public healthcare to “fill their pockets” in private practice, NHS consultants may be aggravating labour shortages in the public sector.

Professor Colton highlighted how private providers can add flexibility and dynamism to healthcare provision

None of this is to say the private sector should be playing no role in the health sector whatsoever. Professor Colton highlighted how private providers can add flexibility and dynamism to healthcare provision. Moreover, Katharina Hauck, Professor in Health Economics at Imperial College London, discussed the crucial role of public-private partnerships in vaccine development.

What is clear, however, is that the government must engage with private health provision more carefully than it currently is. Whether it be prodigious rent-seeking that drives up costs or a lack of transparency, there is a wide range of legitimate concerns about private healthcare. Labour, therefore, must proceed with caution. If Starmer and Streeting truly wish to proceed “totally unburdened by dogma”, they should treat criticisms of their approach with the respect they deserve rather than with derision.