Private firms are looking for opportunities to invest in the NHS. If this occurs, how do we ensure that the quality and safety of care received by patients?

Studies from the USA showed a 25% increase in adverse events after admission for a medical procedure in the three years after private equity investors took over compared with before and did fewer procedures among younger and treated fewer disadvantaged patients. This study looked at nearly 5 million episodes of which over 600,000 were provided by private equity companies. 

The Financial Times (August 2023) reported that private equity firms struck 150 deals for UK healthcare companies in the past two years, including some providing NHS services, such as eye surgery and diagnostics. 

A BMJ article (July 2023) found an increase in private equity ownership across all healthcare settings was “often associated with harmful impacts” on costs to patients as well as quality. 

As early as 2021, doctors were commenting and concerned about private firms when Operose Health (UK subsidiary of Centene, a multi-billion-dollar US corporation whose main business is health insurance) purchased 37 general practices in London across 49 sites. Others were less worried saying that many GP practices are privately owned. However, the small business model has one customer the NHS. General practitioners have the patients’ best interests, quality of care, and staff wellbeing as their main priorities. They do not have to return a profit for shareholders or investors. If they did there would be another priority to consider when deciding whether they could afford another nurse or whether to replace a clinician with a cheaper, but less expert healthcare professional.  

How does private equity work? The capital is provided by wealthy individuals who buy companies and then sell them on for profit. Private equity is not scrutinised by financial or public health regulators. 

The most concerns are related to quality of care but there are many others too. What about the cost of care when it is a publicly funded service, as this usually increases in private equity companies. The health outcomes can be poorer so is this a good use of public funds and what impact will it have on our general nation’s health. 

The benefits of the NHS include universal access based on need rather than ability to pay. It is cost-effective with economies of scale leading to less financial burden on the state. It has a focus on prevention promoting healthier populations and lower healthcare costs. 

However, we are faced with long waiting times for non-urgent services and demand is greater than resources. The bureaucracy can limit innovation and some efficiencies. The budget constraints since 2010 austerity have had an enormous impact on quality and delivery of service, research and innovation, staff wellbeing and retention.  

The difficulties highlighted will not be improved by private healthcare. The only advantages of private healthcare are choice, competition for patients (so visible quality to customers will be good e.g. environment) and reduced waiting times. There will always be inequality of access, based on those who can afford to pay, high costs, and a focus on profit. 

We need to consider this very carefully. Investors who see healthcare as a source of revenue and profit are going to run services in a different way to what me may desire. Policy makers in the UK have not appeared to be concerned about private equity investors owning our vital healthcare infrastructure.

There is also a concern about the security of our individual patient data, who may have access to this and what will it be used for. The NHS has enormous amounts of population data that is useful in research but if it goes outside of the NHS is it protected?

We also need to be aware that top-management have moved into the NHS and out to private sector health providers and then back into the NHS again, which may be good for their professional development, but we need to be mindful of their experiences and their motives (profit or quality of care).