England's NHS is being steadily privatised as each year more and more patients are being treated in the private sector. Last year over 2 million NHS patients were treated by private companies, just short of 10% of all treatments - which is up from around 3% in 2011. Doctoral researcher Ben Goodair’s work evaluates whether this is impacting the quality of care and the health of patients.
“I think that privatisation in health and social care services is one of those societal trends which is steadily increasing year by year but, based on the evidence we have, probably shouldn't be. I want my work to detail this as clearly, accurately, and responsibly as possible.”
In an authored paper published in The Lancet alongside co-author Aaron Reeves (Professor of Sociology and Social Policy), the Oxford researchers explored the relationship between regional levels of NHS privatisation and the rates of people dying from curable causes.
“We wanted to understand if people living in areas with more healthcare privatisation had better or worse health outcomes as a result.”
The work found steady increases in the amounts that the NHS is spending on for-profit companies through analysis of data that showed over 11 billion pounds flowing from the NHS to for-profit private companies between 2013 and 2019. The research also found that privatisation corresponded with more people dying of treatable causes, calculating an estimate of 557 additional deaths that might be attributed to increases in privatisation between 2013 and 2019.
“The implications are that privatising the NHS is not corresponding with better quality care, and, starkly, that the inverse might be true.”
The paper, ‘Outsourcing health-care services to the private sector and treatable mortality rates in England, 2013–20: an observational study of NHS privatisation‘ was the source of a mass rally in parliament square in Spring 2023, the findings have been read out in the House of Lords, and made front page news upon release. The work also secured Ben the department’s 2023 annual Barnett Prize, which is awarded to doctoral researchers for the best papers across the academic year.
“I hope this research continues to be used, alongside similar research, by those in positions of power to determine whether healthcare services should be - or remain - nationalised and publicly owned. I also hope this research is part of a wider trend in academia which doubles down on scrutinising the outcomes of the privatisation of public services which is so common across the globe.”
Ben also researches the privatisation of children's social care services with DSPI’s Anders Bach-Mortensen (Senior Postdoctoral Researcher), which has found similarly negative impacts on the quality of services.
“When for-profit provision increases, the quality of care declines. There are competing theories as to why privatisation might result in worse quality healthcare. For my next work, I want to test which mechanisms are evident in England's NHS. Ultimately, I want to answer, 'why privatisation kills'.”
Ben began his doctoral research at DSPI in 2020, having previously spent time researching geographic inequalities in public services at the Bennett Institute for Public Policy at Cambridge University. Producing work which holds governments to account for the policies and decisions they make sits at the heart of what motivates his work.
“Social policy, to me, has three foundational positions which are fundamental to the discipline: 1) policies enacted by governments matter deeply for the lives of people subjected to them; 2) policies, and the process involved in creating them, are inherently political and should therefore be critically challenged; and 3) the issues which policies try to solve such as poverty, inequality, or poor health are structurally, not individually, reproduced.
Social policy then means starting from those foundations and working to identify the impact of policies, challenge policies' inherent politics and recommend structural not individualised solutions.”
Find out more about Ben’s research here.
