Framing Privatisation in the English National Health Service

Abstract

AbstractThe debate on privatisation is central to social policy, yet it tends to generate more heat than light as definitions and operationalisations of ‘privatisation’ are often implicit, unclear and conflicting. This paper aims to explore the extent of privatisation in the NHS over three periods of government through the lens of three approaches of Mixed Economy of Welfare, Wheels of Welfare and Publicness. All have two dimensions of provision and finance in common, but Mixed Economy of Welfare and Publicness stress the third dimension, that of regulation, while Wheels of Welfare stresses decision. All three approaches agree that some policies in the NHS constitute privatisation, but there is some disagreement largely stemming from their differential stress on regulation or decision. It is important to introduce a degree of transparency in the debate which provides clear definitions and rationales. However, all approaches require further development which focuses on the important but neglected point of how different types of privatisation lead to different impacts on patients.