Forty years of failure – Private sector contracting and its impact on the NHS, by Dr John Lister, offers a scathing critique of the NHS’s privatisation experiments. Each chapter peels back layers of policy missteps and their consequences.
The report begins in the Thatcher era, when ideology-led policy dominated and outsourcing was sold as a panacea for public sector inefficiency. Hospital cleaning, catering, and portering were handed to private contractors—often with disastrous consequences for standards and staff. These early decisions laid the foundations for decades of fragmentation.
Lister charts the development of increasingly wild experiments with markets and outsourcing throughout the Lansley era and how, after multiple failures, these policies were partially abandoned.
With the current government now flirting with some of the flawed ideas of competition and outsourcing, Lister offers up a wealth of evidence from the last four decades that should stand as a strong warning to today’s policy makers.
Outsourcing sought to reduce costs, but it also cut into the morale of the NHS workforce. Staff transferred to private providers faced poorer pay, worse conditions, and chronic insecurity. The result was predictable: falling retention, rising sickness, and losing decades of institutional knowledge.
Full article in The Lowdown, 4 April 2025
