Dr Kamran Abbasi | This House Would Privatise The NHS | Cambridge Union

Thank you so much for inviting me to debate this very important matter. I'm so delighted. But first of all, I have two options here. I could just say I rest my case. I think the proposers have made the case for not privatizing the NHS better than we ever could, so thank you very much. We've certainly heard more sense from the students of Parkside College, and I want to congratulate you on your contributions today. Thank you very much for that, because you spoke from the heart and you spoke with sense, and that's what this is about. But I'm going to tackle a bit of the nonsense that I heard from the other side. I could be here for two days, but I've only got two minutes. You said, I quote, there is nothing evil about profits. I'll just let that hang. Your colleague, the advisor Steven Barkley, does not know that we already have a mixed healthcare system. 20% of the healthcare delivered in the UK is via the private sector already. And you said you wanted to pay junior doctors more money. I guess our colleague over there might be a junior doctor one day. My recollection is that your minister, probably advised by you, spent all of his time avoiding speaking to junior doctors about their pay claims. So that's the measure of the bill. And our friend from the US, I loved your talk. I'm a big fan of fiction. You're proud of the iPhone. Some people can't afford the iPhone. What about the child labor that's making the iPhones in India and China, the slave labor around the world that's making the profit for Apple? Have you ever heard of the commercial determinants of health? Look them up. They're in the BMJ. We publish on them on a weekly basis. Pardon? You have an iPhone? I do have an iPhone. But that isn't the point. That's provided by my company. The phone I buy for myself is the cheapest on the market. So I think you should look at the commercial determinants of health. No, no, look at the commercial determinants of health, which are very important. You talked about precision medicine; it's a hope we're all enthusiastic about. There's very little evidence to support its benefits at the moment. You talked about living 250 years, extending the lifespan. That's the one thing we have been unable to extend throughout all the technological and medical advancements of the past 500 years. We have been unable to do that. So I'm trying to understand where the evidence for your conversation came from, because this is all about values and evidence. I'm not going to really give you all of my speech because you've made it for me. I hope that everybody in this room, everything that you do in your careers—and we have some of the brightest minds in the country in this room, not just the students from Parkside but also the rest of you—that you will be guided by values and evidence, because that will make a better world. That's what gets me up every morning and motivates me to work. I hope you are the same. And the NHS was founded on principles of fairness, of a comprehensive service universally available based on clinical need, free at the point of need, funded through collective contributions otherwise known as general taxation. And this debate is not about a mixed model or where the NHS is failing; it's about whether or not we're moving from collective responsibility for everybody in the society or we move to a model where poor people pay and their health gets worse. That isn't what I want. And you admit that the US, the citadel of private healthcare, is in an absolute mess. The evidence supports that. Today the WHO, the UN—therefore all the countries in the world—are signed up to something called Universal Health Coverage. That is what we have in this country. That is prioritizing health and well-being. And there's growing evidence that if we prioritize health and well-being, those values lead to better prosperity and economic growth. If that's what turns you on, we should be supporting health and well-being. You've been told the NHS is not working, but I'll tell you something: if you look at health and well-being outcomes, 20 or 30% of those outcomes is all that the health service is responsible for. Other sectors are responsible for the rest: education, transport, housing, labor, the environment, food—everything else is what is overburdening the health service. We heard about Ara Darzi. In his review, he cited three shocks: one was the failed Lansley reforms which introduced competition, otherwise known as a nod towards privatization, into the health service. The other one was austerity, cutting funding in our health service. There are data that support it; it's factually correct. We increased funding less over the last 10 years than almost any other European nation. And the third was the pandemic, which was also mismanaged by the government. So the health service of course isn't functioning; it's underfunded and the other sectors are adding to the problems. Now, it isn't perfect. We all accept that. But switching to a privatization model is not the answer, because the evidence tells us—I'm just going to quote from two studies here. One is from The Lancet and the other is from something called PLOS Medicine. One is about low and middle-income countries, covering all the countries in the world. It's not one study; it's a systematic review of all the studies, and it found that the evidence from those countries does not support the claim that the private sector is more efficient, accountable, or medically effective than the public sector. I'll share these references with you; you can look at them, dissect them, analyze them. In The Lancet Public Health only a couple of months ago, a review concluded that focusing on the effects of outsourcing health services in high-income countries, i.e. privatizing them, means that by converting hospitals from public to private ownership status, they tend to make higher profits than public hospitals, but does not convert the intake of patients and reductions to staff. That doesn't mean you see less patients, doesn't mean you have more efficient staff. It also means that privatization corresponds with worse health outcomes for patients. So you don't get efficiency; you get worse health outcomes. That's evidence from high-income countries across Europe and North America. So privatization is not the answer. Look at Scandinavia; their system is funded through taxation. They have, as a block, the best outcomes, the highest prosperity, the happiest populations. That should be our model. That's the one we should aspire to. More generally, privatization does not work. Take the railways, take the water companies, the energy companies—all privatized in this country in the 1980s and 1990s, all now struggling and potentially being renationalized. The private sector in the UK has not been good for health. We've had a failed private finance initiative. We have had regulatory problems in private care. We have had the private sector failing to provide a comprehensive service. You told us about that: if you get seriously ill in the private sector, you have to go to an NHS hospital. When you need urgent care, you don't go to your private hospital; you go to the NHS. But we needed capacity during COVID. We paid private hospitals, but they gave us nothing back—they took the profits. When private interests in government got involved with the unseemly scramble for business around PPE and diagnostics during the pandemic, the government blew billions of public money, and some individuals grew ridiculously rich. So I want to say to you that we've had a lot of emotion and no evidence, and all the evidence that we have is against privatization. The values are the right values. I want to quote something that was written in the BMJ in 1948—I'm sorry, I'm about to conclude—by Anuerin Bevan, just before the NHS was founded. And this is what he wrote on July the 5th when the NHS began: 'There is no reason why the whole of the doctor-patient relationship should not be freed from what most of us feel should be irrelevant to it: the money factor. The picture I have always visualized is one of a nation deciding to make healthcare easier and more effective by pooling its resources, each sharing the cost as they can through regular taxation and otherwise while they are well, and each able to use the resulting resources if and when they are ill.' That is why we are today. That is why many of us are standing here, fit and well today. So this house says it would privatize the NHS; we should say no, no, no. Stand with us. Thank you.