I HAVE always been intrigued by the strong attachment the British have to the NHS. Maybe because I didn’t grow up here, I don’t quite share at same adoration and fondness.

But don’t get me wrong – I absolutely love it. The NHS is a remarkable thing to have, a necessary thing too. However, over time, that same sentiment started to grow. So whenever there is a conversation about the future of the NHS, it does feel very personal.

When I gave birth and relied on the NHS, I saw firsthand the dedication of the healthcare staff. They were stretched so thin, working tirelessly to provide care. Unfortunately, there simply weren’t enough of them, so I felt I didn’t receive the support I needed having a baby in pretty traumatic conditions. My birth experience, one of the most beautiful and intense moments of my life, is laced with painful memories of feeling unsupported and overlooked by a system struggling to meet demands.

In France, where my mum works as a nurse, I hear similar stories. Local hospitals struggle to find enough nurses to properly care for patients. Funding decisions made by successive governments have left hospitals in dire straits for more than two decades. The over-reliance on outsourcing may offer short-term relief, but it ultimately worsens the situation in the long run.

Outsourcing health and social care refers to transferring services – such as operations, in-patient care, or community services – to for-profit firms rather than having the public health service or local authorities provide them directly.

In French hospitals, both in rural areas and cities, there is a significant understaffing issue. To address this, interim nurses are often brought in. These nurses are typically better paid than full-time public hospital nurses, but they lack job security.

However, because hospitals everywhere desperately need staff and struggle with recruitment, interim nurses are in high demand and rarely out of work. They have the freedom to choose where they want to go, consequently making the system more unstable.

Consequently, hospital wards struggle more, spending more and more money, putting additional pressure on existing nurses and worsening their working conditions. This situation leads some nurses to consider becoming interim nurses themselves. It is a vicious circle with increased costs which delivers suboptimal outcomes.

As a response to this concern, a recent law enacted at the end of last year, championed by a conservative MP and supported by the French government, bans early-career health professionals from going directly into interim work without serving in the public sector first.

Across the political spectrum on the continent, there is a growing recognition that outsourcing isn’t a silver bullet to solve healthcare challenges. Countries such as Spain has even contemplated legislation to rein in private healthcare outsourcing.

However, in its characteristic manner of being slightly behind the curve, the UK has yet to reach a similar stage of realisation.

Labour’s shadow health secretary, Wes Streeting, has stirred controversy by expressing his willingness to “hold the door wide open” to private healthcare companies to support the NHS.

Despite facing criticism within his own party, Streeting stands firm in his position. He is unswayed by criticisms from what he views as “middle-class lefties” who oppose the idea of using the private sector to alleviate waiting lists.

Streeting insists on the importance of providing timely access to care for those in need, prioritising practical solutions over ideology. He says: “I don’t think I could look someone in the eye who’s waiting for months and months, sometimes over a year in pain and agony for treatment, and tell them that they should wait longer because my principles trump their timely access to care.”

It is difficult to disagree with that. We cannot and should not accept a system where individuals are forced to endure pain or delay necessary treatments due to delays and ever-expanding waiting lists.

The yearly Audit Scotland report on Scotland’s health service showed that the NHS was dealing with rising costs, patients had to wait longer to see doctors, and there weren’t enough staff available.

In parallel, private hospital admissions in Scotland are escalating rapidly, fuelled by a surge in people opting for privately funded treatments. Last year, approximately one in every 486 Scots underwent a self-funded or insurance-funded procedure in a private hospital, compared to one in every 275 in England.

It is no surprise that finding a solution is urgent. But it is important to realise that outsourcing isn’t a new solution, and we already know it’s not a long-term fix.

As governments deal with financial strains and an ageing population, there is a growing trend of outsourcing healthcare to private companies. This is because nobody is too keen on raising taxes to fund healthcare and a perception that governments cannot afford to invest more in the system.

Consequently, outsourcing is seen as a way to cut costs while theoretically maintaining the quality of care. However, in reality, outsourcing often doesn’t work as well as hoped.

According to Benjamin Goodair and Aaron Reeves from the University of Oxford: “Studies typically find that increases in for-profit outsourcing correspond with increases in mortality rates from treatable causes ... In fact, despite the hopes for privatisation as a root to discover efficiency gains, it turns out that outsourcing is actually damaging for population health.”

To clarify, it’s not that the private sector is inherently dangerous. Nevertheless, the poorer outcomes associated with it can be attributed to various factors, according to these academics.

For example, for-profit providers often have less training, worse working conditions, and fewer staff compared to public providers. These differences in approach to service provision likely contribute to the worse outcomes seen with for-profit providers.

Another thing to worry about is the ripple effect of outsourcing. It can put public hospitals in a tough spot when it comes to keeping up their usual standard of care. There is a chance the private sector will lure more staff away from public hospitals over time, because the pay is better.

That’s a significant shift already happening. In 2021/22, a whopping 38% of nurses who left their NHS registered nursing job but stayed in the workforce moved into roles in private hospitals, agencies, or charities.

This trend highlights the growing competition for healthcare professionals between the public and private sectors, which could further strain the resources and quality of care in public hospitals. Additionally, there’s a related concern that NHS clinicians may experience an increase in the proportion of complex and chronic cases compared to simpler, easier-to-treat problems that are more easily outsourced.

The ongoing crisis in the NHS doesn’t come out of the blue. It isn’t bad luck. It is absolutely linked to years of systematic underfunding during the tenure of consecutive Conservative governments, spanning a 14-year period.

Add to that the lack of a comprehensive social care policy, the impact of Brexit and the pandemic, inflation … and now health spending in England is set to undergo a significant 1.2% cut, equivalent to £2 billion, in the coming financial year, the largest cut in real terms since the 1970s. This is, as we say in French, the remedy that kills the patient.

What alarms me is that after 14 years in opposition, it appears that the future Labour government – unless, in a crazy turn of events, the Tories miraculously win the next General Election – lacks a sense of innovation or forward-thinking.

I am just not sure how applying the recipes of the past is going to deliver better results.

The externalisation of public services was brought in precisely because of the same issues we are facing now. What is it going to solve now that it didn’t solve before?