Privitisation is difficult to define. Our railway system is privitised, yet receives a certain amount of public funding. Our roads are public, but almost all the work done on them is delivered by private contractors. So it's not who delivers the services that makes it public or private, but who commissions the services and whether the service user has to pay up front or not.
With prescription, opticians' and dental charges the NHS can no longer be said to be free at the point of delivery. With private businesses (GP practices) instead of publicly owned primary care trusts doing the commissioning, the fundng can no longer be said to be under public control. Which makes the NHS under reforms more akin to the rail system, where service users pay some up-front fees and the state provides a subsidy to the private operators, than to the road system, where although the providers are mainly private, the commissioning is done by national and local government organisations and the service user pays through taxation, not up-front fees.
Those in favour of the reforms will cry foul at this point, pointing out that the GP commissioning consortia won't have complete free reign but will be accountable to the central NHS Commissioning Board, and providers of NHS services will be accountable to the regulator, Monitor. However, that's no different to the train operating companies being accountable to the Office of the Rail Regulator. The only real difference between the two systems is that the trains are privately owned whereas some, but not all by any means, of the hospitals and other clinical buildings are publicly owned. The owner of the title deeds doesn't really matter to the service user; what makes the difference is how the service runs operationally, and who calls the shots. Under the proposed reforms, the organisations choosing what services are available and being given the cash to spend on them will be private businesses. It is privitisation in everything but name.
