On the south London streets around King's College Hospital, the truth stares you in the face. There, ambulances fill the parking bays, waiting for the call to action. But these are not the ambulances we'd expect from our nationalised health system; the vanity of their private operators ensures we know that. Because emblazoned on so many of the more idle vehicles are logos proclaiming the identities of their owners.

In London alone, NHS spending on private ambulances ballooned from £700,000 in 2011 to £10 million five years later - expenditure in 2015 touched the £12 million mark. Yet London isn't even the biggest spender; the South Central Ambulance Service, which covers the home counties, has long led the country in buying private patient transport, splashing out £13.6 million in 2015/16 on private ambulances to respond to emergencies. Nationwide, the NHS is splashing out more than £68million a year for private ambulances to answer 999 calls - a three-fold increase in just four years.

Private Ambulances fill the streets around King's College Hospital, London

Perversely, the main cause of this reliance on the private sector is a lack of investment in the Health Service itself. This has left NHS Trusts unable to make the necessary capital expenditure for new vehicles and training, which means they've had to resort to the cheaper short-term option of bringing in private contractors. Yet as we've seen with previous such schemes (think PFI/PPP), cheaper upfront costs mean much greater expense in the medium to long term. And as with those private finance initiatives, these extra costs will be used as proof that a nationalised health service is too expensive, and will lead to the kind of fee payer/insurance system which Mr Hunt so vehemently denies is his aim.

But cost is not the only problem. Up to March of this year, the Care Quality Commission (CQC) had carried out 70 inspections on independent ambulance companies, covering around one fifth of all those registered. The CQC "identified common concerns around poor medicines management, cleanliness and infection control practices and a lack of appropriate recruitment checks." Having so far published 39 reports on 33 of these companies, more than half have been ordered to improve and two have had contracts cancelled. The Times [paywall] reported that "the watchdog has taken the unusual step of writing to all 260 registered ambulance providers warning them about fundamental standards."

One of the worst offenders is a company called Coperforma. Having undercut the South East Coast Ambulance Service (SECAmb) to win the tender for transporting patients in the county of Sussex, they soon found themselves out of their depth. Less than a week after taking over in April 2016 they were already seeking to shift the blame, at the same time as apologising for delays in transfers. These 'delays' meant cancer patients missed oncology appointments; patients with kidney failure missed two or three dialysis sessions in a week; patients, relatives and NHS staff had to wait the best part of an hour to get through to the firm's phone lines; and Coperforma ambulances even turned up to collect patients who were already dead.

By the middle of April 2016 Coperforma's drivers were speaking to the local press, saying "Coperforma are a total shower. They're out of their depth. I think it's because they've never moved patients in these quantities anywhere before." Another driver was quoted as saying "When I was a SECAmb driver we would transport 18 patients a day, now it's four or five. Yesterday we only did two."

The company at least had the good sense to step down from the contract just 7 months later, when those serial privatisers the South Central Ambulance Service were asked to step in and take over operations until a more permanent solution could be found. That transition took another six months and further upheavals.

And yet this situation is hardly unprecedented. In 2013 the bus company Arriva transport, a wholly owned subsidiary of the German state-owned rail company DB, undercut the North West Ambulance Service to the tune of £3.5million to win the rights to run ambulances in Greater Manchester. Having left thousands of patients waiting for hours, they received over 400 complaints in their first six months of operations. Local (Labour) MPs had been against the deal from the start, and by the start of new tendering in 2015 Arriva didn't even bother competing; the company was threatened with legal action by the Serious Fraud Office for misreporting their performance in order to gain £1.5 million in bonuses from the state. They did eventually return this money, but only after the North West Ambulance Service had paid them more an average of £1.4 million per month. Arriva continue to provide ambulances in the Midlands and elsewhere.

However, around the streets of King's College Hospital, another operator dominates. Medical Services Ltd, with its blue Star of Life and winged caduceus logo, is inconspicuous by design. With no fanfare, it has become Britain's largest provider of private ambulance services. Although the company only really sprang to life with the breakup of courier company Lewis Day plc in 2010/11, Medical Services' first year of trading saw a turnover of £12 million and profits of £84,000. By 2013 turnover was up to £32 million, returning post-tax profits of £1.3million. That's when the Danish emergency service company Falck took over. Falck A/S was what was left of Group 4 Falck after their 2004 merger with Securicor created G4S. By the end of 2016, Falck were operating more than 2,500 ambulances in 22 countries, generating a global turnover of DKK 6,528 million (£750million) from transporting patients.

Yet their entrance in to the British market through Medical Services has not been an easy one. Last year, Medical Services Ltd made a loss of £9.4million on a turnover of £33million. This is even worse than their 2015 performance, when they lost just under £9 million on revenues of £36 million, having received net tax rebates of £1.9 million that year. By 2016 Her Majesty's Revenue and Customs returned just £157,000 net.

While it could be a Starbucks-style tax avoidance trick, Falck blames these losses on "the infrastructure established and prices obtained not [being] enough to handle the significant new contracts won shortly before Falck took control of the company." Whatever the truth, it is telling that even a company as established as Falck is having difficulties in this new competitive 'marketplace' in National Health Service provision.

Why the United Kingdom is embarking on this race to the bottom is manifold. Part of it must be that continual Tory effort to break the Unions - paramedics and other related workers are forced to agree to new contracts when their employer is changed beneath them. Part of it is also the Orwellian sheep mentality of neoliberalism, whose advocates bleat 'private good, public bad'. But mostly, surely, it is part of the pernicious truth that Jeremy Hunt is doing his best to hide - that our beloved National Health Service is being stolen away from us one chunk at a time.

Adam R. Mathews,
London, August 2017