Jeremy Laurance: What the Government has really done for the NHS

Are you among those who accuse the Labour Government of betraying the NHS's founding principles by promoting privatisation of the service? If so, consider this...

Two major changes have happened to the nation's doctors over the last decade: they have become significantly better paid and more of them are women. These trends have combined to produce a curious and unexpected result: a decline in private medicine.

Doctors who do private practice in their spare time make, on average, £50,000 on top of NHS incomes of £100,000-plus. Nice work if you can get it. Of course, many earn a lot less than 50k and a few earn a lot more. But why would they turn down the opportunity?

It may be precisely because they are significantly better paid for their NHS work that they feel under less financial pressure to moonlight in Harley Street (or local equivalent). That is Derek Machin's view, the veteran chairman of the British Medical Association's private practice committee. Only 30 per cent of young consultants (within five years of appointment) are entering private practice compared with 70 per cent of their older peers, according to a survey carried out by the committee.

If confirmed, this is a remarkable finding. Consultants who don't go into private practice early tend not to do it at all, according to Dr Machin. Moreover, women now account for two thirds of medical students and they are expected to be less keen on juggling private patients with their domestic commitments as they rise through the ranks.

If Dr Machin is right, this could cement support for the NHS by making the nation's doctors more dependent on it. It could also reduce the private sector to providing, in addition to its time-honoured five-star service for the wealthy, an occasional escape route for the middle classes when dissatisfied with what the state offers. That is the social function that it performs best – as the grit in the oyster that keeps NHS performance up to the mark.

Labour has been roundly criticised for wasting the NHS's extra billions on over-generous pay awards to doctors. But if the net effect is to anchor them more securely to it, thereby protecting its future, it could be money well spent.

Duncan Williams had a different line in private medicine. A miracle cure he had developed with his wife would, when injected, dissolve fat as effectively as liposuction. Or so he claimed. Marketed as the "flabjab", it was made from crushed soya beans and cost £250 a time.

Last week Williams, 53, was fined £5,000 at the Old Bailey for selling an unlicensed medicinal product. But the shocking bit was what came next. He was ordered to pay back £800,000. That is an awful lot of duped patients.

That is the trouble with private medicine – all it takes to succeed (with apologies to Nick Tomalin) is a plausible manner, a little scientific ability and rat-like cunni