The National Health Service is perhaps the greatest single achievement of the British people in the 20th century. Outstanding for both efficiency and fairness, it is unsurprising that it remains one of the most popular institutions in Britain.
A survey of 20,000 patients in eleven industrialised countries found that the NHS was almost the least costly healthcare system of them all, and, at the same time, offered among the highest levels of care. The survey further found that healthcare per head averages twice as much in the US as in the UK, and that one in three people in the US avoided seeking care because of the cost.[1]
Little wonder that a YouGov opinion poll revealed that 71% of British people were opposed to the privatisation of the NHS, and only 7% in favour.
As Colin Leys and Stewart Player explain in their 2011 study The Plot Against the NHS: ‘the NHS has not only worked well, providing high-quality, equal care for everyone, free of charge, at low cost: it is also the historic achievement of millions of people – those who fought to establish it, those who have spent their lives working for it, and everyone who has paid their taxes to build it up over the more than 60 years since it was created. Its founding principles of comprehensiveness and equal access for all have been core values of modern British society.’[2
The roots of Tory hostility
And that is one reason the Tories have always hated it. When the NHS was founded in 1948, 69% of the British people rated it a ‘good’ thing, and only 13% ‘bad’.[3] Yet the Tories in Parliament voted solidly against.[4] So popular did it become immediately thereafter, however, that continued open opposition would have been politically fatal. The Tories accepted the fait accompli for three decades – until the neoliberal counteroffensive against the welfare state began to gather momentum under Margaret Thatcher from the late 1970s onwards.
A paper prepared by the Central Policy Review Staff, a Tory government think tank, made some radical suggestions for cutting public spending in 1983. Student loans should replace grants, benefits should no longer rise in line with inflation, and the NHS was to be abolished and replaced by a system of private health insurance, with charges for doctors’ visits and higher prescription charges. Thatcher was in favour, but a majority of the cabinet regarded the proposals as too politically toxic at the time.[5] Now, of course, they think the time has come.
The Tories are not hostile to the NHS simply because they are rich enough to go private and therefore do not care about the service on which the rest of us depend. They are hostile because the NHS enshrines forms of social organisation that are inimical to the interests of the class they represent. Instead of profit and greed, instead of competition and the anarchy of the market, there is public service, rational planning, and full and equal access for all, at the moment of need, in a place nearby, regardless of ability to pay.
This contradiction – between overwhelming public support for the NHS and the festering antagonism towards it of the Tory rich – has now been providing the framework for debate about the NHS for 12 years. It is a contradiction that has been mediated by systematic and institutionalised lying.
The privatisation plot
What Leys and Player call ‘the plot’ to privatise the NHS was hatched in 2000 by Tony Blair’s New Labour government. That year the Independent Healthcare Association, representing private healthcare corporations, negotiated a ‘concordat’ with the Department of Health. Reflecting on this, Tim Evans, the Association’s lead negotiator, looked forward ‘to a time when the NHS would simply be a kitemark attached to the institutions and activities of purely private providers’.[6]
It was the beginning of a ten-year siege of the NHS, with a drip-drip of politically orchestrated media critique providing the cover for wholesale marketisation and outsourcing. Then, following the Con-Dem Coalition election victory in May 2010, a Trojan horse was constructed to bring the entire structure down: the Health and Social Care Act. The black heart of the Act is privatisation: the selling off of healthcare provision to profiteers. Because this is so deeply unpopular, every stage in the passage and implementation of the Act has been hedged about with a thicket of lies.
There is no reference to the Act or to the privatisation of the NHS in either the Tory or Lib-Dem 2010 election manifestos. When former Health Minister Andrew Lansley was challenged during the passage of the Bill, he assured Clinical Commissioning Groups that it was ‘absolutely not the case’ that they would be ‘forced to fragment services or put services out to tender’. Similarly, Health Minister Earl Howe said that ‘clinicians will be free to commission services in the way they consider best’ and that ‘they will be under no legal obligation to create new markets’.
Lying for their class
These statements were lies. New regulations are now being introduced concerning ‘procurement, patient choice, and competition’ – neoliberal code for privatisation. Government healthcare regulator Monitor will be required to compel health commissioners to open up virtually all services to competition, either through a process of competitive tendering, or through the exercise of ‘patient choice’ using a shopping list of services from the ‘Any Qualified Provider’ market.
‘There is no doubt that Monitor are preparing the ground for a competitive market,’ said Labour’s Philip Hunt, ‘and that we’re on a journey to competition, marketisation, and privatisation.’
This, of course, is a journey ordained not just by New Labour and the Con-Dem Coalition in Britain. It is also the policy of the EU. What radical economist Costas Lapavitsas calls ‘the holy trinity of austerity, liberalisation, and privatisation’ is now hard-wired by treaty into the workings of the entire European economy.[7] The welfare states constructed after the Second World War are being sacrificed as working people across the continent are driven by their rulers into a ‘race to the bottom’ with precarious workers in newly industrialising countries, and into funding a succession of monster bailouts designed to prop up the banks and the property portfolios of the super-rich.
The long-term objectives of the neoliberal counteroffensive which began in the late 1970s have, in other words, now fused with the short-term crisis management of the lords of finance-capital. The NHS is one of the potential casualties: it is being slowly ground into the disparate marketised fragments of a private healthcare system in which the rich will get premium service, the majority will be fleeced, and the poor will get nothing. The combination of £20 billion of scheduled cuts, of PFI schemes which turn healthcare funding into private profit, and the sinister hidden agenda behind the misnamed Health and Social Care Act will, if we do not act to stop it, destroy the NHS.
The defence of the service will involve confronting and defeating immensely powerful vested interests. More than a million people work in the NHS and more than a million use it every day. The annual budget is more than £100 billion. The sharks of corporate capital are already buying up great chunks of it, and, as the more honest of them admit, their intention is eventually to take the lot. If they do, access to care will be rationed by ability to pay. If they do, health care in Britain will be returned to the 1930s.
There are three great forces in modern British society: the state, the corporations, and the mass of working people. The state and the corporations are working in harness to destroy the NHS. We have to build great movement of ordinary people to defend it. To do that, we have to unite. Every health activist, every NHS campaign, every health workers’ union branch, everyone who cares about the NHS, needs to build the People’s Assembly on 22 June this year.
Notes
1. Colin Leys and Stewart Player, 2011, The Plot Against the NHS, Pontypool, Merlin, 10.
2. Leys and Player, ibid., 10.
3. Michael Foot, Aneurin Bevan, 1945-1960, St Albans, Granada, 192.
4. Foot, ibid., 189.
5. Hugo Young, 1990, One of Us, London, Pan, 300-301.
6. Leys and Player, ibid., 1.
7. Costas Lapavitsas et al, 2012, Crisis in the Eurozone, London, Verso, 180-181.
From the Coalition of Resistance site
