The privatisation of the NHS and the democratic deficit: the case for direct action
It is perhaps the greatest achievement of the British people in the 20th century. The National Health Service, the centrepiece of the post-war Welfare State, became the most cost-efficient and egalitarian system of public health care in the world. It was – and in large degree still is – a model of rational planning and collective provision.
The Tories have always hated the NHS. Its core activities are not-for-profit, so, from the perspective of the rich and the private corporations they represent, it is a wasted opportunity. It sets a bad example: it demonstrates the superiority of public ownership and collective endeavour in the service of human need. The Tories have therefore been out to destroy the NHS since Thatcher. And now they are close to succeeding.
For a quarter of a century, the political and corporate elite has been dismantling the NHS. This is not the place to discuss in detail how they have set about it. For those who do not understand what is happening – and they are many – I can recommend my friend and colleague Youssef El-Gingihy’s How to Dismantle the NHS in 10 Easy Steps (Zero Books).
How is it being done?
Youssef is a GP. He is one of a group of radical doctors who have come together with other health workers and health activists to form NHS Solidarity. They know the NHS is being destroyed. They understand how it is being done. The bullet-points are these:
- The creation of an internal market to create a purchaser-provider divide and to chop the NHS into saleable chunks
- The introduction of public-private partnerships (PPPs) and private finance initiatives (PFIs) to provide streams of public revenue to private corporations in the form of debt repayments
- The opening up of what is now called ‘the public health market’ to private providers
- The starving of the NHS of funds, the loading of it with PFI debt, and then the running of a media smear campaign against ‘failing hospitals’ to neutralise public opinion.
- The passing of the Health & Social Care Act in 2012 to introduce competitive tendering for NHS services by – three deadly words – ‘any qualified provider’
They know what they are doing. They being Britain’s political and corporate elite, part of an international class of super-rich who are hoovering up wealth in a highly dysfunctional, debt-based economy that is locked in permanent slump and hard-wired for austerity, privatisation, and speculation. A central mechanism of that economy is wholesale plundering of the commons: the sell-off of public wealth to private capital, with the exclusive purpose of enriching the already very rich at the expense of everyone else.
Take an example at random. Mark Britnell started out as an NHS manager, became a leading Department of Health bureaucrat, and then went on to work as a top executive for consultants KPMG, one of the global corporate vultures trying to buy chunks of the British ‘public health market’. This ‘revolving door’ is now the norm. The technocratic elite moves effortlessly between the political system, the public sector, and the private corporations. That is why it is correct to speak of a single ‘political and corporate elite’.
Here is Britnell on the intended fate of the NHS:
In future, the NHS will be a state insurance provider, not a state deliverer… The NHS will be shown no mercy, and the best time to take advantage of this will be in the next couple of years.
Who is doing it?
Leading Tories have been speaking for years about the NHS as ‘Britain’s biggest enterprise’. They have been bragging about their intention to open up the £100 billion a year NHS oyster to private profit. And they are perfectly clear that the end result will be a US-style private health insurance scheme, where the rich get first-class treatment, those who can afford it get reasonable treatment, and those who cannot get third-rate care in rundown, overcrowded, underfunded ‘public’ hospitals.
Not only do they know this; they already have a prototype under test. Experimental ‘personal health budgets’ are now being rolled out to 50,000 patients, and there are plans for the scheme to go nationwide very soon. In parallel, public health authorities – squeezed by cuts, debts, and Whitehall-imposed budget limits – are beginning to reduce or ration the services available from the local NHS.
They are now driving forwards the privatisation programme faster than ever, with 44 Sustainability and Transformation Plan ‘footprints’ from health authorities across the country delivered to NHS England in June. For sustainability, read ‘cuts’. For transformation, read ‘privatisation’. And Simon Stevens, the Privatiser-in-Chief who heads up NHS England, has made it absolutely clear that authorities that have failed to submit plans that are approved will lose funding.
All of this has happened – and is happening – with the full co-operation and support of New Labour. Blair’s enthusiasm for markets and sell-offs was equal to Thatcher’s. Alan Milburn, Labour Health Secretary under Blair, negotiated a ‘concordat’ with the Independent Healthcare Associations representing private health corporates. The Association’s lead negotiator, Tim Evans, was clear about the ultimate aim, looking forward ‘to a time when the NHS would simply be a kitemark attached to the institutions and activities of a system of purely private providers’.
To achieve this, the New Labour spivs knew the corporates would need a lot of help. As Milburn’s health advisor Paul Corrigan put it, ‘The state has to actively create a market; they don’t appear of their own account.’
Nothing has changed. Heidi Alexander, Labour’s shadow health minister, will be on the platform at a major conference to promote NHS privatisation – Health+Care 2016 at the Excel Centre on 29-30 June – alongside private health conglomerates. Presumably she thinks she is doing her job. Labour has no policy for halting NHS privatisation, let alone reversing it. Indeed, there is good deal of evidence to suggest that senior – even very senior – Labour politicians do not even understand what is actually happening. Maybe Heidi Alexander is one of them. Or maybe she knows perfectly well and is hoping for a job with KPMG if Labour loses the next election.
Why are they lying?
The lying and deceit, the contempt for democracy, the absence of any accountability with regard to health policy is staggering. No leading politician has made a speech explaining that the NHS is being privatised. No party has proclaimed this as an aim in its manifesto. No democratic mandate of any kind has been sought or obtained for what is being done.
The reason is obvious. To advocate the privatisation of the NHS would be political suicide. Polls suggest that 85% of the British people favour a publicly funded and provided health service free at the point of delivery.
So the political and corporate elite have no choice but to lie about what they are doing. They have now been lying about the NHS for a generation, and they have achieved remarkable success, in that the programme is well advanced, and we are close to a tipping-point, with little time left to save the NHS from the profiteers. The creeping privatisation of health provision in Britain is surely one of the most glaring examples of what has been dubbed ‘the democratic deficit’.
Why has it not been stopped?
Nothing has stopped the process. Despite countless exposés, meetings, and protests over the last 25 years, the demolition of the NHS in England has not been halted. Partly this is because so many people do not know what is happening. And that is because the politicians – and their media echo-chambers – are serial liars.
Once upon a time, the struggle to defend the NHS was spearheaded by industrial action. But the unions have been weakened by a generation of neoliberalism. There is a culture of fear in the workplaces – fear of speaking out, fear of answering back, fear of making a stand. Health workers know what is happening, and hate what they know, but they lack the strong workplace organisation that might once have stopped the privatisation programme.
Foundation hospitals can now earn 49% of their income treating private patients. That means exactly what you think it means: NHS beds are colonised by the rich and the waiting times get longer for the rest of us. Strong workplace unions could have stopped that: NHS workers could simply have refused to treat private patients. But that is not where we are.
What do we need to do?
Something deeply inspiring has happened. A group of ordinary health workers have come together to lead an all-out fight for the NHS. The group – NHS Solidarity – is appealing for support from all existing NHS campaigns, national and local, from all NHS workers, and from everyone who depends upon the NHS because they cannot afford private health insurance. The group, in short, is appealing for support from the whole of the 90% against the 1% and their hangers-on.
The intention is to engage in mass struggle. Not simply to register a protest, but to engage in mass disruption and direct action – to use the method of blockades, sit-downs, occupations, and strikes. Not simply to demonstrate, then, but to fight – in the manner of the Chartists, the Suffragettes, the Civil Rights Movement, the Miners’ Strike, and the Poll Tax Rebellion.
That we have a moral right to do this is beyond question. The profiteers are buying up our NHS, but we have not agreed to sell it. So this amounts to a conspiracy of the political and corporate elite to defraud and dispossess the common people of their collective wealth.
We, the people, created the NHS. A million of us work in it. A million of us use it every day. It belongs to all of us, and it works in the interests of all of us. We have a duty to defend it, for ourselves, especially for the poorest among us, and because it is the social inheritance of our children and the generations to come. So we must act now to stop the juggernaut of corporate greed before it destroys the NHS.
There should be no compromise. NHS Solidarity’s Charter has a simple message: the NHS should be fully renationalised, all public funding should henceforward be spent on public facilities, and all NHS workers should be directly employed on union negotiated terms. In other words, no privatisation, no outsourcing, no corporate profiteering.
But we should be under no illusions about the stakes and the challenge. The elite cannot concede on the NHS without endangering the entire neoliberal project. If the corporate takeover of the NHS is halted and reversed, every other scammy privatisation scheme for public services will be in question.
So any serious struggle to save the NHS will be long, hard, and bitter. It will be a class war between the rich and the rest; an elemental struggle between corporate power and public interest.
How can we win?
To have any chance, we will have to create a bushfire of resistance across the country that will involve hundreds of thousands in active struggle. The junior doctors have blazed a trail, mounting a succession of determined strikes, and are perhaps now set to reject the contracts sell-out negotiated by the BMA. If the contract is indeed thrown out, that front of the struggle for the NHS will remain open.
For we should be in no doubt: the junior doctors’ contract dispute is about the privatisation of the NHS. The Tories have made half a dozen U-turns on key policies over the last few months: but not over junior doctors’ contracts. The reason is simple. Private medicine is more expensive than public medicine – because of the waste of duplication and the creaming of profits. The main cost is wages. So to make chunks of the NHS attractive to the corporates, the Tories need to get the wage bill down. If they can screw the junior doctors, they will then go for the nurses, the care workers, the ancillaries. The contracts dispute is rooted in the privatisation programme. If the junior doctors vote against the sell-out, we have a major front still open.
Then there are the student nurses. They currently spend 50% of their time actually working in the NHS without pay. But the Tories plan to axe their bursaries and replace them with loans. Nursing courses will become fee-paying, leaving students with more than £50,000 of debt over a three-year degree. Most will never be able to pay this off. Student nurses will be performing unpaid labour for the NHS while piling up unsustainable levels of personal debt. The union-backed Bursary or Bust campaign, which has staged a serious of angry protests, is a second front.
The aim of NHS Solidarity is to open a third, one that everyone who works in the NHS, uses the NHS, or cares about the NHS can join.
By taking the campaign onto the streets, by engaging in deliberate mass direct action, the aim is to create a rupture, to break the consensus, to rouse the people to action, and to throw the political elite into crisis.
The intention at our first action is to stage a mass sit-down protest in the City during the evening rush-hour. This is where the big banks behind the private health consortia do business. This is the heartland of privatisation.
Our action is not intended to be a either a small stunt or a one-off event. We want thousands, and we plan to do it again and again, with more and more people. We want a peaceful protest and a carnival atmosphere. But this is about defiance and a drama of confrontation to expose the conspiracy of our rulers to privatise the NHS. It is an attempt to galvanise mass resistance to that process.
There will be safety in numbers, but no-one coming should feel pressured to do anything they do not wish to do. To come, to be there in support, to give moral backing to those in the front-line, that in itself will be a tremendous thing.
Can we trigger a mass movement to save the NHS? We must at least try. And we have no time to lose. Please share the NHS Solidarity Charter, affiliate your organisation to the campaign, publicise the protest, and join us on 14 July to help launch a campaign to stop the rich stealing the NHS from the people.
Neil Faulkner is active in Brick Lane Debates, a member of the NHS Solidarity Steering Committee, and the author of A Marxist History of the World.