Ever since Margaret Thatcher began to vandalise Britain’s public goods, her heirs and successors have loathed the NHS for three reasons. First, because it demonstrably gives the lie to their creed that the market always knows best. Secondly, because the British public love the freedom from the market that the NHS affords them in the case of their health. And, thirdly, because their “associates” lose mountains of cash due to the remaining barriers to the commodification of health services and data.
That these barriers to commodification are still standing is a feat largely attributable to the brave staff working in the NHS and the public’s passion for it. But decades of concerted assaults by privateers, under the political cover provided by the Major, Blair, Cameron and May governments, have left these defences rickety and full of holes through which the rats of privatisation manage to smuggle out increasing amounts of value extracted at the expense of public health.
For decades now, its sworn enemies have been proclaiming that “the NHS is safe with us” while portraying it as a black hole that no amount of public money can plug, and which only privateers can streamline. This is, of course, a lie the real purpose of which was always to pave the ground for privatisation-from-within. Their prize? Billions of pounds siphoned off from care and into the coffers of privateers, mostly US corporations who are now deeply embedded in what once was an integrated, publicly run service. And when the ill-effects of their lucrative mismanagement affect the public, (for example, with waiting lists), they divert blame to the same doctors and nurses whom their shenanigans starve of resources.
So far, privatisation has been justified as the necessary remedy for chronic underfunding of the health service. But underfunding was never only the problem – although the UK does spend less than other comparable nations. Waste of resources due to privatisation was. Put differently, privatisation within the NHS created the disease of underfunding it was meant to cure. The numbers don’t lie. In the 1980s, NHS administration costs accounted for just 4 per cent of the budget. By the mid-2000s, they ate up 14 per cent of a much larger budget.
It makes sense: the greater the penetration of privateers in any health system, the greater its inefficiency, as highly paid managers bring in more underlings from the private sector, pay themselves more, and facilitate the outsourcing to their private sector buddies of goods the NHS could provide internally more cheaply and collegially. When care is fully privatised, inefficiency and ill-health reach their zenith. The US, where private health reigns supreme, is the principal example: administration accounts for 36 per cent of the health budget and life expectancy lingers at levels lower than in several Indian prefectures or African states.
Today, the new excuse for wrecking what is left of the NHS is digitalisation, artificial intelligence and robotics. Privateers linked to Big Tech wait outside the NHS gates while their political mouthpieces in parliament and the media wax lyrical about a brave new NHS that the public sector cannot deliver. They envisage an NHS acting as a market where privateers provide “clients” with genomic sequencers to check their food, wearable technology to detect their cancer – and in which medical engineers replace doctors while robots take over nursing. “When that almighty crunch point comes,” Sherelle Jacobs wrote recently in the Daily Telegraph, “the creaky, tax-sucking public sector leviathan will be shown for what it is: a system that trapped the country in an insane hell of cyclical problems.”
Their dystopian manifesto is being implemented now. The government’s Health and Care Bill is its foundation. By breaking up the English NHS into 42 Integrated Care Systems, the bill is demolishing the barriers preventing, first, the complete monopolisation of NHS budgets by US insurance conglomerates, and second, the expropriation of the most valuable NHS asset: its data. Health corporations and Big Pharma will have free rein over the NHS budget while Big Tech (with Google and Amazon leading the pack) will realise its dream of adding incredible value to its apps by immersing itself in the reams of health data the NHS has amassed since the 1940s.
The time to stop them is now. As Boris Johnson continues to lull the public into complacency, and Keir Starmer continues to speak of the NHS “partnering with the private sector”, it falls to the British public to resist. This is why we have launched, along with doctors, academics, artists, journalists, unions and a range of dedicated civil society organisations, the national #yourNHSneedsYou! campaign.
Our aim is to stop the government’s bill and start the renationalisation of the NHS: the restoration of a market-free system delivering care as a right, not as a commodity, within a community of providers who extend public provision to social, dental and optician care, and to do so by using the latest in modern technology. We must also focus on public health measures that reduce the need for treatment without falling prey to Big Tech’s hunger for data extracted from patients in order to turn them into commodities.
There is another aspect of our #yourNHSneedsYou! campaign that progressives can draw comfort from. It emerged after we were gathered by DiEM25 to iron out differences in the context of a series of discussions that we labelled the “New Putney Debates”. Together, we recognised that, after Brexit, and in the face of further intensifying attacks on our public services and liberties, it is time to move beyond past differences and electoral considerations. Instead, as the #yourNHSneedsYou! campaign demonstrates, we decided to encourage our friends, members and supporters to work together towards common goals. Starting with the preservation of the NHS as a magnificent commons, we hope to show the way for a new form of progressive, collaborative politics in the UK and beyond – something we’re already seeing in some local authority “rainbow coalitions”.