Labour Affairs

(The image above shows an ad for the privatisation of British Gas in 1986)

We can look at the question of the NHS through historical trends.

Since Thatcher, trends have taken three directions.

One towards a small state and a greater part played by the private sector.

The second is the principle that goods should be produced where they are cheapest.

The third, which goes with the first two, is the promotion of individualist ideology: what matters first is the individual, not the common good.

The second is perhaps the most crucial: deindustrialisation and reliance on services, especially financial services, to sustain the British economy. Other services became staffed by immigrants, again for cheapness.

The first led to privatisations of gas and electricity, water, transport, steel, post office and telecommunication, ports and airports etc. 

Local Authority Housing has shrunk massively with Right to Buy and no money for building.

Education and Health have not been privatised in the same way; in education non local authority schools (academies) have appeared, bought by private entities and running on state money, but non profit making. The status of teachers has shrunk at the same time, leading to poor retention of staff.

The health system was split into an internal market in 1989 (The Working for Patients Act) with two parts; a buying service (commissioning) part and a service part. The commissioning part could increase the share of private services they bought, again with the state providing the income stream. In 2012 the Minister for Health was relieved of final responsibility for providing services, the state symbolically washing its hands of the Health Service.

The status of doctors shrunk at the same time, leading to poor retention and worsening conditions due to understaffed shifts.  

The third element. What better illustration of the individualist ideology than the name of the 1989 Act “Working for Patients”. The implication was that the original NHS was not working for patients:  the state is a bad thing, anything run by the state is badly run. Since then, changes have been presented as good for patients in terms of greater choice and more personal treatment.

The other element in the NHS picture is the increase in population, increased longevity, better technology meaning more ways to keep people living longer, so more work for the NHS.

The NHS can’t completely cope with the demands: 7m people are on a waiting list, of which 3 for more than a year (round figures).  This September 2023 saw a joint strike by junior doctors and consultants, following on from unheard of strikes by nurses.

What to do?

The population is opposed to privatisations: polls show a majority clearly in favouring of bringing back water, energy and railways back under public ownership, even among Tories.

This is the way forward; once these are back in public ownership, the rest will follow. Opinion will change back towards the common good. 

The financial angle

Every aspect of what was previously delivered as a state funded public service has been remoulded over the past 40 years in a way that was deliberately designed to ingrain them with, and provide opportunities for, free enterprise and the financial service industry in Britain. 

The public utility privatisation programmes were the first and most obvious examples, then the public housing stock and the NHS. The utility privatisations and Right to Buy housing schemes directly involved the financial industry (through loans and mortgage provision) but the NHS, as a service in the purer sense of the word – i.e., its purpose is not related to a physical transferable tradable commodity – will inevitably display that feature in a more opaque way. 

Thus, we see the manner in which things like social care have been reconfigured to offer “more individual choice” through grants and subsidies that the individual recipient can spend as they see fit. Whereas in the past there was a district nurse or a care visitor directly employed by the local NHS whose responsibilities included visiting people in their own home, that service is now in many cases either done by a contracted out company which the recipient can either use the subsidy for or just pocket the cash and use it as they wish. Similarly, people requiring accommodation in care homes can enter a local council care home if they are lucky or if not are forced to avail of private care homes. In both cases they end up using part or all of their income and assets to pay for such care, which ultimately could include their own homes should they be lucky enough to own one. 

In those many instances where that home was previously a council home purchased under the Right to Buy schemes or where the profits from that scheme were later used by the ex-tenant to move up the property ladder we have the farcical situation where the Right to Buy scheme ends up ultimately financing the care facilities of the ex-tenant which may or may not be provided by a public health provider but in many cases may more likely be a private enterprise one.

 Then to complete the circle of interdependence we have the pension funds and the way in which they are now intrinsically tied in with the finance and insurance industry, the property industry and the pharmaceutical industry. 

Pension funds invest in anything that can yield a profit, so that they own or part own care homes and private medical provision (laboratories, some hospitals) or to put it another way, the financial services are the source of the prosperity of this country, the “means of production, distribution and exchange” of yore. 

The challenge that this poses is the one which we all struggle to solve but the solution, even allowing that there may be one, is that it cannot be effective unless this inter-connectability is acknowledged as part of the problem.