Since the 1980s, our world-class and value-for-money public NHS has been fragmented at enormous cost into a jigsaw puzzle of businesses and quangos. We now have less than half the beds we had when ‘reforms’ started; many fewer hospitals, A&Es and GPs; a massive shortage of doctors and nurses; and a much larger population.
The picture doesn’t make sense, until you realise that some of the pieces are missing. While in government, the Conservatives, Liberal Democrats and New Labour brought privatisers into NHS England, who diverted a large portion of the budget (paid for with our hard-earned taxes!) away from care and into the pockets of managers and corporations. They installed American private health insurers in the NHS ready for the Health and Care Act 2022 to switch us to an increasingly privately provided, American-style ‘managed care’ system. How was this allowed to happen, and why is renationalisation the only way to save our NHS?
The Story of NHS Privatisation… made simple
Before the Second World War, doctors’ fees were out of most people’s reach. Few could afford treatment, so a serious diagnosis was often a death sentence. Grandparents who fell ill would sometimes take their own life so as not to become a financial burden on their loved ones. Parents would stand by helplessly as their children died from treatable illnesses.
The war made life even harder but there was a silver lining; it built a strong sense of community and service to others. In 1945, people voted overwhelmingly for Clement Attlee’s Labour government to set up a welfare state and a universal healthcare system funded by the taxpayer, free at the point of delivery and provided as a public service. Everyone would receive the same high quality of care and the whole society would share the cost. In 1948 the NHS was born, and the profit-motive was banished from healthcare! Doctors could now make decisions based on a patient’s health needs alone. Families were finally free from crippling medical bills and heart-breaking, unnecessary loss.
Caring was the beating heart of the NHS, but it was also the most efficient system in the world. Senior doctors ran medical departments often with only a manager and secretary in support. Matrons ran the wards. In the 1980s, admin costs were just 4% of the total NHS budget. No wonder everyone fell in love with the NHS!
Well, everyone apart from the businessmen who had once made fortunes selling medicines and treatments to anyone who could scrape enough pennies together. And the banks who see healthcare as a goldmine. And the politicians who represent Big Business. This powerful clique was itching to get their hands on the NHS. In the early 1980s, the Conservative government under Margaret Thatcher began chipping away at the edges, privatising the bits they thought we wouldn’t notice, like NHS kitchens, porters and cleaners. With cleaning no longer under matron’s control, standards dropped, eventually leading to more hospital-caught infections. The Conservatives also cut back on free NHS optician and dental care, and brought in new charges.
In 1988, privatisation expert Oliver Letwin and Conservative MP John Redwood wrote a manual on how to turn the NHS into Britain’s Biggest Enterprise by gradually and stealthily turning it into a private health insurance system. Thatcher’s government began implementing the plan, setting up an artificial market in the NHS, in which GP surgeries became purchasers and hospitals became providers competing to sell their services. Under John Major, the Conservatives put the next steps in place. Letwin soon became a Conservative MP, advising on the privatisation behind the scenes for the next two decades.
Had doctors got wind of the plot, many would have opposed it. Taking the cash out of care had allowed them to practise truly ethical medicine based on patients’ needs, with no financial conflict of interest. Public health experts tell us that to weaken the influence of doctors, the Thatcher and Major governments hired an army of managers at huge expense to control how NHS care was delivered. From here on, it was drummed into doctors that running the NHS, which they had always done, was a job for non-medical experts. It was extremely difficult and doctors simply didn’t have the right skills — or so they were told!
Thatcher’s government began reducing access to medical care by merging or closing hospitals and A&Es, and massively cutting beds and medical staff. They came up with the idea of private loans at extortionate rates of interest (PFIs), instead of using the normal and much cheaper public option of government borrowing. Major continued the policy.
Despite promising to reverse NHS privatisation, Tony Blair’s government got into bed with Big Business. In the 2000s, New Labour used PFIs to borrow over £11 billion, saddling the NHS and, by extension, the public with debts of £88 billion during a decade of very low inflation. That’s right, PFIs meant that the NHS would have to pay back 8 times the amount it had borrowed, yet the public won’t even own the hospitals once the loan is repaid! PFIs made bankers rich, while threatening to bankrupt the NHS.
Money was being wasted in other ways too. By the mid-2000s, estimates showed that the NHS market had pushed up admin costs from 4% to 14% of the budget. Costs have continued to rise steeply. In the privatised US system that we’re heading towards, admin costs are 36% of the budget. This means that over £10 billion each year is being diverted away from care to move us over to the American system.
New Labour also hired US corporations like McKinsey and UnitedHealth to advise on how to run the NHS along profit-making American lines. Blair’s government paid private companies to carry out operations and procedures at a higher cost than the same care on the NHS. Managers imposed business-style ‘performance targets’, which put a big strain on staff. Doctors and nurses who didn’t meet the targets faced intimidation by bureaucrats. Some dedicated medical staff were forced out of the NHS.
Behind the scenes, McKinsey co-wrote the Conservative/Liberal Democrat coalition’s 2012 health law, which abolished the government’s legal duty to provide healthcare. The coalition, and later May’s Conservative government, went on to sell off swathes of NHS land and buildings to the private sector. David Cameron & Nick Clegg’s coalition created a new quango: NHS England. In 2014, they put Simon Stevens in charge. The same Simon Stevens who had previously worked for ten years as CEO of the Global Health Division of UnitedHealth: America’s largest private health insurer.
With Stevens at the helm, privatisation has gone into overdrive. All over England, Stevens has overseen the introduction of software, staff and business practices from his old boss UnitedHealth. Its UK subsidiary Optum has been paid £millions to train NHS and local council leaders in US ‘managed care’, the system exposed by Michael Moore in his film Sicko. GP surgeries and hospitals have been shut down, employing fewer and less qualified staff. Experts warn that this is designed to push down the wage bill to make the NHS more profitable for corporate take-over. Unfortunately, most health unions have done little to oppose the privatisation. Ongoing cuts are further reducing patient safety. And now, Big Data are poised to swoop in and buy our private medical records.
The English NHS is increasingly unable to give patients all the care they need, as so much of the budget is being wasted. In addition to the cost of the market bureaucracy, in 2020 the NHS paid almost £10 billion on outsourcing care to private companies, and £billions more on PFI debts. Yet we have many fewer hospital beds and 25% fewer mental health beds than in 2010. It’s not only a lack of money, but how money is spent that is so damaging to the NHS. Several NHS staff have spoken out about threats to patient safety caused by cuts and re-structuring. They’ve been crushed in costly court cases and left bankrupt, losing their careers and sometimes their homes. The public have been left to foot the legal bill.
The American model of privately provided care is not just extremely expensive, it is also plagued by malpractice, fraud, and fines. It has far worse health outcomes, with medical error in the top three most common causes of death. It costs more than double the price of care per person than in the UK, yet patients have less access to highly qualified medical staff. It is rife with down-skilling and cost-cutting to boost profits; has eye-wateringly expensive drugs; routinely sells wealthy patients operations they don’t need; leaves millions of poorer patients with no access to treatment and is the Number One cause of personal bankruptcy. What’s not to like?
Samantha Jones, the former CEO of the UK arm of American health insurance corporation, Centene, was ‘expert adviser for NHS transformation’ to Boris Johnson’s government. The Conservative’s Health and Care Act is one of the last pieces of the privatisation puzzle. It breaks the English NHS into 42 easy-to-manage chunks. Initially called Accountable Care Organisations (ACOs) like their American counterparts (which was a bit of a give-away!) they were quickly renamed Integrated Care Systems or ICSs. Health policy experts warn that ICS boards will operate like commercial entities.
Like all UK health law since 1990, the direction of travel of the Act is towards an American insurance industry take-over of the NHS. It gives private corporations a bigger than ever stake in the NHS. And, as happens in the US Kaiser Permanente ‘managed care’ model on which NHS privatisation is based, the more they cut and deny care, the bigger the profits they’ll make.
If the two-tier American system is imposed on England, standards will take a nose-dive. People who can afford it will (understandably) get scared and take out costly private health insurance for privately provided care, not realising that three quarters of people bankrupted by healthcare in the USA had health insurance. Those who can’t afford health insurance will be left with a run-down, privately provided, skeleton NHS funded by taxation—the same failing system operating in the USA. Of course, until the last piece is in place and the 40-year demolition of England’s NHS is done and dusted, smooth-talking politicians will keep repeating that worn-out old lie, “The NHS is safe in our hands!”
And this is how the story will end, unless you and I and all of us take a stand and write a different ending. We must build a movement for the complete renationalisation of the NHS to restore it to its former glory. This means bringing back a publicly funded and publicly run, universal service, managed by medical staff who deliver high quality care to all. To do so, we need to reverse four decades of health and care law; kick out private providers; cancel PFI debt; bring back social, dental and optician care; and get rid of the hugely wasteful internal market and the highly paid bureaucrats who run it.
Put simply, renationalisation means handing the NHS back to the nation.