Since the 1980s, our NHS has undergone draconian cuts and ‘reforms’. We now have less than half the beds, many fewer hospitals and A&Es, a massive shortage of doctors and nurses, and a much larger population. This picture is puzzling because key pieces are missing. In government, the Conservatives, Liberal Democrats and New Labour brought privatisers into the NHS to divert a huge portion of the budget (from our hard-earned taxes) away from care and into the pockets of managers, accountants, business consultants and private health providers. UK and US private health insurers were installed in the English NHS ready for the Health and Care Act 2022 to switch us to American-style ‘managed care’. How was this allowed to happen? To cut a long story short…
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 family. 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, solidarity 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. Envisioned by Socialist Nye Bevan, it was to be 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 between 3.5 and 5% of the total NHS budget. No wonder everyone fell in love with the service!
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 of the NHS, privatising the bits they thought we wouldn’t notice, like kitchens, porters and cleaners. With cleaning no longer under matron’s control, standards dropped, eventually leading to more hospital-caught infections. Thatcher 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 published a manual on how to turn the NHS into Britain’s Biggest Enterprise, by gradually, stealthily and almost imperceptibly re-purposing 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. Conservative PM John Major 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. So, to weaken the influence of doctors, public health experts tell us that 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 had begun reducing access to medical care by merging or closing hospitals and A&Es, and massively cutting numbers of beds and medical staff. Instead of using the normal and much cheaper public option of government borrowing, she had started taking out private loans (PFIs) at extortionate rates of interest to fund NHS infrastructure. Major continued this policy.
Breaking his election promise to reverse NHS privatisation, Tony Blair continued using extortionate private loans. In the 2000s, New Labour used PFIs to borrow over £12 billion, saddling the NHS (which means us) with debts of over £80 billion during a decade of very low inflation. With PFIs, the NHS must pay back almost 7 times the amount borrowed, yet the public won’t even own the hospitals once the loans are repaid! PFIs make private banks rich, while bankrupting parts of the NHS.
New Labour hired US corporation McKinsey and US private health insurer UnitedHealth to advise on how to run the NHS along profit-making American lines. Blair’s government was the first to hire private companies to carry out NHS treatments, paying up to 40% more than for the same care on the NHS. New Labour also privatised many community health services in England. In just 7 years, NHS spending on private community health doubled from 15% to over 30%.
Money was being wasted in other ways too. From the early 1990s to the mid-2000s, estimates show that Thatcher‘s NHS market had pushed up admin costs from 4% to 14% of the budget. Costs have continued to rise steeply. In the privately-provided American system that we’re heading towards, admin costs are 36% of the budget!
Under Blair, admin staff began imposing business-style ‘performance targets’ on the NHS, which put arbitrary pressure on dedicated doctors and nurses. Those who didn’t meet their targets faced intimidation and were forced out of the NHS by management.
McKinsey was also hired by the Conservative/LibDem Coalition to co-write its 2012 health law, which abolished the government’s legal duty to provide healthcare. The coalition (and, later, Theresa May’s Conservative government), went on to sell off swathes of NHS land and buildings to the private sector at knock-down prices. David Cameron & Nick Clegg’s Coalition then created NHS England and, in 2014, 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 arm, Optum, has been paid £millions to train NHS and local council leaders in American ‘managed care’, the system exposed by Michael Moore in his film ‘Sicko’.
Many GP surgeries and hospitals have been shut down, employing fewer and less qualified staff. ‘Physician Associates’ with only two years training are replacing doctors with seven-year qualifications! Experts warn that this is designed to push down the wage bill to make the NHS more profitable for corporate take-over. Most health unions have done little to oppose the privatisation, suggesting that NHS privatisers have been put in charge of unions. UnitedHealth and American spy-tech firm Palantir have swooped in and bought up the Patient Access website and our confidential medical records!
Damaging cuts have further reducing patient safety, and the NHS is increasingly unable to give patients the care they need as much of its budget is being squandered. In addition to the cost of the market bureaucracy, in the year 2020 alone the NHS paid almost £10 billion on outsourcing care to private companies, and £billions more on repaying PFI debts. Yet we have thousands 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. The NHS staff who have spoken out about threats to patient safety caused by cuts and re-structuring have been crushed in costly court cases and left bankrupt, losing their careers and sometimes their homes, while the public foot the legal bill. When the pandemic hit, waiting lists for treatment were already at the then all-time high of 4.6 million. The Conservatives could have invested in more beds to treat the 10% increase in hospital patients with Covid 19. Instead, Boris Johnson‘s government shrank NHS capacity by 8%, creating a further 18% shortage of beds and contributing to 100,000 needless deaths.
Johnson made Samantha Jones (the former CEO of the UK arm of American health insurer Centene) his ‘expert adviser for NHS transformation’. He then wasted £37 billion on the failed, privately run Test & Trace system. Rishi Sunak then hired private healthcare lobbyist, Bill Morgan, as his advisor.
The Conservative’s Health and Care Act 2022 was one of the last big pieces of the privatisation puzzle. It broke the English NHS into 42 easy-to-manage chunks. Initially called Accountable Care Organisations (ACOs) like their American counterparts (a bit of a give-away!), they were quickly renamed Integrated Care Systems (ICSs).
Like all UK health law since 1990, the direction of travel of the 2022 act is towards an insurance industry take-over of the NHS, giving UK and US private corporations a bigger than ever stake in our healthcare. 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.
Yet the American model of privately-provided care is much more expensive and plagued by medical 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 per person than the NHS, yet patients have less access to highly qualified medical staff. It is rife with down-skilling and cost-cutting to boost profits. It has eye-wateringly expensive drugs, routinely sells wealthy patients operations and procedures they don’t need, leaves millions of poorer patients with no access to treatment, and is America’s Number One cause of personal bankruptcy!
In 2022, the British Medical Association said the NHS was at ‘breaking point’, with thousands of patients dying avoidably each month, and nurses and junior doctors using NHS food banks to survive. In December that year, nurses went on strike for the first time in NHS history, soon joined by ambulance workers and doctors. By early 2023, two thirds of junior doctors and almost half of consultants said they were planning to leave the NHS. The strikes continued well into 2024 before pay deals were reached.
Like Conservative MPs and peers before them, Labour PM Kier Starmer and Health Secretary Wes Streeting have been taking large donations from private healthcare. Streeting has chosen to use the private sector to reduce NHS waiting lists, making the NHS ever more reliant on private providers. Yet the private sector is staffed by doctors and nurses trained in the NHS, so pouring funds into private healthcare is completely unsustainable! Any government set on saving the NHS would invest that funding and support in the NHS itself to quickly increase its short-term capacity and build up sustainable, long-term NHS capacity.
If two-tier, American-style healthcare continues to be imposed on England, standards and access to doctors will nose-dive even further. People who can afford it will buy costly private health insurance for privately-provided care, not realising that three quarters of those bankrupted by healthcare in America have health insurance! People who can’t afford private health insurance will be left with a run-down, privately provided, skeleton NHS funded by taxation—the very same failing system operating in America. With an all time high of between 7 and 8 million on NHS waiting lists, people are already turning to the private sector in droves, and Britain’s Biggest Enterprise is fast becoming a reality. Soon, all that will remain of our once world-leading National Health Service will be the logo.
And this is how the story will end, unless you and I and many of us take a stand and write a different ending. We must build the movement for a fully renationalised NHS. This means bringing back a publicly-funded, publicly-provided and publicly-run universal service, managed by fully qualified medical staff delivering high quality care to all. To do so, we need to reverse four decades of health law, kick out private providers, cancel PFI debts, bring back social, dental and optician care, and get rid of the hugely wasteful internal market and the highly paid bureaucrats who run it. Let’s get our NHS back!