1948 Clement Attlee (Labour) sets up the National Health Service, a publicly financed, publicly provided healthcare system for all, including optician and dental care.
1983 Margaret Thatcher (Conservative) introduces competitive tendering to outsource ancillary services including porters, kitchens and cleaning to private companies, which eventually leads to increased levels of hospital-acquired infections. Access to NHS optician and dental care is reduced and charges are brought in.
1988 Oliver Letwin, a privatisation expert at NM Rothschild Bank, and MP John Redwood (Conservative) write Britain’s Biggest Enterprise, a manual on how to privatise the NHS through the stealthy and gradual introduction of trusts, private companies, charges, profits and health insurance. The Adam Smith Institute, a neoliberal think tank, flesh out this manual in The Health of Nations by Pirie & Butler.
1991 John Major (Conservative) brings in the NHS and Community Care Act introducing an Internal Market to the NHS with a ‘purchaser-provider’ split, de-centralising the service by forming NHS trusts, adding a corporate management structure and the principle of competition. Analyses of NHS marketisation show costs escalating. By 2005, the cost of NHS bureaucracy is estimated to have increased by 10% (Bloor Report).
1992 The Conservatives introduce Private Finance Initiatives (PFIs), an unnecessary and expensive method of borrowing money for new hospitals designed to deliver attractive, risk-free returns for private investors, drain money out of the NHS, lock the taxpayer into long-term debt and justify hospital closures.
1997 Tony Blair (New Labour) dumps Labour’s tradition of support for public service and opts for privatisation and deregulation, funding 100 new NHS hospitals with PFIs. In total, approximately £12.7 billion is borrowed, with repayments reaching over £80 billion. Even when fully repaid, the public won’t own the hospitals! PFIs enable a covert bed closure program to shrink NHS capacity, and a future land grab. As the costs of paying off debts rise, NHS trusts will be forced to sell assets. Oliver Letwin becomes a Conservative MP to action his NHS privatisation manual.
2000 New Labour’s NHS Plan introduces private provision of medical services into the NHS for the first time to ‘modernise’ and ‘reform’ its practices. Routine planned surgery, diagnostic tests and procedures are contracted out to private sector treatment centres at greater cost than the same care on the NHS.
2003 New Labour allows NHS trusts to apply to become Foundation Trusts (FTs), arms-length business entities independent of government control. This further embeds commercial priorities and leadership into the system.
2004 New Labour brings in Payment by Results. Providers are paid a fixed price per unit of completed health care. This helps the private sector to cherry-pick the easiest, most profitable treatments.
2009 Gordon Brown (New Labour) brings in the Unsustainable Provider Regime, the framework for using the PFI hospital debt burden to close and sell off publicly-owned NHS land and property.
2012 David Cameron & Nick Clegg’s (Conservative / LibDem coalition) Health and Social Care Act (HSCA) abolishes the legal foundation of the NHS, removes the Secretary of State for Health’s legal duty to provide healthcare for all, hands responsibility to a series of new quangos – most notably NHS England (NHSE) – and opens all major NHS contracts to the private sector. This accelerates private involvement in the NHS and substantially increases administration costs.
2013 The Conservative / LibDem coalition replaces Primary Care Trusts (PCTs) with new, GP-run Clinical Commissioning Groups (CCGs), transitional state-owned-and-run insurance pools based on American private Health Maintenance Organisations. 60% of NHS budgets flow through CCGs.
2014 The Conservative / LibDem coalition appoints Simon Stevens, former head of the global division of American health insurance giant UnitedHealth, as Chief Executive of NHS England to manage the final stage of privatisation; the coalition continue to support his efforts. Stevens spends £millions embedding UnitedHealth’s UK subsidiary Optum and US ‘managed care’ in England. He oversees the introduction of Optum software, algorithms, personnel, business practices, and the training of local council leaders to replicate American Medicare, which will reduce England’s NHS to a funding stream and a logo.
Stevens publishes his Five Year Forward View (FYFV) introducing Sustainability and Transformation Plans (STPs) and New Models of Care, creating the impression that these are NHS sanctioned policy. The narrative of ‘integration’ points to a move to Accountable Care Organisations (ACOs), based on the American private insurance industry-devised model. The plan is to:
- Reduce the number of full A&E hospitals from 140 (in 2013) to between 70 and 40
- Reduce the number of GP surgeries from 7500 to 1500 “superhubs”
- Close smaller hospitals to produce economies of scale and cut future private sector costs
- Shrink provision of expensive, high risk, unprofitable healthcare to the sickest patients
- Consolidate lower risk routine planned healthcare ahead of outsourcing
2015-17 Stevens rolls out STPs, dividing NHS England into 44 regions or Footprints to be run by ACOs (now re-named Integrated Care Systems – ICSs).
2016 Junior doctors strike over a new contract adversely affecting pay, part-time female doctors, and more anti-social working hours that put lives in danger. Exercise Alice, a dry-run of how the NHS would respond to a coronavirus-like pandemic, identifies the need for more trained NHS personnel, beds and Personal Protective Equipment (PPE) as well as the need to maintain contact tracing and patient isolation capacity. Both Theresa May’s government (Conservative) and Simon Stevens fail to implement these recommendations.
2017 The Naylor Review report by global accounting consultant Deloitte & Sir Robert Naylor for the Conservative Secretary of State for Health, and Project Phoenix, create incentives for Trusts to sell NHS land and assets as the only option to raise funds to buy, improve and maintain hospitals, equipment and NHS properties.
2018 The Commissioning Capabilities Programme run by UnitedHealth / Optum in partnership with global accounting consultant Price Waterhouse Cooper (PwC), is an exercise setting out the curriculum and all the design functions for both advanced and aspiring ICSs.
2019 A major new contract for GPs means they are grouped together to form Primary Care Networks (PCNs), which form the foundation of American-style Integrated Care. Managers and computer software (rather than doctors) determine ‘care pathways’ for patients and decide on treatments. The British Medical Association (BMA), the doctors’ union, wave through the contract binding GPs in to PCNs, with hardly any debate and no vote of GPs.
2020 Under Boris Johnson (Conservative), NHS privatisation, the decision by Theresa May’s government and Simon Stevens not to prepare for pandemics, and Covid19 create a perfect storm. Hospitals become emergency Covid treatment centres. GPs are instructed by NHS England (NHSE) to replace face-to-face appointments with phone consultations, making it almost impossible to see a GP—a taste of what’s to come under American-style ‘managed care’. More than 1,500 health and care staff die from Covid due to the lack of PPE, the unofficial Tory ‘herd immunity’ policy, delayed lockdowns etc. The Conservatives pay two corporations without any expertise in public health—global accounting consultant Deloitte and outsourcing giant Serco—£37 billion to set up Test & Trace, which makes ‘no measurable difference’. Sir David King, former government Chief Scientific Officer, estimates that more than 100,000 UK Covid deaths could have been avoided.
2021 The Conservative’s Health and Care Bill revises the number of ICSs to 42. Each ICS board will serve private corporate interests, control all spending and decide what treatments to allow patients in their region. As with US ‘managed care’, the more private corporations cut and deny care, the more profit they’ll make. The Bill removes Section 75 of HSCA to allow private companies to be awarded £multi-billion contracts behind closed doors without competition, normalising what went on during the pandemic with PPE and Test & Trace.
2022 The Health and Care Act puts ICSs on a legal footing. From July 1st, ICSs start operating throughout England, effectively de-nationalising the English NHS. Waiting lists top 7 million, the highest since records began. NHS wage stagnation, the cost of living crisis and rampant inflation lead hospital trusts to open food banks for nurses and junior doctors who are going hungry. This, together with a new round of austerity imposed by Rishi Sunak‘s government (Conservative), leads NHS nurses to vote to strike against low pay and patient safety concerns for the first time in their history. They are soon joined by ambulance drivers and paramedics for similar reasons.
2023 Junior doctors strike for full pay restoration (after losing around 30% of their income since the Conservatives took power in 2020), safeguards against inflation and reforms to protect the recruitment and retention of junior doctors.