Jeremy Corbyn just revealed a 451-page dossier showing talks had taken place on drug pricing and access to NHS contracts, contradicting Boris Johnson and the Tories claims that the NHS is not for sale.
Throughout Europe, neoliberal, profit-driven approaches to healthcare have pushed services to near crisis point. Our NHS is not for sale, in these texts from Vital Signs, author Lee Humber outlines why. Get 30% off Vital Signs using the discount code: GE2019.
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In the years following World War II, governments were primarily responsible for attending to the health needs of their populations, developing versions of state-driven welfare provision to provide medical and social care directly. From the late 1970s onwards this began to change, and increasingly healthcare came to be dominated by private healthcare capital, touching every corner of the globe. From the UK to Tajikistan private healthcare has come to dominate large sectors of health and social care provision.
In the UK, since before the beginning of the twenty-first century, the growth of neoliberalism in the healthcare sector has been actively encouraged and facilitated by successive governments of all parties. Especially since 2010, but also in evidence before that, a flood of legislation seeking to reconfigure healthcare systems has changed the face of services. Most recently, two Health and Social Care Acts (2012/2015), a Care Act (2014), the Five Year Forward View (2014), ‘vanguards’, ‘Multispecialty Community Providers’ (MCPs) and the ‘Primary and Acute Care System’ (PACS) all passed into law between 2010 and 2018 and had major impacts on healthcare at governance, systemic and service level.
Arguments governments have used to open up formerly state-run services to the private sector include the idea that given rising demand for health services, an ageing population and improved medication along with the growth of health-related technology, both of which help people live longer, governments can no longer afford to maintain a nationalised healthcare service. In the process, over the past two decades the NHS has variously been accused of being ‘too big’, too expensive, inefficient and bureaucratic. As a result, it has been argued, governments need the help of private business, set free by the tenets of neoliberalism, allowing private capital to intervene to develop profit-generating care provision to fill the gaps left by this decrepit and outmoded welfare approach to healthcare. As a result, since before the 1990s private capital has made huge inroads into healthcare services. One very obvious consequence of this is that in care services throughout Europe neoliberal, profit-driven approaches have pushed services to near crisis point. In the UK, 47 major care providers closed in 2014–15 alone and this trend is likely to have accelerated since then.
In 2017 in Oxfordshire during the first part of 2017 four or five providers went out of business each month, causing a crisis that saw council administration staff being sent into residential homes to provide care themselves. Across Europe, state-run healthcare provision of all kinds is under intense pressure as a result of years of government-led austerity contextualised by the for-profit approach of neoliberal healthcare, with – especially but not only in Spain, Portugal, Ireland and Greece – the selling off and slashed funding of publicly run healthcare provision. The situation in the ‘market leader’ in commodified health, the US, is worse and continues to deteriorate.
In the UK, the privatisation of healthcare grinds on, driven by a combination of economic requirements, employers’ needs to ensure a relatively healthy workforce fit enough to work, an ideological belief in the superiority of a health market to deliver this and a belief that health represents a new area of potential profit.
Politically, given the huge popularity – and effectiveness – of the state-run, free at the point of delivery model of healthcare the UK has enjoyed for the past 60 years, fully imposing market relations on healthcare services continues to prove difficult for governments, with numerous local campaigns defending local hospitals and national campaigns coming together in support of the NHS model. Yet governments persist, even when, as we have seen, the market model breaks down and fails to provide a care service adequate for the task. In a sense, UK governments have little choice unless they choose to buck the trend entirely and challenge the dominance of neoliberal polity. The dominant paradigm in healthcare provision, and with regard to health more generally, is that of the commodification of health within the context of competitive market relations of healthcare. Until the dominance of that paradigm is ended those in control of UK healthcare provision must compete in this global market or be outmanoeuvred by other providers.
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This is an extract from Lee Humber’s book Vital Signs: The Deadly Costs of Health Inequality Get 30% off Lee Humber’s book using the discount code: GE2019.
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Lee Humber is a health and social care academic and activist. He has contributed to numerous journals including Critical and Radical Social Work and Disability and Society. He