By the time this blog is published on the morning of Friday 8th May, we may be a step closer to knowing what the next UK government is going to look like. Having said that, we may be further away than ever from knowing what that government might look like. Rather than engage in idle speculation, I thought I might try and review the chaos that the last 5 years of coalition government has wrought upon the NHS, a national institution.
Herein lies a problem. Such is the scale and scope of this chaos it is difficult to know where to start. Does it make sense to go back Lansley’s ‘Magnum Opus’ white paper published in 2010 – ‘Equity and Excellence: Liberating the NHS’? History may very well identify this as the death knell of the NHS, but to do so is to ignore the role of the previous governments, whether this is Labour policies (foundation hospitals and the expansion of Private Finance Initiative (PFI) arrangements, and payment by results) or even prior to this with an internal market driven by a Conservative government with the neo-liberal bit firmly between its teeth.
Viewed this way we can see that the demise of universal healthcare, based on need, not ability to pay, did not really start with Lansley and his toxic white paper. Indeed, a longer historical view allows us to better make sense of the NHS reforms that took place after 2010 as part of a broader suite of neoliberal reforms intended to extend the limits of the project to hollow out the UK public sector. This process of hollowing out the NHS is characterised by processes of defunding. In this context defunding is understood via Chomsky as “the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital.”
What we have seen in the UK over the last 5 years represents a brutal and aggressive extension of that neoliberal project. How did we get to this point? How did it come to pass that it became possible to maintain political legitimacy whilst explicitly undermining a system of free universal healthcare? That really is the neoliberal trick right there.
Allyson Pollock has been vociferous in calling attention to the fundamental mechanism – a switch from the statutory duty to provide a universal health service, to a statutory duty to promote a universal health service. The provider becomes the promoter. This switch, with a raft of attendant legislation, opens the door to the private sector. Essentially, everyone becomes a qualified provider, NHS, non-statutory sector, voluntary sector and for-profit sector; there is no difference as far as the promoter is concerned. And, the promoter ensures there is no difference as far as the public are concerned, ensuring the blue and white NHS logo prevails across all sites of service delivery. This functions to promote a form of provider blind provision, where the emphasis is placed on cost-effective and efficient services, driven by need to ensure value for money rather than any deeper commitment to a collective public good. This expansion of principles of effectiveness and efficiency promotes a fundamental economic logic, underpinned by austerity, which warmly welcomes any ‘competitively priced’ provider into the newly created marketplace.
It is in this context that we see Circle Health, Capita, Serco, Virgincare, and Optum, amongst a whole host of others, providing NHS care under an NHS banner. It is in this context that we see Circle Health withdrawing from its contract to run Hinchingbrooke Hospital. Circle Health claimed that the contract to run the hospital was unsustainable, blaming funding cuts and the A&E crisis. How long before a cash-starved NHS trust has to make a similar move?
So, if there is a sense of an ending to mark Friday the 8th of May and the result of the UK general election result, its not the sense of an ending to nasty neoliberal policies designed to undermine and pave the way for the privatisation of the NHS. Indeed the sense of an ending may be more appropriately applied to the end of the idea of free universal healthcare based on need. No matter which party (or parties) form the next government, unless we are alert and alive to the ongoing vagaries of the neoliberal asset strippers who have been loosed on the public sector, we run the risk of history repeating, and repeating and repeating. I fear that the barbarians have stormed the gates and that they are largely ambivalent as to whether it’s a red coalition, a blue coalition or a rainbow coalition.
Editors Note: as of 07:16am, 08.05.15, this post, with its talk of coalitions, now looks overly optimistic…