The NHS at 70: The Neoliberal Assault

By Lambert Strether of Corrente.

In our last post on international health care systems, we looked at the neoliberal assault on Canadian Medicare using the “wait times” talking point (a talking point you will hear in this country when the Canadian system is attacked, and which has been successfully used to privatize some services in our Veterans Administration). In this post, I’ll look at the neoliberal assault on the United Kingdom’s (UK) National Health Service (NHS)[1]. Let me caveat at the outset that the NHS is 70 years old and has a legislative history that’s much more complicated than Canadian Medicare. It hasn’t been easy to get control of the material, and so I hope our UK readers will call attention to any howlers I make (but in as kindly a fashion as possible). First, I’ll present a timeline of the highlights of NHS history, including the neoliberal assaults on it. Second, I’ll contextualize today’s assaults at a high level using our familiar model of the neoliberal playbook. Third, I’ll look at two such assaults, first, Virgin’s, and then a complicated piece of wreckage involving “clinical commissioning groups.” (Both assaults were enabled by legislation that the Tories passed. I’m sure Tony Blair’s Labour did their own little bit to degrade and destroy the NHS, but I simply didn’t encounter it in my searches. Possibly the Blairites were subtler.) To the history:

NHS History

The NHS in a nutshell, from the NHS:

On 5 July 1948, the NHS was launched by the then Health Secretary, Aneurin Bevan, at Park Hospital in Manchester (known today as Trafford General Hospital).

For the first time, hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella to provide services for free at the point of delivery.

The “umbrella” is the state; it’s a national health service.[2] And from a useful timeline on NHS “Reform” produced by the Nuffield Trust, the 1942 White Paper led to the NHS’s founding in 1948:

(This is back in the day, when the UK had a functioning Civil Service capable of doing work of national scope.) I like to think of the NHS as the compensation extracted by the UK’s working class for the elite’s slaughter of them, in their millions, in World Wars I and II[3].

The first neoliberal assault, by Maggie Thatcher’s Tories; the “National Health Service and Community Care Act” (NHSCCA), to which we will return. Note the highlighted “internal markets”:

The second neoliberal assault, by David Cameron’s Tories with Nick Clegg’s Liberal Democrats helping; the “Health and Social Care Act” (HSCA), to which we will also return. Note the highlighted “competition”:

Finally, this screen came up when I was doing my searches:

How a search for “National Health Service” ended up producing a clutch of (poorly cropped, Google programmers, poorly cropped) corporate logos — including Virgin’s, which is why I decided to look into them — is in many ways the theme of this piece.

Underfunding and Predictable Crisis

Readers will recall the neoliberal playbook: “[1] Defund [or sabotage], [2] claim crisis, [3] call for privatization… [4] Profit!” (rinse, repeat as necessary). The UK is clearly undergoing both steps [1] and [2].

Step [1]: Defund and sabotage. From Laurie Macfarlane at Open Democracy, a handy chart:

Macfarlane writes:

In recent decades spending on the NHS has indeed increased: since 1948, spending has risen by 3.7% each year on average (adjusting for inflation). Spending relative to the size of the economy – the most effective way to evaluate trends in health spending – increased from 4.1% of GDP in 1978/9 to 7.6% in 2009/10.

Since 2010, however, this trend has reversed. As the Kings Fund has reported, we are now experiencing an unprecedented sustained decline in NHS spending as a share of GDP.

The NHS is a complex beast, but as usual it helps to follow the money. There are good reasons why spending on health should be expected to increase over time: an ageing population means that demands on health services rise since older individuals on average consume more, and more expensive, healthcare. Demand will also increase over time as a result of the rising prevalence of some chronic conditions, improvements in access to care, and improvements in technology.

More than anything else, the reason the NHS is under so much pressure is that the Government has decided to squeeze resources at a time when demands on the service are increasing.

(Rule #2 of Neoliberalism.[3]) The results are entirely predictable.

Step [2]: Claim crisis, especially, of course, if the crisis is real. A sampling of headlines:

(I’m including U.S. sources not only because neoliberal ideologues on this side of the pond like nothing better than to point at problems in the NHS in their battle against #MedicareForAll, but because corrupt behemoths like SERCO benefit from privatization, there and here.)

Amidst all the yammering and moanage, let’s not forget that the NHS is a highly successful institution with broad public support:

It’s important to look at everything the NHS achieves, too.

Every 36 hours the NHS treats one million patients (according to data from the NHS Confederation).

Over 80% of those who use the NHS say they have a good experience (according to the British Social Attitudes survey, reported by the King’s Fund), and more than 63% of the public strongly support the NHS.

This rate of public support and productivity has been hard won by NHS staff, says UNISON head of health Sara Gorton.

It is also the result of financial investments made in the decade between 2000 and 2010. “The last 10 years of under-funding, with no let-up promised anytime soon, is extremely damaging,” says Ms Gorton.

Further, the NHS model of care delivery retains popular support despite the (neoliberals’ manufactured) crisis. From 2015:

The news that A&E departments have seen their worst quarter for a decade crystallised the phrase that had slowly been coming into focus over the past month: “NHS crisis”.

Note the lack of personal or political agency in “crystallised the phrase.” More:

One of the key challenges that Labour has faced over the past four years is how to attack the Government over healthcare without attacking their cherished NHS itself. If they criticise the NHS too much they risk harming public support for it and giving oxygen to the case for privatisation. This point has not yet been reached though. Although half the public (49%) don’t think the NHS is a well-managed organisation, just one in eight (13%) thinks it is damaged beyond repair and two thirds (65%) actively disagree. It is a political issue rather than one of the NHS model being dead.

(The source, ComRes, is a public relations firm, but given Labour’s resurgence with Corbyn, I see no reason for the numbers to have changed.) From The Conversation:

The principles of the NHS are that it offers universal health care coverage, meets the needs of everyone, is free at the point of delivery, and is based on clinical need, not ability to pay.

These principles formed the foundation stones of the NHS when it was created after the desolation of the Second World War, and the British public remains committed to them today.

With this background, let’s turn to cases. First, Virgin.

The Neoliberal Assault: Virgin

Let’s start with this headline from the Independent: “NHS privatisation soars as private companies win 70% of clinical contracts in England.” The deck: “[Grinning, photogenic gasbag enthusiast and squillionaire] Richard Branson’s Virgin Care won a record £1bn worth of contracts.”

NHS spending on care provided by private companies has jumped by £700m to £3.1bn with non-NHS firms winning almost 70 per cent of tendered contracts in England last year.

Private care providers were awarded 267 out of a total of 386 contracts made available in 2016-17, including the seven highest value opportunities, worth £2.4bn.

Richard Branson’s Virgin Care scooped a record £1bn worth of contracts last year, meaning the company now has over 400 separate NHS contracts, making it the dominant private provider in the NHS market.

The extent of Virgin Care’s portfolio has angered campaigners, as the company pays no tax in the UK, and its parent company is registered in the British Virgin Islands – a tax haven.

Virgin Care also sued six NHS commissioning care groups (CCGs) last year after it failed to win an £82m care contract, losing out to an NHS provider and two social enterprises.

(The lawsuit ended in victory and damages for Branson, although hilariously “[the controversy] included a petition signed by over 100,000 people addressed to Richard Branson and Virgin Care, demanding that they ‘return the NHS’s money, and never sue the NHS again.”)

As a sidebar, VirginCare gets a one-star (✮) rating at “NHS Choices[4],” a ludicrous Silicon Valley-style attempt to rein in ginormous corporate predators with a Yelp-like web page so, ya know, you can search for the best deal from the comfort of your racing ambulance. There is a grand total of fourteen (14) ratings. Here is VirginCare’s response to one complaint on 23 April 2018:

Thank you for sending us your message through NHS Choices. We aim to provide a great experience for everyone who uses our services and we are so sorry that you have not had such an experience. We have passed your comments on to the service manager, particularly the issues you have raised around your cancelled appointment and if you would like the service to contact you to discuss these concerns please contact the Customer Experience Team at or on 0300 303 9509.

Thanks again for your feedback. Carol Dale, Lead for Customer Experience.

And here is the response to another customer on 22 March 2018:

Thank you for sending us your message through NHS Choices. We aim to provide a great experience for everyone who uses our services and we are so sorry that you have not had such an experience. We have passed your comments on to the service manager, particularly the issues you have raised around obtaining a suitable appointment and if you would like the service to contact you to discuss these concerns please contact the Customer Experience Team at or on 0300 303 9509.

Thanks again for your feedback. Carol Dale, Lead for Customer Experience.

“Your call is very important to us….” Does anybody else get the impression that “Carol Dale” is a bot? Even that there’s another bot out there going by the moniker “Dale Caroll”? End sidebar….

Yes, VirginCare’s IT is indeed awful. As is much more. Speaking of those star ratings, from Somerset Live:

[A Virgin Care worker staff member,] who wishes to remain anonymous, shared her concerns in an open letter to council and NHS commissioners…

The company’s £700 million contract to run community health and care services in the area began in April 2017.

In a damning critique of Virgin Care’s first year in charge, the staff member reached for the classifications used by the health watchdog to rate services.

“After all, historically our services were rated good to outstanding in the county and I assumed you wanted to maintain or improve the services to the community”, she told B&NES Council and the area’s NHS Clinical Commissioning Group who jointly awarded Virgin Care the contract.

Describing her experience of the company over the past year, the employee said that staff have struggled to cope because of “slow and ineffective” recruitment and continuing IT issues, and that their complaints have been “whitewashed”, leaving them feeling demoralised and ignored.

“I know of complaints being minimised and recategorised as ‘concerns’ through the head office communication team,” she said.

Staff were also asked to close care cases that remained unresolved without being told why, she claimed….

Among numerous other criticisms levelled at Virgin Care, the employee said the company’s IT systems and services were still unsatisfactory, and that staff training in the new systems had been insufficient.

“Services have continued during this turbulent year but in no part due to Virgin Care. The services in B&NES have continued solely due to the tenacity, diligence and determination of the staff, many of which were transitioned with the equipment from one provider to another.

“[C]lose care cases that remained unresolved.” Well, I’m sure not very many people died in their beds, waiting for help that never came. And I’m sure the Virgin executives got their bonuses for reducing the caseload, so there’s that. More systematically, one can only wonder why VirginCare would wish to demoralize staff, eh? By, for example, screwing up their pensions:

Virgin Care failed to hand over Bath staff pension payments

The “internal administrative error”, which has since been rectified, appears to have occurred between April and October of last year.

Staff members in Bath and North East Somerset first realised something was amiss when they received personal letters from their workplace pension fund manager, Aviva, telling them their pensions would be closed due to a lack of contributions.

One employee, who wishes to remain anonymous, said a number of staff approached Virgin Care management to find out what was going on.

The employee said: “Some managers went back to Virgin Care and they said ‘oh yes, we haven’t been paying.'”

Virgin Care did not answer questions put to it by the Bath Chronicle about how many staff were affected by the glitch, how much of their money and how long it sat in the company’s bank account before it was handed to Aviva.

Confidence builder! Maybe Virgin should stick to running trains? Oh, wait…[5]. I grant this is anecdotal (although perhaps knowledgeable UK readers will help me with better sources). However, I would argue that when a ginormous corporation goes bad, it goes bad all the way through; see under Verizon and Comcast, for example. Or Wells Fargo.

Crucially, however, all this Bransonite crapification is down to the architecture of Maggie Thatcher’s “National Health Service and Community Care Act,” back in 1990. From, of all places, The Spectator (!). Max Pemberton, a doctor:

And here’s the rub. There is crippling, shameful waste in the NHS. The kind we hear about are things like missed appointments or doctors prescribing remedies that could be bought over the counter. Equipment such as walking frames that can’t be returned. Or health tourism or failure to recoup the cost of treating overseas nationals. Of course, all of these are important. But there is a source of inefficiency that eclipses all this, wasting billions every year. It is the internal market.

This was first introduced into the NHS in 1990, when the National Health Service and Community Care Act put health authorities in charge of their own budgets.

That is the “split between purchasers and providers of care” found in the timeline in 1990. (Or, one might say, that time when the NHS became no longer “national,” and not about “health,” and not about “service.”) Neoliberals are really good at thinking long term, aren’t they? Now let’s turn to the wreckage “reforms” introduced in 2012.

The Neoliberal Assault: Clinical commissioning Groups

You may have noticed that the Somerset VirginCare whistleblower sent their letter not only to their local Council, but to the “the area’s NHS Clinical Commissioning Group.” (Sounds complicated. It is.) The Health and Social Care Act 2012 was also on our timeline; besides the highlighted neoliberal buzzword “competition,” note “thousands of amendments” (rather like ObamaCare, or Dodd-Frank. How’s all that complexity working out for ya?) The NHS summarizes the goals of the Act:

The Health and Social Care Act 2012 was first published on June 15 2012 and took effect on April 1 2013. The act brought in the most wide-ranging reforms of the NHS since it was founded in 1948.

It puts clinicians at the centre of commissioning, frees up providers to innovate [Hoo boy!], empowers patients and gives a new focus to public health. The act covers the following 5 themes:

  • strengthening the commissioning of NHS services
  • increasing democratic accountability and public voice
  • liberating [from what?] provision of NHS services
  • strengthening public health services
  • reforming health and care arm’s-length bodies

So, at the purchaser/provider divide, the HSCA tilted the balance even more toward providers. From PloS Medicine, “Association between the 2012 Health and Social Care Act and specialist visits and hospitalisations in England: A controlled interrupted time series analysis,” the abstract:

The 2012 Health and Social Care Act (HSCA) in England led to among the largest healthcare reforms in the history of the National Health Service (NHS). It gave control of £67 billion of the NHS budget for secondary care to general practitioner (GP) led Clinical Commissioning Groups (CCGs). An expected outcome was that patient care would shift away from expensive hospital and specialist settings, towards less expensive community-based models. However, there is little evidence for the effectiveness of this approach. In this study, we aimed to assess the association between the NHS reforms and hospital admissions and outpatient specialist visits.

And what happened?

Our findings suggest that giving control of healthcare budgets to GP-led CCGs was not associated with a reduction in overall hospitalisations and was associated with an increase in specialist visits.

Ka-ching. (That’s what they’re “liberating”!) And the structure — in the same way that ObamaCare, with its own set of bizarre and artificial complexities, “relentlessly created” second-class citizens — makes the delivery of care a crapshoot. From the Guardian (and note the letters in square brackets):

Psychiatrists claim the [a]small sums being spent by GP-led [b]clinical commissioning groups (CCGs) in England constitute a national scandal at a time when youth self-harm and suicide are rising.

“It is a national scandal that opportunities to prevent mental illness from occurring in childhood are being missed because of unacceptably low investment,” said Prof Sir Simon Wessely, the president of the Royal College of Psychiatrists.

Ten CCGs are spending less than £10 a head this year treating the growing number of psychological and psychiatric illnesses which are occurring in under-18s. Twenty-five will spend £25 or less per head….

But research earlier this week by the Education Policy Institute said much of the extra £250m a year which the coalition government pledged to put into CAMHS care during each of the five years of this parliament was [c]not reaching the frontline. Specialist children’s psychiatrists in many areas agree.

Berger said that underfunding CAMHS care was “a false economy” because 75% of adults who developed mental health problems first exhibited symptoms in childhood, and problems left unaddressed cost the NHS more.

The [National Society for the Prevention of Cruelty to Children (NSPCC)] said the [d]wide variation in the amounts put into CAMHS care reflected a “postcode lottery”.

Hard to see how a “postcode lottery” “empowers patients,” “innovative” though it may be. Granted, this is one example; for all I know, your average CCG is brilliant. But I’ve helpfully labeled the systemic problems that pertain to the neoliberal playbook: [a] Step one, defund; [b] step one, sabotage (here through complexity) [c] step four, profit: If the money’s not reaching the front lines, where is it going? And finally [d], the “postcard lottery” not only creates a constant stream of crises in underserved areas (step three), it undermines belief in the ability of the state to deliver services fairly, or at all. CCGs are a four-fer!


In summary and IMNSHO, there is no “NHS crisis” condition that funding the service according to the historical, er, norm + surgical excision of the “internal market” won’t solve. Once again, this entire article article in the Spectator (!!) is worth a read, but here’s a summary:

The unintended consequence [oh?] [of the ‘purchaser-provider split” has been bureaucracy on a gargantuan scale. And the spiralling cost has no discernible benefit to patients. A recent study from the Organisation For Economic Co-operation and Development (OECD) suggests that about one fifth of spending on health makes no or minimal contribution to improved health outcomes.

Even last June’s Conservative manifesto acknowledged this, admitting that the NHS internal market can fail ‘to act in the interests of patients and creates costly bureaucracy’. This demonstrates that many within the party have become disillusioned with the free-marketers. And disillusioned they should be. The introduction of the free market to healthcare was based on ideology and has shown itself to be costly, inefficient and a woefully inadequate system.

We know from other countries, such as the US and Germany, that introducing the market into healthcare results in higher costs. Putting an exact cost on the internal market is tricky, but the Centre for Health and the Public Interest gives a conservative estimate of £4.5 billion. Others have suggested about £10 billion is diverted [ka-ching] away from frontline services to administer the complex negotiations and contract monitoring that the market system requires.

What’s more, there are the indirect costs due to inefficiency. In 2010, the select committee on health divulged that even under Labour, the cost of administering the purchaser-provider split was 14 per cent of all NHS spending [ka-ching]. Some have now estimated the cost to be in the region of 25 per cent. It’s quite clear that the more providers of healthcare there are, the higher the risk of duplication, confusion and misunderstandings. We were told by the free-marketers that the internal market would push up innovation, reduce costs and result in efficiency savings. The evidence shows this isn’t the case. I see this day in and day out in my own practice because I, like every other doctor, has to collect data that is essential to services competing for contracts.

Any truly international left movement — at least, one that’s ashamed when it has to handwave over the relation between the current fan fave, “Open Borders,” and labor arbitrage — should be looking at health care in the United States, Canada, and the United Kingdom, and defending them from assault by their common enemy. And I would bet that anywhere you follow the supply chain, you’ll find the neoliberal playbook in action everywhere I welcome reader suggestions for further avenues of research, in the UK and elsewhere[6].


[1] Canadian Medicare is a “single payer” system, where services are (in the main) privately provided but publicly billed and paid for (hence giving the single payer, the state, maximum leverage over prices or, to put this another way, putting prices under a measure of democratic control). Hence, in Canada, neoliberals battle for services to be privately provided and privately paid for. In the UK’s NHS, services, at least in principle, are both publicly provided and publicly paid for. In the UK, neoliberals are fighting the same battle as in Canada, but on immensely more complicated terrain and for a longer period of time.

[2] “Free at the point of delivery” is a mantra that U.S. #MedicareForAll advocates should adopt; the complex system of eligibility determination and payment collection and processing (co-pays, and so forth) creates thousands of potential sites for neoliberal infestation; it should be abolished root and branch.

[3] U.S. #MedicareForAll advocates might consider this “payback” framing as well. “You took my house in the Crash; the least you can do is make sure I have health care.”

[4] The market provides “choice,” except when it doesn’t. So “choice” is always good. “Choice” focus groups well.

[5] I knew if I searched on “Virgin train debacle” I’d find something, and sure enough….

[6] For example, I have’t looked at trusts, or selling off NHS property. I’m sure there’s more. There’s a lot of ruin in a National Health Service.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Altandmain

    The NHS certainly has its share of problems, but many of them, as Lambert notes, are caused by the Conservatives in the UK to begin with. They are deliberately underfunding the NHS in the hopes that it fails so that it is Americanized. It should be noted that the so called “Third Way” Labour types should also be blamed for the current situation, most notably under former PM Tony Blair, not just the Tories. That is why having a person like Cobryn in control of Labour is so important.

    Ideologically the neoliberals don’t want universal healthcare or any government program to succeed. It would mean that the government and public sector can at times provide superior service at a lower cost than any private system.

    They hate and fear universal healthcare becuase it would fatally undermine their ideology, which I think that many neoliberals deep inside know is a lie.

    The ultimate goal of neoliberalism has always been to create intellectual cover for the rich to dismantle the middle class and loot society for themselves.

    In the left side, I think though that is why the culture war left can only focus on issues like identity politics or open borders. Such things serve as a distraction or in the case of open borders arguably an outright transfer of wealth from working class to wealthy. The identity politics left has largely been co-opted by the neoliberals. Identify politics is largely a cover for the neoliberal movement.

    As Lambert has concluded, a true left wing movement would likely demand that the wealthy pay for a universal healthcare system across the world.

    1. Synoia

      The ultimate goal of neoliberalism has always been to create intellectual cover for the rich to dismantle the middle class and loot society for themselves.

      Yes, and I do wonder what’s discussed at length at Davos.

      1. John Wright

        To be even more cynical, perhaps the rich are truly climate change believers and realize the carrying capacity of the world for the aspirations of a good human lifestyle for 7 billion people is already or soon will be limited by climate change concerns.

        By dismantling as many public services as possible while preserving a well-funded national security state and police force to protect them, the elite may preserve THEIR lifestyles and grab more resources, while the prole lifestyles go into decline.

        1. Steve

          Spot On! There is no chance with leaks of climate/environmental damaged knowledge by Shell and Exxon from back in 1970 that the uber rich and our government don’t know. I have said for years the rich have a plan and we are not part of it.

    2. Expat

      The other issue is where funding is targeted. Conservatives have been closing major hospitals and clinics and creating waiting list, etc. I suppose the money not going to treatment is going to higher salaries for NHS administrators.

  2. clarky90

    We have a mixed public private health care system in NZ.

    It is under assault from all directions. The Big Pharma is teaching people to demand their hair-brained, $5,000 per week “wonder drugs”. For those inclined towards miracle cures there are plenty, imo, that are free (or cheaper, like fasting) with a better/longer track record. For instance Chaga and Turkey Tail Mushroom extract. AND, they at least, will not bankrupt public care, bankrupt you, make you sicker than you are, or kill you faster.

    This is the stupidity that we are up against!
    Trial of Viagra on pregnant Dutch women shut down early after 11 babies die

    My point; Free (or very affordable) universal public health care is an inalienable right.

    But, Allelopathic medicine has no idea of how to treat the degenerative, metabolic, autoimmune diseases (like diabetes, depression….) that are destroying us.

    Carnaby Street 1960s

    Forget about my earnest blah blah blahing, and look at the healthy vigorous population (think a herd of humans) of only 50 years ago.

    It is obvious that our experts are clueless.

    OTOH, they are brilliant at trauma medicine; broken legs, complicated births, car crashes…

    1. Conrad

      Allowing the advertising of prescription medicines was a terrible mistake which I sincerely hope will be rectified by a future government.

    2. Jamie

      OTOH, they are brilliant at trauma medicine; broken legs, complicated births, car crashes…

      That’s because the bulk of modern medical knowledge was gained through treating casualties of war. And that was largely motivated by the need to get soldiers back in fighting form, not from some noble humanitarian desire to treat people well, though I’m sure most doctors feel such a desire. We invested heavily in treating trauma to keep the war machine going as smoothly as possible. Cuba offers a different model, where the major investment has been in treating the most common disabling and degenerative conditions, training lots of doctors and sending them out into the community. Even if we gain “Medicare for all”, we will still need a shift in emphasis toward preventive and public medicine that spends adequately (on the same scale that we have invested in surgeries) to tackle the debilitating and chronic ills we suffer.

      Here in the U.S., even with Medicare, part A (hospitalization insurance) is “free” but annual check-ups and non-hospital doctor care insurance, you have to purchase.

  3. The Rev Kev

    “One of the key challenges that Labour has faced over the past four years is how to attack the Government over healthcare without attacking their cherished NHS itself.”

    For the love of god, even I could come up with a campaign for Labour. They should tell the public that the Tories want to privatize and Americanize the public health system thus abolishing the NHS. Feature nightmare stories out of American healthcare and say that this is your future. Tell them that their mum and dads will die of medical neglect because they won’t have the money to be treated. Tell young women that having babies will be much more riskier and more babies will die at an earlier age. Tell men that the costs of healthcare will then be more expensive that paying for a mortgage. Say here is our program for reinvigorating the NHS properly funded and here is a copy of the legislation that we will pass unchanged.
    Unless of course the Blairite faction of the Labour party wants the same outcome.

    1. Tempestteacup

      Corbyn-Labour has been unequivocal in its attacks on Tory custodianship of the NHS – and they’ve also explicitly talked about covert privatization, deliberate and strategic underfunding etc. They are of course able to do so to a much greater extent than New Labour, since the latter was complicit in the hostile political culture that characterizes all neoliberal ideologues in their relations to successful socialist or communitarian institutions. When Corbyn had just become leader in 2015, and was trying to be inclusive and emollient with the party‘s right wing, he appointed the Blairite Heidi Alexander as shadow Health Sec. It is emblematic of their devious, essentially antagonistic approach to the NHS that while Corbyn and shadow Chancellor John McDonnell were marching with striking junior doctors, Alexander was doing something much closer to her heart – speaking at a conference of liberal wealth creators. When she spoke about the strike, it was to express a desire to see the junior doctors back down – the lack of solidarity when compared with her own colleagues in the leadership couldn’t have been clearer. The coordinated mass resignations that followed the Brexit referendum enabled Corbyn to replace people like Alexander – but her vacillating apathy was very much the New Labour way from the mid-90s to 2015.

      Lambert doesn’t mention it but New Labour contributed to the NHS crisis not just through their general acceptance of the neoliberal architecture inherited from Thatcher, but through their devotion to PFIs. It‘s true that when Blair came to power, Labour began to address some of the chronic underfunding and calculated deterioration that had left the NHS in such a state after the Thatcher/Major years. But in their eagerness to appear fiscally conservative and because of their own chronic fidelity to the market, instead of investing directly in improvements they organised an interminably complex net of private contracts. Companies built the new hospitals and took on their long-term maintenance while the government willingly bound itself in to 20, 30, 40 years contracts on far, far worse terms than anything they could have achieved by investing directly. NHS Trusts are now in many cases bleeding money to fulfill these contracts – and of course it was another way of introducing predatory companies into the functioning of the NHS.

      Because the NHS is arguably the UK‘s most beloved and widely supported institution, every species of neoliberal ghoul has to play a kind of shell game whereby lip service is paid to „Our free at the point of use NHS“ while fresh methods are sourced to privatize the way it operates without it becoming so obvious that it becomes a political problem. All of which means that it is especially important to draw attention to what is being done – the NHS already enjoys broad support and there is no mandate at all for the changes the Tories are so eager to push through, so one hopes this is one example where raising consciousness could be immediately successful.

  4. Monty

    I was at university in London during the 90s. There were no tuition fees at any universitys then. In fact I was actually paid a small, means tested grant whilst I was there. I had no worries about getting sick because the NHS had my back…

    When I graduated, I had the opportunity to get involved with a startup company and worked for peanuts and a few % sweat equity. Many years later, that company sold for ~$1.5b… Kerching.

    If I had been unfortunate enough to be born in the US, I would never have been able to afford this path. The costs of healthcare and student loans would have meant I’d have to “get a real job”… And now I’d be stuck in a miserable corporate environment as a debt slave, instead of retired and debt free.

    1. Unna

      I spent a few years at a German University in the 70’s, and even as an Amercan citizen, the tuition was free. My understanding is that that’s the way it is now again. Read sometime last year that American kids are learning German so as to go there for a free university education. Great investment for Germany: toss a free university education to qualified foreigners (It’s not a cakewalk to get in) and maybe they get caught up in the place, find a mate as young people are want to do, get a job offer, can’t bring themselves to leave, and Germany adds a talented university educated internationally experienced young worker to their skills pool.

  5. paul

    The NHS in Scotland is run along quite different lines:
    Here is a short briefing paper on the differences (google can’t give me a working link unfortunately but it’s the second web result using this search
    key points:

    • Scottish healthcare delivery is based around NHS Boards, who are responsible for all the healthcare services in their geographical area. They are directly funded by, and accountable to, Scottish Ministers. Hospitals and all community services, are managed directly by their relevant NHS Board

    • There is no purchaser/provider split, no commissioning of services, and there are no independent sector treatment centres. GPs do not commission services and there is no plan that they will in future. But some services are provided by not-for-profit sector, such as charities, through service level agreements.

    • The current ruling party (Scottish Nationalist Party) have an explicit anti-privatisation policy.

    The Nuffield trust says UK health services could ‘learn lessons’ from Scottish NHS (ignore the red tory bleating tacked on the end for ‘balance’ and be informed that the labour run welsh service has significantly poorer outcomes and staffing).

    The original paper is here

    It’s not perfect, but it does seem to work pretty well.

    1. makedoanmend

      Hiya Paul,

      Isn’t it true though that the Scottish NHS is essentially funded through Westminster? Scotland is allocated a % of total monies transferred to the entire NHS organisation. I’ve read (I don’t have the reference) that when the Tories take the NHS budget to zero, as they will, then Scotland’s NHS budget will be a % of zero.

      I hope I’m wrong.

      I’ll also noted that the Metro recently ran a hatchet piece on the cost of prescriptions to the Scottish NHS and basically subliminally suggested that the SNP should scrap free prescriptions and, quelle surprise, people wrote in suggesting that all prescriptions should be profitably monetised.

      The onslaught continues. And I fear that my Glasgow educated GP will become disillusioned further. My GP has been the best diagnostician I’ve ever encountered.

      1. paul

        Funding for scotland is a pretty murky affair, made worse by the tory wheeze of GERS.

        But it basically is a block grant with some limited tax raising powers and a little borrowing. What it does with this is on devolved matters is largely up to the holyrood parliament. ie it can (and did) choose to mitigate the bedroom tax, despite the enthusiasm for it from the three main other parties.

        There are other aspects,barnett formula etc, it is hardly my area of expertise, but then that applies to 99.9% of the population.

        The level of funding is dependent on the UK budget, so you are correct.

        Free prescriptions are a good thing and the SG has managed to afford it while outperforming the rUK health service.
        It did so by using a national procurement policy, that old fashioned and uncompetitive idea of government exploiting the economies of scale it is afforded.

        That is why drug costs have risen in england by 34% in six years and 26% (not inflation indexed) here in ten.

        They also removed parking charges at all but three hospitals in scotland (those were under a labour PFI scheme deemed too costly to buy out).

        One of the exasperating things about the general competence and ingenuity the SNP have brought to mitigate the assault on all aspects of social security is that their efforts are under unappreciated.
        The relentless criticism from the unionist papers,parties and the bbc further undermine their acheivements.

        1. makedoanmend

          Thanks for the reply Paul.

          If the money is coming from Westminster, the Scottish NHS is, well, on borrowed time.

          Yeah, I particularly liked that the Cameron Tories told the SNP that they should not build social housing in Scotland but the SNP just worked around the issue via Housing Associations and in some cases just stuck up two fingers and built some council housing.

          It was also reported during the build-up to the independence referendum that Alex Salmond offered to call off the referendum if Cameron and Osborne would state that they would not privitise the NHS, and also allow Scotland to run its own social security system. Cameron refused. TINA, don’t ya know.

          Your other points ring all too true. I’m assuming post-Brexit, working people are in for a world of hurt and probably shorter life spans.

  6. Clive

    Ah, yes, “internal markets”. The self-same mechanism by which the BBC was neutered. Says it all that McKinsey have the nous to get a dose of corporate amnesia over that one.

    Even my TBTF is realising and starting to roll back on attempts to “cost” and “recharge” everything.

    One of the biggest scandals and wastes of public money ev-ah (and this is saying something) was the same approach to running the London Underground — depressing predictability that many of these public-private so-called partnerships set up in the NHS will end up the same way.

  7. Sound of the Suburbs

    Two whistle blowers from the NHS speak out:

    My wife is a district nurse and has experienced Virgin Care directly.

    They took over for a while and messed things up and it then went back to the NHS, but fixing it again is easier said than done.

    When the good staff have gone they don’t come back.

  8. Unna

    Not about the NHS, but I ran across this article in CBC showing the problems in BC care homes run by private for profit corporations vs those run by the public health care authorities. A report was done by the B.C. Office of the Seniors Advocate. This from the article:

    ….According to the data, compared to public care homes seniors living in private facilities are:
    • 32 per cent more likely to be sent to the emergency department;
    • 34 per cent more likely to be hospitalized;
    • Likely to stay in hospital 32 per cent longer;
    • 54 per cent more likely to die in hospital.
    The report stops short of making conclusions about the disparities, but does highlight potential issues in continuity of care at private homes due to staff turnover, lower wages, lower levels of clinical and educational support, and a system that allows operators to continue to receive funding for a bed left empty by a hospitalized client….
    All the things you do to make a higher profit. Also the practice of “Contract Flipping” where the for-profit home contracts out therapy and nursing care services to other companies which are constantly flipped to maintain best profit margins forcing the staff to “reapply” for their jobs and, from my reading on this, also to disrupt the formation of labour unions thereby disrupting continuity of care by the same care providers who know the patient.
    The PDF report:
    This for-profit system, causing seniors to become hospitalized at higher rates, is horribly expensive to the taxpayers and also is a danger to health. So much for saving money through the magic of the market place. The new NDP government has a lot to clean up in this Province after a decade and a half of the BC’ Liberal’s “free enterprise party” party for corporations. I wish them luck. And they’re constrained by the massive debt the BC Liberals left behind, you know, because the Libs are the party of fiscal rectitude. And BC doesn’t print its own money.
    Conclusion: the for profit neoliberal model for delivering health care appears to be bad for your health.

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