Covid-19, Privatisation and the NHS
Covid-19 has exposed where we are with the mindset created by 40 years of privatisation and neo-liberalism. The key phrase that is being trotted out by Ministers is – “we have to protect the NHS”. This social construction is interesting as the NHS was set up to protect the population from the inequity of charity on the one hand and insurance-based healthcare, that only the rich could afford, on the other. By turning it on its head, your ‘duty’ to the country is now to protect the NHS. This illustrates just how important the NHS is in UK politics. The Tories have identified that, in place of the old jingoism of wrapping yourself in the Union Jack, it is now expedient to use the NHS flag for the purpose of winning popular support. The sight of Tory Ministers, who have written books and political pamphlets about dismantling the universal and socialised NHS in favour of an insurance-based US style health system, extolling the virtues and even claiming credit for setting it up in the first place, is a sick joke. It is worth remembering the Tories voted against the establishment of the NHS in parliament in 1948.
The Coalition Government’s, Health and Social Care Act of 2012 opened the way for expanding the privatisation of large areas of NHS activity. This has led to tax dodging, Richard Branson’s Virgin Healthcare Group suing the NHS for contracts not won in compulsory tendering processes. The eye watering levels of private sector delivery of services within the NHS was exposed last November by the Guardian:
“Private firms have been handed almost £15bn in NHS contracts in the last 5 years… The value of contracts given to non-NHS providers, mainly profit-driven firms but also including some social enterprises, has soared by 89% since 2015, from £1.9bn to 3.6bn a year.”
The sight of Hunt as the new chair of the all-party parliamentary health select committee holding a new Tory health minister to account for failings, would be funny if it wasn’t a sick joke. The junior doctors who battled so hard for decent pay and conditions remember him in different terms. The TV footage of Iain Duncan Smith and fellow Tories cheering in parliament when they defeated the move by Labour to give NHS staff a pay rise in 2017 sticks in the craw, as does the image of Johnson thanking the staff at St Thomas’s for saving his life. It does however underline the power of the NHS in the British mindset.
Then we remember the Coalition Government and the 2010 general election and Lib Dem Sir Norman Lamb, recently knighted for services to the Tory Party mission to privatise the NHS and save the country from socialist public spending. With no electoral mandate or any mention of austerity in their manifesto the Lib Dems went into Government and set about destroying the NHS and attacking disabled people. Lamb was central to this as health minister, they couldn’t have done it without him. Whilst advocating, particularly for mental health services, Lamb approved billions of so-called ‘efficiency savings’ to the NHS budget – cuts dressed up as necessary belt tightening. He then imposed savage year on year budget cuts whilst bleating in the media about individual cases where patient care was being adversely impacted. For this he came to be known as hypocritical ‘unacceptable’ Norman, bemoaning the cuts he himself and his Government had imposed on his constituents and the country. Sir Norman’s legacy continues to scar the NHS and its ability to respond to the Covid-19 pandemic and the lives of people in mental health distress.
One of the biggest areas to be affected was mental health, an area supposedly championed by Sir Norman. The combined effects of the ‘efficiency’ savings and austerity cuts directly led to disastrous reorganisations of services with many community-based front-line services being closed. This in turn led to a deaths crisis of patients in the homeless and rough sleeping communities. It led to the destruction of drug and alcohol services and for those with enduring mental health conditions. These services have never recovered and Sir Norman’s legacy continues to scar the NHS and its ability to respond to the Covid-19 pandemic and the lives of people in mental health distress.
Naomi Klein alerted us to the ruling class using crisis to expand their neo-liberal project. In, The Shock Doctrine – The Rise of Disaster Capitalism, she argues that national crises, disasters or upheavals are used to accelerate radical and reactionary solutions while populations are too emotionally and physically distracted to resist. Under the cover of Covid-19 the Government have sneaked through and ramped up outsourcing in the NHS. This is a naked power-grab by the private sector designed to boost profits and undermine the ability of the NHS to deliver, even further than has already happened. Testing has been handed to by those well-known health specialists in Deloitte, KPMG, Serco, Sodexo, Mitie and Palantir, a US data-mining group. These parasitic management consultancy arms of global accountancy firms are being rewarded for helping the rich evade and avoid paying taxes and off-shore profits to tax havens. The Government are not fully utilising accredited laboratories in the NHS in favour of their donors and supporters.
The failure of this policy has seen the Government forced into partial retreat and return some testing services to local public health bodies, but the damage has already been done and unnecessary lives lost.
Two factors that have undermined the UK’s ability to implement an effective and coordinated response to the pandemic - the undermining of public health and the privatisation of social care in general and care and nursing homes in particular.
The relentless privatisation of social care, begun under Thatcher, continued by Blair and Brown and accelerated by the Coalition and Tory regimes since 2010, has resulted in a deaths crisis in care homes and the community which will equal and may surpass those in hospitals.
Public health was not a ‘saleable’ asset so it was moved to local government in 2012. The Tories hostility to local government has seen massive funding cuts to public health and preventive and community-based services since 2010. This has further weakened public health’s ability to respond in the pandemic. The result is that the two weakest areas, care homes and contact tracing and testing have been exposed in the Covid-19 response.
The other thing we have to remember about the NHS is that policies adopted in the years since Thatcher, mean that it is now not only one of the largest organisations in Europe, but also one of the most contradictory. This, more than just external political threats, helps explain both its poor state of preparedness for the pandemic and also its often inappropriate response to it.
First, we should ask ourselves a question. Those hundreds of thousands of people, now clapping the NHS, especially those who voted for an extreme right wing Johnson government in the last election, who do they have in mind when they applaud? Is it the ranks of junior doctors, highly skilled consultants, expert nurses and other medical staff, or the ever-growing ranks of senior managers and money men who are actually determining the NHS’s culture and direction of travel?
We can guess it’s the former that they have in their mind’s eye, but, bet your bottom dollar, it will be the serried ranks of bureaucrats who come off best after the pandemic. They will get the plaudits, the promotions, the gongs. But most of all we can expect their power to increase.
And this is the ‘other’ face of the NHS we have to acknowledge. It is expressed in its culture of bullying; the demoralization of many overloaded staff; the oppression of whistleblowers and its wrong-headed target system (as we saw at Mid-Staffs), that can damage rather than prioritize patients. Sadly, while healthcare (alongside social care) frontline staff have been worked to a standstill, under Covid-19, offered inadequate protection and too often have died, senior managers have colluded in appalling political decision-making over the pandemic.
Where are the highly paid managers who broke ranks and challenged initial failures to address Covid-19 properly? Instead, evidence suggests, they presided over a regime which called a halt to other necessary treatments - causing long term damage to thousands; frightened people away from outpatients and accident and emergency departments and acquiesced to the ludicrous Nightingale and other prefab hospital project, with all its cost and waste.
If we really love the NHS and if we don’t want to see it fail again when there is another public health emergency, then we have to be honest about its two faced nature. Years of hollowing out, privatization and bureaucratization mean that only the commitment and often exploitation of its front line staff and dedicated clinical leaders are deflecting it from its ever-growing political purpose. This is to be a cash cow for the private sector and a nest egg for an ever growing corps of second rate senior managers and governance committees. It’s no longer enough to clap, support or even fight for the NHS. We have to fight for our NHS not the Tory Party’s and its investors’, otherwise that’s all we’ll be left with.
