Monday, June 28, 2021


Conservative politicians always try to evade, avoid or challenge the claim that they are privatising the NHS, so here this post is setting out the evidence that the NHS is in fact being privatised as briefly and simply as possible.

Conservative ideology can be summed up in the slogan that private is good, and public is bad. 

This is based on the philosophy of individualism, which believes that politics must be based on the individual. 

This philosophy is contradicted by biological science, which has established beyond doubt that Homo Sapiens is a social animal.  However, their false ideology is backed up by the massive power of health corporations, especially US health corporations, who have saturated the US market, and who therefore need to expand into the UK. It is very much in their interest for the NHS to be privatised. Unfortunately, big corporations can persuade politicians to see things their way by giving donations to the Conservative Party. They can also get Cabinet Minsters on their payroll. This Mirror article lists no less than 70 MPs, mainly Conservative, who have received serious money from health corporations, or have had other connections.

In 1977, Nicholas Ridley (a Conservative Minister) wrote :

“denationalisation should not be attempted by frontal attack but by preparation for return to the private sector by stealth. We should first pass legislation to destroy the public sector monopolies. We might also need to take power to sell assets. Secondly, we should fragment the industries as far as possible and set up the units as separate profit centres” (source). 

Ridley here has given a very concise summary of the subsequent history of the NHS.

Here is a step by step record of the privatisation process:

1. In 1987, the Thatcher Government introduced the “Internal Market” in the NHS, by creating a division between purchasers of care services and providers of care services. This immediately increased complexity and inefficiency in the NHS, with huge amounts of administrative work needed to calculate (or estimate) the costs of everything from brain surgery to hip replacements to visiting your GP. This administrative work has imposed a serious cost burden on the NHS. 

2. Foundation Trusts were introduced by a Labour Government, which breaks the NHS down into smaller chunks which are more capable of being sold off. This was attempted in the case of Hinchingbrooke Hospital, but the experiment failed.

3. GPs have been re-organised first into fund holders, and later into consortia, amalgamating practices into larger units which are capable of being taken over by corporations. 

4. Integrated Care Systems were introduced in 2017, which are closely analogous to the US Accountable Care Organisations model. Their aim is to reduce spending. If a private partner in the ICS manages to reduce spending, it is allowed to keep the savings. This is a clear incentive to cut corners.

5. Sir Simon Stevens, CEO of NHS England, has introduced Sustainability and Transformation plans which aim to reduce NHS beds (the UK has among the lowest ratio of beds to population in the developed world), save £5 billion a year in NHS spending, and reduce the number of A&E departments in the UK from 144 to 50. Sir Simon was involved in opposition to Obamacare when he was CEO of a US healthcare corporation.

6. In the negotiations of a post-Brexit trade deal, US corporations are very keen to reduce the ability of the NHS to control drug prices. Their plans could increase the cost of drugs to the NHS by a massive £27 billion.

7. Hospitals are increasingly renting space and facilities to private health care organisations. For instance, Guy’s hospital has rented space to the Hospital Corporation of America for cancer services.

8. Increasing numbers of private centres are being set up to do things like hip replacement surgery, which are simple and relatively predictable. If anything goes wrong subsequently, the NHS is expected to put things right, not the private corporation who did the operation.

The Conservative defence of privatisation

In response to accusations that they are privatising the NHS, Conservatives will say that GPs, pharmacists, dentists and opticians have always been independent sub-contractors. This is quite true, but the difference is that this arrangement was, prior to 1987, stable, but since then, the changes that Conservatives (and to a lesser extent, Labour and LibDems) are creating is causing the private agencies’ role in the NHS to be steadily expanding. 

Tories argue that privatised medicine will be more efficient than care provided by the NHS. The opposite is true. Private provision is far more expensive because of all the accountancy: the bills and invoices applied to every item, right down to the cost of a disposable cardboard bedpan. In the US, administration costs amount to about 40% of total healthcare costs; in the UK before privatisation began, administration costs were 6%. 

It is quite clear that medical insurance is all based on risk assessment. Insurance companies will screen off high-risk patients, leaving them to fend for themselves.

Conservatives also argue that it does not matter who owns the bricks and mortar of the place where treatment takes place, so long as the treatment is delivered. This begs the question of how the treatment is paid for, whether out of general taxation or out of the patient’s ability to pay.  

Conservatives also argue that health care costs are rising unsustainably. This is true, and is due to a number of factors, including changes in the numbers, age, and lifestyle of the population, and changes in medical technology. Rising costs of health care is a universal problem in the modern world, and the NHS is placed in the middle the range in international comparisons regarding cost. 

The answer to this problem of rising healthcare costs is to address demand management by improving the health of the people, and increasing their understanding of self-management of their health. In my 1996 book Bills of Health I calculated that about 20% of the NHS clinical budget was devoted to treating problems caused by unemployment, inequality, sub-standard housing, and pollution. 

In conclusion, there is no reasonable doubt that for the last 40 years of its 73 year history, the NHS has been subject to an insidious series of changes that will facilitate the eventual privatisation and  Americanisation of a much-valued British institution. More evidence on the privatisation can be found on the Keep Our NHS Public website here.

The fundamental reason for Government to exist is to protect the well-being of the population of the country, and ready availability of health care is an integral part of well-being. Any country where a human is denied vital healthcare because they do not have the means to pay for it a country that is simply lacking in civilisation and humanity. The process of NHS privatisation must be stopped and reversed.

This change can only be brought about by grassroots action by the British people. 

Campaigning to save the NHS

We must bring pressure not just on our MPs but also on Parliamentary candidates of all parties, demanding a clear and unambiguous commitment from them that they will work to stop and reverse the privatisation of the NHS. 

We can start by writing a letter, or rather, opening a conversation. The first response from the politician will nearly always be a bland, non-specific set of words. We must go for a long, serial correspondence, in which the MPs’ (or candidates’) responses are defined and refined until they have made a clear commitment will help save the NHS. 

This will be a long process. It will take time and effort and cooperation in local letter writing groups, and we will have to send MP responses to expert groups like Keep Our NHS Public to get their help in answering detailed points. 

This is what it takes to prevent the destruction of our much loved and much valued National Health Service.

Here is a model letter to get you started


DocRichard said...

PFI must not be forgotten.

DocRichard said...
Boris Johnson is facing fresh questions over privatisation in the NHS after new research revealed that £15bn of health service contracts have been handed to private companies since 2015.
The analysis found that almost two-thirds of NHS contracts by value have gone to the private sector in the last four years, and that their total yearly value has almost doubled since then. NHS contracts worth £15bn given to private companies since 2015 despite government’s ‘no privatisation’ pledge, analysis reveals | The Independent