We can restore Bevan’s full service only if we talk about its corporate capture, argues Esther Giles, presenting a new Report to last Saturday’s Socialist Health Association Conference marking 75 years of the NHS

In its Report, In Place of Profit, released at its National Conference on 1^st July, the Socialist Health Association shines a light on the corporate and relentless creep on the NHS. It argues that political donations are a symptom of a deeper issue – that of corporate capture and progressive privatisation. Thus, we have seen England’s NHS services pruned back from comprehensive, universal provision, to make space for the global healthcare industry.

The NHS’s 1948 creation under Aneurin Bevan’s In Place of Fear gathered all health services and staff under public control, to bring everyone the healthcare they needed- from local general practice to the local general hospital. This would wipe out private, for-profit health care.

Bevan noted with satisfaction how these “innumerable harpies who battened on the sick… are slowly being eliminated.”

For the harpies, the service and the wider welfare state became a problem to solve.

So though most of the UK still cherishes Bevan’s agenda, corporate healthcare and its political representatives have led a four-decade counter-revolution against a service they called “monopolistic”. They have done this to an antithetical, now dominant agenda, of shrinking essential services into socially insufficient profit schemes.

Current mainstream critique of corporate influence focuses heavily on political donations (which the SHA analyses separately). However, donations are but one part of more entrenched and consistent expressions of power. For another, our report illustrates for-profit healthcare’s revolving door with our NHS, via a dose of senior executive career paths: Michael MacDonnell to DeepMind; Tim Ferris from Mass General; Sam Jones to Operose Health.

The SHA view is that defending the NHS means understanding how symptoms like donations and the revolving door fit within a political system that business has tailored for itself. And the need to dismantle that edifice, wrenching back a service built on simply bringing the best local primary care and hospital services to the whole country.

Decades of lived experience say we can provide such a comprehensive, public NHS, no matter the population’s age. The 1979 Merrison Royal Commission also found it to be the most cost-effective approach to healthcare provision.

Conversely, the US has non-universal care that costs more than double per head as the UK’s. Beyond what is profitable, it is, in fact, the private sector that is unable to sustain comprehensive, universal provision! So, clearly, emulating the US’ accountable care organisations’ (ACOs) “efficiency savings” has been about developing and sustaining that sector.

In over thirty years’ experience, particularly in the English NHS, ‘market’ policy thinking – which differs little from the commercial practice of corner-cutting – has not shown any social purpose. This is despite recurrent ‘reforms’, each one somehow pretending to reverse its previous stage, while all steadily furthered US managed care, thus signalling quiet, long-term Establishment commitment.

The more these commercial forces maldistribute healthcare, the more they vindicate Julian Tudor Hart’s inverse care law – whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. The SHA strongly believes that a future Labour government must break with the commitment to Integrated Care Systems’(ICSs) smaller, US-government-like role for public healthcare – however many bridges this may burn with the private healthcare Establishment.

But this is also a challenge to policymakers and managers – to them we ask: “Is there really no alternative than shrinking from such a valued public service as our NHS?”

The SHA and Labour Conference already have committed to the Reinstatement of the NHS as set out in the NHS Reinstatement Bill, which proposes to: 

“restore the NHS as an accountable public service… abolishing the purchaser-provider split, ending contracting and re-establishing public bodies and public services accountable to local communities.”

The SHA view is that:

• The NHS should deliver for the different populations and nations of the United Kingdom a level of healthcare based on their needs rather than ability to pay.

• This should be comprehensive, public provision.

• It should operate in the context of a functioning welfare state which holistically addresses the social determinants of health.

In providing the framework for the Restored NHS, we should potentially refer to an updated NHS Reinstatement Bill in light of the 2022 Health and Care Act.

Esther Giles is a Former NH S Regional Finance Director (Specialised Services) & SHA Treasurer. The Report In Place of Profit, written by the SHA NHS Policy Influences Working Group, can be downloaded here. The Working Group’s members were Esther Giles (Chair of Working Group): MA: MSc: CPFA, Tony Beddow: BSc; FIHSA, Nicholas Csergő, Brian Gibbons FRCGP, MB, BCh, BAO, Mervyn Hyde.

Main image: Esther Giles presenting the Report to the SHA Conference, also pictured in text.

Upcoming events

Keep Our NHS Public Rally tonight Wednesday July 5th

• 6:30 Start
• Ellen Clifford – DPAC activist and author
• Lester Holloway – The Voice
• Andrew Meyerson – Junior Doctor + SOS NHS
• Tony O’Sullivan – Co-chair – Keep Our NHS Public
• Holly Turner – Nurse – NHS Workers Say No
• Pallavi Devulapalli – GP – Green Party Health Spokesperson
• Richard Burgon MP – Labour Party
• Harry Eccles – Nurse – NHS Workers Say No
• David Wrigley – NHS GP and BMA Council
• Jordan Rivera – Occupation Therapist
• Chantelle Lunt – Merseyside BLM Alliance
• Margaret Greenwood MP – Labour Party
• Announcements
• 8:00 Close

Register here

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SHA fringe meeting on the eve of the Durham Miners’ Gala in the Old Town Hall, Durham from 18.00 on Friday 7th July 

SPEAKERS:

• Mary Kelly Foy MP for City of Durham;
• Alex Gordon President, RMT;
• Jamie Driscoll, Mayor North of Tyne;
• Allyson Pollock, professor of public health Newcastle University:
• Jude Letham, Co-ordinator KONPNE;
• Lesley Spillard, Vice Chair SHA.