The NHS lurches from crisis to crisis. In this explainer, Alia Butt analyses why

Counterfire’s Socialist Explainers series

It seems that we’re constantly being told that the NHS is unaffordable and that our healthcare demands keep growing beyond what a public service can sustain. This is the established story, but is it the reality? In actual fact, the UK spend per person on healthcare is lower than that of countries like France or Germany, and less than half that of the US. Our spend on long-term care is also lower than that of most other First World nations. So, why the insistence that the NHS is unreasonably expensive?

The truth about the NHS is that the private sector has been enmeshed within it from the very beginning. When the Labour government that was elected after World War Two moved to set up a national health service, the overwhelming majority of doctors, including the BMA, were vehemently opposed. The Tories voted against the bill twenty-one times. The NHS that resulted was a compromise, with GP surgeries remaining as private businesses and senior doctors allowed to continue their private practices.

The uneasy co-existence of the public sector and the private sector in the health service continues to this day with the balance tipping further in favour of private ownership. The drive towards privatisation started almost immediately with the introduction of prescription charges in 1952. Politicians ideologically opposed to the NHS as a public service have never wanted us to see free healthcare as possible. They prefer we understand the NHS as something needing private sector ‘efficiencies’ to function effectively.

In 1983, for example, Margaret Thatcher deceitfully promised to keep the NHS safe, but was keen to underline how much public money it took:

“Let us never forget this fundamental truth: the state has no source of money other than the money that people earn themselves …. People talk about a free service. It isn’t free. You have to pay for it.”

Thatcher’s complaint here was that the wealthy and corporations were having to pay their share of everyone’s healthcare costs, as opposed to a private model where everyone had to find the money to pay for their own healthcare needs, regardless of their capacity to do so.

It is the oldest trick in the book to destabilise a social infrastructure intentionally by taking more money out of it, so it becomes completely inadequate and collapses under pressure. The more the government creates crises in the NHS, the more the potential support for privatisation, even from people who don’t like the idea but agree that things are currently unsustainable.

Whether it be the winter crisis, mental-health crisis, wheelchair crisis, bed crisis, cancer-care crisis, maternity crisis, emergency-service crisis; all have been generated and maintained by the Conservative government’s drive to syphon taxpayer money away from the NHS and into other areas of spending. The Covid-19 crisis has indeed been a catalyst for the demise of the NHS, but the NHS would not have been at such a weakened starting point had it not been for over a decade of unnecessary austerity.

With unchallenged Tory corruption on the rise, privatisation is now thoroughly ripping through the NHS. Twenty-five percent of NHS funding is going into private companies. GP surgeries are increasingly in corporate hands, for example, and many people are resorting to the use of private healthcare as NHS waiting lists lengthen to record highs. Crucially, however, much like before the creation of the NHS, many others once again go without.

The Health and Care Bill will mean further uncertainty. Legislation will make it easier for private companies to bid on tenders without competition, while allowing them to sit on boards that make decisions where and how taxpayer money is spent.

It will also introduce a decrease in staff pay and deregulation of professions, leaving staff and patients to struggle further. The NHS will look less like the one imagined in 1948 – free at the point of use, delivered by well-trained professionals – and more like the US system, which costs more than twice as much.

The private sector is keen on some kind of healthcare service as there is money to be made from it, but its involvement compromises equity, efficiency and affordability. The fairest and cheapest way to provide decent healthcare to all remains a publicly funded and publicly run health service.