NHS plc by Allyson Pollock

8 February 2008

Rupert Read reviews NHS plc by Allyson Pollock.

This book exposes the terrible damage being done to the NHS by New Labour's addiction to privatization.

I've just finished reading a book by Larry Elliott and Dan Atkinson: their prescient polemical little masterpiece, Fantasy Island: Waking up to the incredible economic, political and social illusions of the Blair legacy. That book paints a powerful picture of Britain as a debt-sodden country overdrawing badly on its ‘natural capital'. (See also Theodore Dalrymple's provocative review here) One of the cleverest chapters in the book is their devastating and in fact very funny (if it wasn't so tragic) expose of the dreadful worst-of-all-worlds melange that is the Blair-Brown looking-glass landscape of the ‘public services' as they are ‘reformed' (i.e. privatised) into oblivion. Elliott and Atkinson show powerfully how Britain has to choose between, on the one hand, public services for all, and on the other hand, a ‘choice'-based illusion of public service which will serve the wealthy and leave the poor reliant on a second-class (but nice-and-cheap) system.

They rely heavily on and cite with appropriate hat-tipping the book that above all others makes clear the painful nature of this choice: Alysson Pollock's magisterial NHS plc. The opening lines of its closing chapter, "The emerging health care market", make the stakes starkly evident:

The NHS is being dismantled and privatised. Very soon every part of it will have been ‘unbundled' and commodified...a new business dynamic is taking charge of the ways in which services are provided and patients are responded to. The dramatic costs involved - in terms of loss of equal access and universal standards, as well as of money - are concealed by claims of ‘commercial confidentiality' and by tearing up the once-exemplary systems of NHS accounting

Our New Labour government's most brilliant achievement of spin has not been its - exposed and now failed - effort to conceal the truth over why it attacked Iraq, but its - largely successful - concealment of the destruction under its tutelage of Labour's greatest ever achievement. It is an act of true political brilliance that the NHS is being dismantled by the Party that created it whilst successfully posing as its saviour.

But, as Pollock predicted, and Elliott and Atkinson point out, this PR success too is unravelling. The NHS is in serious financial trouble, and for the first time ever, more citizens now trust the Tories (heaven help us!) with the NHS than New Labour.

When I was at Oxford taking PPE 20 years ago, my best friend was Simon Stevens, who went on to become Tony Blair's key health policy adviser. Back then, he was a socialist. Now, he is Chair of United Health Europe, one of the US's giant corporations profiteering from the break-up of the NHS, and angling to take over doctor's surgeries across the UK. That little timeline symbolises quite a lot about what has happened to the NHS.

As for me, meanwhile: One of my proudest moments ever at Green Party Conference was chairing a plenary session at which Pollock's mentor and co-author Colin Leys spoke out about NHS plc to rapturous applause. But the message needs to get out far wider. The almost unbelievable story about how the most successful health service in the world is being taken from us brick by brick and pound by pound needs to be widely known.

One can say in response that the NHS was never perfect. Indeed, Pollock herself details how it was perhaps fatally compromised by primary care never being nationalised. One could add to that something that Pollock neglects to address: the deep importance of prevention, and how ultimately what we need is not only to defend the NHS, but to transform it into a national wellness service, with a smaller budget for its big hospitals.

But the NHS was incredible value for money and the envy of countries and experts from Moscow and Havana to Berlin and Washington. And I've started speaking in the past tense since, for now, the NHS is half-abolished. It is dying; or rather, being killed, because of the dogmatic neo-liberal belief of Brown et al that private solutions must trump public ones. It is on the way to becoming little more than a kite-mark for numerous outsourced profit-making operations.

If one wants to understand how the NHS has been cherry-picked, cream-skimmed, and bled dry financially by the private sector, at the bidding of the Party that once upon a time created it, then there is one thing above all that one needs to do: read this book.

(Allyson Pollock, NHS plc, Verso 2004)

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