Ten common arguments: reframing the NHS debate
The NHS's values are under attack, even more than its funding is. NHS campaigners need to be sure to frame their defences in these terms.
At the age of 21, whilst still at medical school, I was struck by a serious illness. I was admitted to the Royal London Hospital for a week, before being transferred to the nearby London Chest Hospital to undergo a major operation.
The hospital where my life-saving surgery was performed no longer exists. In April 2015, it was sold-off to a private housing developer, and has since been converted into luxury flats.
So the fight for our healthcare service is a very personal one to me. And with the surge in public NHS land sales across England (an increase of over 70% in the past two years), the marketisation and privatisation of the NHS affects all of us.
We each have our own personal stories of how the NHS has been there for us when we’ve needed it most, and we should share these stories with others. Although facts are important, it’s stories that resonate more with people, and leave a lasting impression.
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Driven by opposing values to ours, NHS England and the Department for Health & Social Care are doing well at determining the narrative. They have been successful in persuading the country that the major problems facing the NHS are the burden of an ‘ageing population’ with complex needs, overwhelming the system’s ability to cope, and the ‘unsustainability’ of the rising costs this creates.
The current response of NHS supporters often plays into this ‘burden’ frame by seeking alternative ways to fund the NHS or focusing on the NHS being deliberately underfunded.
So the objective for NHS campaigners is two-fold:
- To challenge existing dominant narratives, and address the systemic cause of NHS woes: namely, the on-going privatisation of the NHS under the influence of powerful corporate lobbyists.
- To propose a clear alternative, positive vision; one that champions a coherent and cohesive public service ethos, as something distinct from competition and financial incentives.
Framing is a necessary strategy in embedding a different narrative in the nation’s collective consciousness, but it’s not intuitive! It’s a science that requires training, discipline, and repetition - a collective effort over years. It is essential work if we are to cut through the spin of ‘integrated / personalised care’ and ‘tech revolution’ solutions that are currently being promoted.
So how do we do it? Begin by focusing on those that are open to persuasion, remain respectful of difference, be descriptive (tell personal stories), and avoid myth busting. As linguist and cognitive scientist, George Lakoff says: “Even when you negate a frame, you activate the frame. If I tell you, “Don’t think of an elephant!” you’ll think of an elephant”.
Speak to our shared values of cooperation, fairness, honesty, and freedom from insecurity, empathy and responsibility. We all hold these values, it just happens that our environment - education, family and what media we read - dictate which values and ideas are regularly strengthened (a bit like a muscle).
I’ve put together a series of ten common arguments that progressives come up against in advocating for a public service NHS, together with my attempt at brief responses (they are by no means absolute), incorporating some of the framing methods discussed. Get those discussions started, and practice framing your ideas daily!
Here are the common arguments (avoid repeating this frame in your response), with, underneath, the reframed response (how to put the discourse on your own terms and dictate the narrative).
Argument: “The NHS is not being privatised”
Reality: The NHS works best as a unified organisation, not a fragmented mess. Catering, cleaning & laundry services were outsourced in the 80s. Private providers hiding behind the NHS logo now run clinical services too; Branson’s Virgin Care has over 400 contracts worth £2bn. It’s out of the public eye because it’s dishonest.
Argument: “But GPs are private providers”
Reality: GPs are self-employed community doctors that prioritise patient care. They’re under threat, with hundreds of practices closing annually and tax-avoiding corporations that prioritise shareholder profit - such as Virgin Care and Care UK - increasingly taking over. GPs are our hardworking & trustworthy allies.
Argument: “Competition and private provision are better”
Reality: Competition (running the markets, the tendering & bidding process, awarding & administering contracts) costs the NHS £billions annually. And it leaves those most in need of good healthcare (less profitable patients) least able to access it. So NHS privatisation is not only inefficient, it’s unfair.
Argument: “The NHS is well funded, but we can’t afford it”
Reality: The NHS provides very good value for money. What we can’t afford are privately built and operated (PFI) hospitals, which drain £2bn a year out of NHS front-line care, and into profits for private companies. We must prioritise public health investment over unaffordable outsourcing and restructuring.
Argument: “The ageing population is a burden”
Reality: People are living more active lives in retirement. Our elders make an immense contribution to society through trade, childcare (UK some of most costly), and voluntary work. The state should offer protection to its citizens, over burdensome tax-avoiding corporations and pharmaceutical industry cartels.
Argument: “We need to stop health tourism”
Reality: The NHS relies on overseas staff (almost 13% of the workforce). Given the global shortage of healthcare workers, we’re lucky the NHS is held in such high esteem that people are prepared to come to work here. By charging and discriminating against migrants, we undermine the very values that make the NHS so special.
Argument: “The German [insert other country] model is better”
Reality: Marketised healthcare systems are more costly to run and provide unequal access. Instead, look to our own great history of community & cooperation for inspiration; it was the ineffective mix of public, private and voluntary sector provision that existed prior to the NHS, which led to its creation after WWII.
Argument: “The NHS is outmoded. Technology is the future”
Reality: State provided, universal healthcare is the most progressive & sustainable form. There’s an important role for tech, but within our privatised system it’s open to exploitation. There are 100,000+ NHS job vacancies - irreplaceable by tech. The priority must be reversal of privatisation and investment in safe staffing levels.
Argument: “People should take individual responsibility, not abuse the NHS”
Reality: Access to good healthcare is a basic freedom from insecurity that the state has a responsibility and the means to provide. It should also remove societal barriers that prevent people from keeping healthy (poverty, education, employment, housing). It is by investing in people that we empower them to help themselves.
Argument: “The NHS will always be there for us”
Reality: Since 2012, the Health Secretary no longer has a duty to provide universal healthcare. So now people are increasingly being denied treatments. We have the longest A&E waiting times & greatest staff shortages on record. None of us voted for privatisation. We demand accountability for the erosion of our NHS.
 Lakoff, George, Don’t Think of an Elephant: Know Your Values and Frame the Debate (Chelsea Green Publishing, White River Junction, Vermont: 2014) xii
 Evans, Robert G., An Undisciplined Economist: Robert G. Evans on Health Economics, Healthcare Policy, and Population Health (McGill-Queen’s University Press, Montreal, Quebec: 2016)
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