NHS plc, by Allyson M Pollock: Verso, 2004
"When the history of the period following Labour's 1997 election triumph comes to be written," writes Allyson Pollock in this new book, "people will ask with some incredulity how it was that the Labour government managed to dismantle so much of their hard-won welfare state without the public understanding what was happening, and without serious opposition from the government's own party."
NHS plc, published by Verso last month, is a truly depressing read but, like unpleasant tasting medicine, sometimes such things are necessary. So much of what has happened to the NHS over the past ten years has appeared to be chaotic responses to unforeseen events, the unplanned reaction to unexpected crises. However, with the private sector now entwined with the NHS in so many ways, and with the market philosophy so dominant, it is possible, looking back, to draw a path through the crises which demonstrates that the undermining of public provision in healthcare was not accidental. This book draws that path in detail.
Allyson Pollock has been a prominent critic of the policy of private financing of public services, in particular the Private Finance Initiative, introduced by the Tories but embraced by the Labour Government, to build schools and hospitals. PFI projects cost more and provide less than their publicly funded counterparts, but Professor Pollock has been hounded by politicians and industrialists alike for saying so. Here, she details a much wider picture of the private sector involvement in the NHS, from the role of businessmen (and they usually are men) in advising Government ministers on public policy, to the profits extracted on cleaning and catering contractors by driving down pay and conditions.. The book also analyses the way that the private medical businesses have been able to skim the profitable 'cream' from the NHS's caseload, leaving NHS hospitals to deal with the elderly, the chronically sick and those suffering trauma and emergencies - including, of course, patients transferred from private hospitals when their 'routine' private surgery goes wrong.
Not only is this a depressing book because it charts close on sixty years of defeat and compromise by advocates of the principles of the NHS, but it also offers no hope of any improvement in the immediate future. This, it appears, is Pollock giving up on the current generation, and laying down a treatise on the dangers of private profiteering in public health for the benefit of a future, more enlightened, generation. Her book is a history only, charting the original creation of the NHS, the compromises made even in the early days, and the consequent inconsistencies in the NHS which modern-day politicians exploit to justify their onslaught against the core principles of the National Health Service. From there to the present day, Pollock examines each cost-cutting measure, each sell-off, each "opening up" of the "healthcare market" and shows how the apparent chaos is in fact a smokescreen for a gradual eradication of the whole 'untouchable' superstructure of the NHS.
To a degree, Pollock is right that such a stark book is necessary. When even the self-proclaimed defenders of the NHS in the Labour Government seek to undermine the NHS in order to save it, it is important that someone still remembers that their predecessors sought to establish a health care system that wasn't just free at the point of need, but also one which was equitable, universal and committed to improving public health. Such objectives are lost today in a health system which gives Directors of Finance more powers than doctors in NHS decision-making, where private businesses now run a slice of everything and where government policy is dedicated only to enlarging the private sector's slice of the pie.
But history is only part of the story, and although this book provides a very comprehensive account of the current destruction by stealth of the NHS, it doesn't, in fact, answer the question "how did they get away with it?" Pollock offers no concrete analysis of why it was possible for a Labour government to privatise services which even the Tories believes were untouchable, nor of why the unions offered no coherent opposition to the destruction of the NHS. Without such analysis, it isn't possible to see how the drive to privatisation in the NHS can be reversed, and this explains the book's defeatist atmosphere. Pollock appears to no longer believe that the NHS can be saved, and is just hoping that someone, some time in the future, will read this book and be inspired to try again.
In many ways it is very understandable that someone in Pollock's position - having spent so much of her academic life being vilified for telling the truth about privatisation in the health service - is despairing of the possibilities for reversing the attacks. But we must not give up on the present. The current fight in all the unions against the drive to 'marketise' pay and conditions in the NHS - Agenda for Change - shows that there is resistance, but that it is scattered, inchoate and timid. Our task, armed with the kind of material provided by Professor Pollock and her team, is to provide that opposition with the confidence to unite, organise and live up to the scale of the task - to rescue the National Health Service from the hands of the privateers in Blair's cabinet, and remake it, not how it was, but how it was intended to be by those who first conceived of it as a public healthcare system which could be a tool for social equality in an unequal world.