Thursday 7 November 2019


Those of you who read my blogposts regularly know how often an article in the London Review of Books (LRB) will shape my way of thinking and lead me to create a piece in which I can share these new insights with a wider audience. The latest edition of the LRB (7 November 2019) carries a short article - under the title The NHS Dismantled - by John Furse, a screenwriter and film-maker whose latest work: Groundswell: The Grassroots Battle for the NHS and Democracy is available online. Reading John Furse's analysis has led to this blogpost but it would be good to reference a couple of blogposts about the NHS I published back in 2016 before sharing my new insights.

Here is how the first of those two posts began:

"Tuesday, 29 November 2016


I am still on a learning curve. Having researched and written my book - The Road to Corbyn [Press here for a link to details about that publication] - about the misgovernment of the UK from 2010 to 2015, I knew a fair bit about the threat to our NHS. But by no means all I needed to. Thanks to a Momentum comrade, Mick Kennedy, I have now discovered and read a book by a London doctor who works as a G.P. in London, in Tower Hamlets. His name is  Youssef El-Gingihy and his book is called 'How to Dismantle the NHS in 10 Easy Steps' (2015). Thank you, Youssef, for widening my understanding. I hope that you will be drawn in to reading what follows as I present the main thrust of his account of this public scandal - the Theft of the NHS from the People of the UK. I hope you are as appalled as I am -  and like me, go and tell the world about this larceny." 

Press this link to read Part 1. This part has had 1121views to date.

Press this link to read Part 2. This part has had 1088 views to date.

The professionals who are the backbone of our NHS

John Furse in November 2019, three years after my first NHS blogposts and four years on from Youssef El-Gingihy's revealing exposure of a public larceny, begins his piece with an assertion:

'The Americanization of the NHS is …. already in full swing.' [My bold lettering) He then proceeds to amply justify his claim.

  • Since 2017 Integrated Care Systems (ICSs) have been taking over the purchasing as well as the provision of NHS services, deciding who gets which services, which are free and which - as with the dentist and prescriptions - we have to pay for. ICSs are partnerships between hospitals, clinicians and private sector providers designed - and incentivised - to limit and reduce public healthcare costs, and in particular to lessen the demand on hospitals. Their inspiration comes from US health insurance provision.
  • The NHS at the beginning - Aneurin Bevan, the Minister for Health and founder of this national service, with a patient and nursing staff
  • Two years before Thatcher came to power in 1979, Nicholas Ridley - a leading Tory neoliberal - wrote that 'denationalisation should not be attempted by frontal attack but by …. stealth. We should first pass legislation to destroy the public sector monopolies. We might also need to take power to sell assets. Secondly, we should fragment the industries as far as possible and set up the units as separate profit centres.' The Tories have had a strategy in place for privatisation for over 40 years.
  • In 1986 hospital cleaning services were privatised.
  • In 1988 Oliver Letwin and John Redwood - yes, they are still active Tory MPs - published 'Britain's Biggest Enterprise: Ideas for Radical Reform of the NHS'.
The NHS worked well - free from the profit motive. Why change? (A clue: greed)

  • In 1990 Ken Clarke created the internal market within the NHS through the NHS and Community Care Act - the NHS was split between 'service purchasers' and 'service providers'. Hospitals and GPs would compete for custom and the successful parties would be rewarded with greater funding. 
  • New Labour too was attracted by these American-inspired ideas. Tony Blair's 1997 National Health Service Act further moved NHS hospitals into being trusts that could operate as commercial businesses. The patient became a 'consumer' and the goal was called 'patient-choice'. Many trusts formed Private Finance Initiative partnerships to build and maintain hospitals. These deals were originally worth £11.4 billion; now they have lumbered the NHS with more than £80 billion of debt.    
    Still the NHS continues to function, despite the cuts and reorganisations. How? (Some clues: love for the job, goodwill and personal sacrifice)
  •  Under the Tory Lib-Dem Coalition government (2010-15) the implementation of the American model accelerated. The  2012 Health and Social Care Act enabled hospital trusts to raise 49% of their budgets from private patients and other sources. 
  • This Act gave more than 60% of the NHS budget to local Clinical Commissioning Groups (CCGs), comprised of GPS and other clinicians, to be used to commission services from the private sector as well as the NHS. Given their lack of business expertise, CCGs were provided with Commissioning Support units run by private companies including KPMG and Price Waterhouse Cooper. In practice, these private companies now run the franchising of NHS services - and make a profit in doing so. 
    Care and love - not profit. Why not? 

  • This is what neoliberalism is all about - the maximising of the number of opportunities to provide a paid-for 'service'; the more such transactions there are, the more the cash flows and the greater the profits to be made in that sector of the economy. But such wealth tends to stay within the hands of those who are rich enough to participate in the first place; there is little 'trickle-down'; and we are talking here about the national health service - our health should not be the source of other people's profit in a country that created the NHS in 1948. 
  • The 2012 Act also abolished the health minister's responsibility for national healthcare provision. [Yes - you read it right.] Such responsibility now lay with NHS England under its new director, Simon Stevens. He had been a health advisor to New Labour and before that the CEO of United Health, leading the corporate opposition to the introduction of Obama-care in the USA. 
    We were out on the local campaign trail here in St Ives, Cornwall in February 2017
  • In 2015, NHS England under Stevens' leadership launched their five-year plan which saw the establishment of Sustainability and Transformation Plans (STPS) which were supposed to create savings of almost £5 billion a year by 2020. How? By reducing access to care. 
  • The STPs divided England into 44 areas all of which were put under pressure to amalgamate hospitals and shrink specialist units. Hospital beds have been cut; the UK's bed-to-patient ration is now one of the lowest in any developed country. Accident and emergency departments, which not only require expensive equipment and high numbers of staff but also take the brunt of the consequences of Austerity and social care failings, are being cut from 144 to about fifty. GP care is increasingly provided by 'physician associates', nurse practitioners and pharmacists. Patients are encouraged to go online and use profit-making and  privately-owned consultancies. US tech and medical giants are queuing up for entry into the NHS market, not least after any post-Brexit, Tory UK-US trade deal.
  • Enforced centralisation has resulted in 'hub' hospitals and fewer, larger GP practices: at least a thousand have closed since 2014 and the number with more than twenty thousand patients has tripled.  
  • The rationing of non-urgent operations such as hip replacements encourages patients to seek private treatment - if they can afford to (and even if they cannot). 
    July 2018 - Stephen Vranch presents our birthday card to a member of the NHS team at Treliske Hospital, Truro

  • Since 2012, the Stevens era has seen mega-large private companies becoming more and more involved in the workings of the NHS. It seems indisputable that private companies, with their increased overheads, higher rates of borrowing and shareholder dividends, are inherently more costly to the public than state-funded services. It seems also the case that the management and administration involved in franchising and marketing NHS services has also become more and more costly. Privatisation is probably adding at least £9 billion a year to the NHS budget.  
  • Stevens recently called for the repeal of Section 75 of the 2012 Health and Social Care Act. This looked as if it was a move away from privatisation but the small print tells a different story - this is another step in the deregulation of the NHS market.
  • NHS property and land assets worth £10 billion are being sold to private developers. 
    August 2019 - a reminder of the most important issue facing us - our extinction through climate change - and how the PM of the country was using every opportunity to present himself as the champion of the NHS by visiting as many hospitals as he could. Here at Treliske, Extinction Rebellion got to hear that he was coming ...

  • The fragmentation of a once fully integrated service into competing and commercially-driven units is well advanced. This transformation has been accomplished without proper public scrutiny, knowledge, consent or appropriate Parliamentary legislation. The media has failed to recognise the overall shape of the project.
    …. and so this protest was organised (I'm on the far left of the picture.)

  • The contacting of ICSs will be concluded within 18 months - if the Labour Party is not returned as the party of Government on December 12, next month. A Jeremy Corbyn-led socialist government will start reclaiming the NHS for the people.   
    High noon - Boris Johnson is driven away -  (a prophetic image!)

This has been such a disturbing blogpost to research, write and publish. Our health is of such fundamental importance. How dare these Tories do all this behind our backs, calculating that their control over the media and our minds is such that we will remain ignorant. A General Election provides that rare opportunity to demonstrate the power and worth of the people. Please, let's use it!   


  1. It has been a disturbing blog to read... but what else can be expected from a morally bankrupt bunch of .... I wish I could give full vent to my anger in written word .. but please fill in with any of the expletives you imagine I would add

  2. "LEST WE FORGET" . This is a compelling revelation of the present and seemingly inexorable drift back to my own childhood days, which began 10 years before the NHS was 'born'. I vividly recall the despair and helplessness of all working class families like mine because of our collective lack of financial resources, to enable us to pay to banish the terrible pain and suffering from the stunted lives of people of all ages. However once Nye and Jennie shone their 'Socialist light' and raised the publics awareness that we could, if we politically organised, bring about the birth of the NHS. This wonderful initiative heralded the removal of the completely unnecessary suffering and premature deaths visited upon the many by the few. We were thereafter, able to produce a social structure that liberated the intellectual and physical talents of all our people. This one, unbelievable 'Political' initiative has allowed us to build a more productive and happier society. All we have to do now is to stop 'the few' from stealing it back from us and returning us to the shadows, where fear and despondency will surely replace the chains that we have, only so recently, shaken off.

    1. Excellent blog post Rob. You clearly lay out the strategy from the first encroachments of Neoliberalist ideology to the current situation. The ideology that private companies competing for work creates efficiency and increases productivity though clearly false where public services are concerned, remains largely unchallenged. The movement from 'Sustainable Transition Plans' (the Orwellian language is blatant) to Integrated Care Services, and then on to Accountable Care Organisations is presented as non-ideological but simply common sense. Bringing all the different organisations and sections under one roof to increase efficiency. This is what we were told by Lib Dem and Tory Cornwall County Councillors when they were debating it. But Accountable Care Organisations, which will orchestrate the provision of care through both Health and Social Care agents, effectively doing what Local Authorities used to do, are not accountable to the people, nor to the clinicians, nor to the Government. They are accountable to the contracts that they sign. These contracts will determine what kind of treatments have to be provided and how many of them within the cost agreed. So if there is a need for more than what has been contracted for, there is no requirement to do them. This is the tried and tested Insurance company system: once the amount you are insured for has run out, you are on your own. If you need a treatment that is not included in the contract, you are on your own.
      Scary. and the Lib Dems support this in Cornwall.

    2. Thanks Harry and Joseph for sharing your thoughts on the NHS - I have been so taken up with campaigning in this all-important General Election, I have only just now realised you've added these comments. You both offer important insights - we are united in our determination to resist these neoliberal moves to dismantle our NHS. Thank goodness, I am finding the NHS my default vote winner in doorstep dialogue.