A new report, from the
Institute of Economic Affairs (IEA), chronicles four decades of
NHS-related privatisation conspiracy theories. It finds that none
of these prophecies have materialised – the UK still has an
unusually state-centred healthcare system – but that claims about
privatisation have been used to shut down discussion about useful
reforms and inhibited progress in healthcare.
Report author and IEA Head of Political Economy, Dr Kristian
Niemietz, finds that privatisation claims are not limited to
obscure blogs, but are found in mainstream newspapers and
magazines such as The Guardian and The
Independent. Its main purveyors are not eccentric fringe figures,
but mainstream journalists, academics, senior members of the
British Medical Association (BMA) and the Royal College of
Nursing (RCN), large trade unions such as Unite, and Members of
Parliament, including shadow cabinet members.
However, the idea that there is a sinister secret plot to
dismantle the NHS and sell off its parts, expand outsourcing,
defund the system or introduce widespread user charges, does not
stand up to scrutiny. As Dr Niemietz notes, spending on private
providers (i.e., companies such as Bupa) accounts for less than
one-tenth of the NHS budget, a figure that has not been rising.
Further, private hospitals only account for one in ten hospital
beds in the UK, compared to three out of ten in Austria, four out
of ten in France, six out of ten in Germany, seven out of ten in
Belgium and ten out of ten in the Netherlands.
Panic about NHS privatisation comes in waves. In the 1980s, many
commentators were convinced that outsourcing non-clinical
hospital services, such as cleaning and catering, would lead to
the ‘creeping privatisation’ of the health service. In the 1990s,
there were elaborate theories about how the internal market
reforms of 1990–91 would be the NHS’ demise. In the Blair years,
the extension of patient choice, the creation of Foundation Trust
hospitals, the Private Finance Initiative (PFI) and the
involvement of independent sector treatment centres were
variously described as the final nails in the NHS’ coffin. Even
in the Brown years, when the financial crisis crowded out most
other issues, NHS privatisation paranoia did not come to a halt.
In the 2000s, the NHS budget grew by more than 6 per cent per
year in real terms, yet The Guardian still talked about
how ‘cash squeezes’ were paving the way for privatisation. The
Health and Social Care Act 2012 was claimed to be a Trojan Horse
for privatisation, and its reversal in 2021 was also described as
a Trojan Horse for privatisation. Throughout 2019 and 2020, there
was a widespread panic about how a post-Brexit UK–US trade deal
would enable privatisation. This, of course, did not happen.
The recurring moral panics around the NHS are not a harmless
eccentricity. It has created a toxic climate of paranoia and
hysteria, in which it becomes nearly impossible to evaluate
healthcare policy changes on their own merits.
Even though the health reforms of the past 30-odd years have
provided plenty of opportunities for it, constructive debates
rarely happen in Britain. There were no meaningful discussions
about the pros and cons of the Health and Care Bill, the Health
and Social Care Act, Foundation Trusts, Independent Sector
Treatment Centres, patient choice, waiting-time targets, PFI, GP
fundholding, the internal market or any other major health
reform.
It is perfectly feasible, if not necessary, to critique current
health policies without claiming that they will lead to the
destruction of the NHS. In order to make better healthcare
policy, conspiracy theorists must be held accountable for their
false prophecies.
Dr Kristian Niemietz, IEA Head of Political Economy and author of
'Repeat Prescription: The NHS and four decades of privatisation
paranoia', said:
“NHS privatisation prophets are a peculiarly British version of a
Millenarian doomsday cult. Campaigners have been predicting the
imminent destruction of the NHS for over 40 years, and so far,
their predictions have had a success rate of exactly 0 per cent.
Yet every time one of their prophecies fails to come true, the
prophets simply replace it with a new one, and keep pushing the
predicted date further into the future.
“What is remarkable is not that these conspiracy theories exist,
but how mainstream they are. NHS privatisation prophets should be
treated as about on a par with David Icke when he talks about his
Lizardmen fantasies, or Piers Corbyn when he talks about his
“anti-vaxx” theories. Instead, we treat NHS privatisation
prophets as great sages, and keep providing them with major media
platforms.
“We need to stop doing that. NHS conspiracy theories are a
wasteful distraction from the real issues at the best of
times.”
