By Judith Niechcial
You may not know that so-called NHS 111 is not the NHS at all. It is run by a company called Sitel, ‘a privately owned contact center [sic] headquartered in Florida Miami’. In April 2020, The Guardian reported that, during the Covid-19 outbreak the company recruited large numbers of unskilled staff, who received inadequate training, and worked in unsafe conditions.
The Covid-19 pandemic has highlighted in a sudden and dramatic manner how dependent we are as a society on the NHS as a public service. The Government, after decades of under-funding and undermining of the NHS, appears to have woken up to the fact that it needs to be able to rely on NHS staff responding to and implementing measures to protect and heal the public. This cannot be done by a patchwork to private providers, all with their own agendas, the most significant of which is to make a profit. However there is no guarantee that the privatisation agenda will not continue after the virus crisis is over.
This article aims to chart the decades’ long process of the undermining of the NHS which began as far back as 1977. Since that time successive governments have introduced policies that have sold off swathes of the NHS to private companies. Because the NHS is so beloved by the British public, no government has been up-front about what they are doing; to do so would be a vote loser. The public therefore remains largely unaware of the insidious dismantling of their much loved health service. This article aims to summarise the incremental changes that have already been made, in order to raise awareness, and, hopefully, lead to action to defend what is left of our public service.
The origins of NHS privatisation
The 2019 film ‘The NHS Heist’ revealed that a document from the Conservative Research Department dated as early as 30 June 1977 (i.e. two years before Mrs Thatcher came to power) declared that ‘Denationalisation should not be attempted by frontal attack, but by a policy of preparation for return to the private sector by stealth’. This set the tone for the subsequent denationalisation of public utilities, and in 1988 the Centre for Policy Studies published a pamphlet written by Oliver Letwin and John Redwood entitled ‘Britain’s Biggest Enterprise’, setting out ‘options for radical reform’ and noting how profitable the enormous NHS would be for the private sector.
The public service ethos within the NHS was arguably undermined by the Griffiths Report of 1983 which is credited with introducing a corporate managerial culture to the NHS, with ideas derived from business management theory. It recommended an NHS Management Board at arm’s length from the Secretary of State and civil servants. A market-based discipline came into the service characterised by performance indicators, and league tables; the priority became the meeting of targets, rather than improving service. For example, setting a target of a maximum four hour wait in A&E does not measure the actual quality of care provided. Furthermore hospitals were fined for not meeting targets, which led to a temptation to falsification of the evidence.
In 1990 Kenneth Clarke introduced the internal market into the NHS through the NHS and Community Care Act which created the ‘purchaser/provider split’, and made hospitals into budget-holding Trusts, independent of the regional health authorities.