Tories worshipping Britain’s National Health System are akin to fanatical carnivores who suddenly extol the virtues of vegans. Has the grave response to COVID-19 signalled a change of heart? In the case of UK Prime Minister Boris Johnson, it was all heart, quite literally. It might have stopped beating and that scruffy, buffoonish essence of a man, a compulsive hand shaker with those who had contracted the coronavirus, might have been snuffed out. But in a message on social media, he was grateful.
His health had gradually worsened after contracting COVID-19. Three nights were spent in intensive care before returning to a ward on Thursday. Effusive praise was given to those NHS workers who “kept putting themselves in harm’s way, kept risking this deadly virus” in a situation that “could have gone either way.” It was “thanks to that courage, that devotion, that duty and that love that our NHS has been unbeatable.” Two nurses, Jenny from New Zealand, and Luis from Portugal, were singled out for special mention.
This language is remote to the traditional tendencies of the Conservatives towards that British jewel of welfare known as the NHS. When founded by Labour minister Aneurin Bevan in the 1940s, Winston Churchill had his issues with it, deeming it a “squalid nuisance” despite admitting that some national health service should be created “in order to ensure that everybody in the country, irrespective of means, age, sex or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”
Whenever an election comes around, the usual fears surface: what will Conservatives do to it? At one end of the spectrum is the fear of rabid dismantlement. Then there is the issue of chronic underfunding, letting a system perish through neglect. Versions of both have been at play, assisted by an effort by the Tories to tinker with the history books and blot the record. Former Conservative Health Secretary Jeremy Hunt has been at the forefront of this, claiming that the NHS was actually the brainchild of Sir Henry Willink, who put forth his ideas of such a health service in 1944. (He did, but based upon a general understanding already noted in the 1942 Beveridge report which stressed the need to “abolish want” in Britain.) Minimising the role of Bevan, Willink is the hero who achieved the NHS vision “with cross-party support. And for me that’s what the NHS should always be: not a political football, not a weapon to win votes but there for all of us with support from all of us.”
Then Shadow Health Secretary Jonathan Ashworth threw the historical record back at Hunt. “The Tories fought [the creation of the NHS] tooth and nail all the way through Parliament on a three to one whip. In fact they voted against the creation of the NHS 22 times including the third reading.”
Throughout its life, the broad shoulders of the NHS has always had the eager attention of the iconoclasts. Ideas have been floated on how to trim it and bring it within the orbit of the private sector. The bull dozer approach that would become a feature of Margaret Thatcher’s stewardship was eschewed. Nicholas Ridley, in a report to the Conservative Party’s Economic Reconstruction Group in 1977, suggested a “preparation for the return to the private sector by stealth. We should first pass legislation to destroy the public sector monopolies. We might need to take power to sell assets.” The second point of the plan would involve a policy of fragmentation, setting up “units as separate profit centres.”
Such ideas proved catching. Despite Thatcherism’s failure to privatise the NHS, the Tories were still circulating ideas of “radical reform”. Oliver Letwin and John Redwood did not shy back in their 1988 publication Britain’s Biggest Enterprise: Ideas for Radical Reform of the NHS. Letwin, rather appropriately, was then adviser on the matter of privatisation for overseas governments. Redwood was a long devotee of privatisation, notably of social services. Both condemned the NHS as “a bureaucratic monster that cannot be tamed.” It actually neglected patients, reducing them to “cases”. It wasted money in all sorts of unfathomable ways.
Their proposed solutions are all too familiar, among them turning the NHS into an independent trust; more “joint ventures between the NHS and the private sector”; greater use of charging patients; and health credits. The ideological reverence for the private sector is telling, as it “could make a great contribution to increasing the ‘friendliness’ of hospitals, and to providing patients with more comfortable conditions.”
Writing in the London Review of Books last November, John Furse was adamant that the Americanisation of the NHS had not been postponed to a post-Brexit future. It had already taken aggressive root. “Since 2017, Integrated Care Systems (ICSs) have been taking over the purchasing as well as the provision of NHS services in England, deciding who gets which services, which are free and which – as with the dentist and prescriptions – we have to pay for.” Such partnerships, modelled on Accountable Care Organisations – a US creature of provenance – links hospitals, clinicians and providers from the private sector. Their purpose: to limit the costs of healthcare and reduce demand on hospitals. Initially, the 2017 reforms were to run as ACOs. Anger followed at the direct importation of this American notion, necessitating a rebranding. This did not get away from the fundamental fact: the agents of privatisation had been heavily armed.
Tory politicians have had to repeatedly deny the obvious: that in terms of philosophy and approach, the NHS is anathema, an aberration of the natural order. When former Labor leader Jeremy Corbyn stated that familiar position, Michael Gove took issue. “The NHS has been kept safe and well-funded for most of its life by Conservative Governments.” With varying degrees of stealth and clumsiness, they have let the private sector burrow into the provision of health care through such ventures as the 2013 sale of 80 percent stake in the state-owned plasma supplier to US private equity firm Bain Capital. Three years later, that stake was sold to a Chinese company for £820 million, along with the residual government share. To this can be added a shortage of hospital beds and nurses, and a general shortage of capital funding.
With all that going on, it was disconcerting to see the relish and gratitude being showered upon health workers and those in the NHS by a prime minister whose party has been its most dedicated enemy. The ravages of COVID-19 will not do away with such sentiments, whatever praise is heaped upon during this crisis. We are instead saddled with the slogan health secretary Matthew Hancock is proud to publicise at any given moment: “Stay at home, protect the NHS and save lives.”