Beware the false prophets of NHS “privatisation”
10 December 2021
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Economic Theory
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15 December 2021
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25 June 2024
I sometimes wonder whether some of the Guardian’s regular contributors secretly despise their readers, given how easily they believe obvious nonsense as long as it confirms their fashionable, high-status beliefs. If I were Allyson Pollock, a professor of Public Health at Newcastle University, I certainly would.
Prof Pollock has been writing guest contributions for the Guardian for over twenty years. On the face of it, she has written dozens of articles, but it is really just one single article, which she keeps writing over and over and over again. More specifically, every time there is a major or minor health reform (or sometimes even when there is none), Prof Pollock reliably pops up to claim that it is a Trojan Horse, which will lead to the privatisation of the NHS. Her latest article, on the Health and Care Bill 2021, is no exception:
“The new bill will continue the dismantling of the NHS […] by adopting more features from the US health system. For anyone who cares about the NHS, this should set off alarm bells.”
Now, Prof Pollock is by no means the only writer in the country who has a particular pet obsession, and who sees everything that happens in the world through that lens. Nor is she the only one who keeps repeating a familiar argument. However, in some cases, the mere fact that you keep repeating the same argument over an extended period of time is, in itself, an indication that there must be something fundamentally wrong with that argument.
A privatisation is a one-off process. It can, of course, be spread out over a number of years; for example, the privatisation of British Telecom took over a decade to complete. But even then, it is a process with a well-defined endpoint. You cannot keep privatising the same institution forever. There comes a point when it is – you know – private. We can argue where exactly that point is – no healthcare system is 100% private or 100% public – but there can be no doubt that we are very, very far away from that point. The vast majority of healthcare in the UK is both publicly funded, and publicly provided, and there is no indication that this is currently changing, or is about to change.
So what happened to all those earlier prophecies of the NHS’s imminent privatisation? Prof Pollock already claimed in 2001:
“Labour has continued to sell off NHS hospitals and services with gusto […]
[P]rivatisation […] is now being extended throughout the NHS.”
In 2002, when the Blair government reorganised the healthcare commissioning process, Prof Pollock warned that this would set us on a path towards the US health system:
“The government’s modernisation plans for the NHS have all the hallmarks of the US model […]
If the government persists in […] importing US models of care, they will import the US care crisis and all the inequities which follow.”
In 2003, the New Labour government decided to give some NHS hospitals greater operational autonomy by giving them the status of Foundation Trusts. In response, Prof Pollock wrote an article with the self-explanatory title “Foundation hospitals will kill the NHS – Don’t be fooled by the rhetoric: this is about privatisation”:
“[T]his is simply a fig leaf for privatisation […]
Foundation status is part of a broader pattern of health service privatisation under New Labour. […]
Today MPs will vote on a bill, which, if passed, will effectively privatise NHS hospitals.”
In 2004, she published her book with the, again, unambiguous title NHS plc: The privatisation of our healthcare, in which she argued:
“What is occurring is an accelerating erosion, and increasingly a reversal, of what the NHS was created to achieve: making healthcare a right, and no longer something that could be bought or sold. [p. 15]
[…]
With each new insertion of private provision into the NHS the political clout of the private providers increases, and the dominant culture shifts still further into a private enterprise direction, while the structures of national control are being progressively dismantled. [p. 84]”
In 2005, Prof Pollock assured her readers that “Privatisation of the NHS is accelerating”, and in 2006, she warned:
“Market mechanisms must be abolished. […] If this does not happen, the NHS in England is destined to become no more than a logo attached to a group of corporate chains, while all the old health inequalities and fears return.”
In 2007, Michael Moore’s movie Sicko, an indictment of the US healthcare system, made a big splash. Supporters of the NHS could (and mostly did) use the movie as an occasion for being self-congratulatory about their own preferred system, but Prof Pollock used it as an occasion for issuing yet another privatisation warning:
“The film is very much made for a US audience. Moore does not go into […] the new, privatising project going on here. […] [T]he British government […] is actively trying to remodel the NHS along American lines. All the reforms carried out by the government over the past few years have been aimed at that.”
In 2008, this time for no obvious reason, Prof Pollock wrote:
“Lord Darzi, the unelected health minister, has signalled that Labour will continue to dismantle and privatise the NHS delivery system, its staff and services – handing taxpayers’ funds to multinational companies, and remodelling the service along the lines of US healthcare. […]
Darzi provides the clearest sign yet that Labour is planning to introduce charges for healthcare, crossing the final rubicon of NHS privatisation”
We could easily carry on in the same vein the whole day, perhaps in the format of a pub quiz, in which the reader is presented with a series of Pollock quotes, and has to guess what year they are from. But suffice it to say that a decade and a half after her book NHS plc: The privatisation of our healthcare had predicted the imminent privatisation of the NHS, Pollock went on to publish another book, The End of the NHS: Why the Government Wants to Destroy the Health Service. “The end of the NHS”, as it happens, is reminiscent of the subtitle of an article Pollock wrote in 1993, “The end of health for all?”.
I have no doubt that in a decade’s time, the NHS will still be there – and so will Prof Pollock, still warning us regularly about its imminent demise. Nor do I have any doubt that her readers will continue to lap it up.
Prof Pollock has been writing guest contributions for the Guardian for over twenty years. On the face of it, she has written dozens of articles, but it is really just one single article, which she keeps writing over and over and over again. More specifically, every time there is a major or minor health reform (or sometimes even when there is none), Prof Pollock reliably pops up to claim that it is a Trojan Horse, which will lead to the privatisation of the NHS. Her latest article, on the Health and Care Bill 2021, is no exception:
“The new bill will continue the dismantling of the NHS […] by adopting more features from the US health system. For anyone who cares about the NHS, this should set off alarm bells.”
Now, Prof Pollock is by no means the only writer in the country who has a particular pet obsession, and who sees everything that happens in the world through that lens. Nor is she the only one who keeps repeating a familiar argument. However, in some cases, the mere fact that you keep repeating the same argument over an extended period of time is, in itself, an indication that there must be something fundamentally wrong with that argument.
A privatisation is a one-off process. It can, of course, be spread out over a number of years; for example, the privatisation of British Telecom took over a decade to complete. But even then, it is a process with a well-defined endpoint. You cannot keep privatising the same institution forever. There comes a point when it is – you know – private. We can argue where exactly that point is – no healthcare system is 100% private or 100% public – but there can be no doubt that we are very, very far away from that point. The vast majority of healthcare in the UK is both publicly funded, and publicly provided, and there is no indication that this is currently changing, or is about to change.
So what happened to all those earlier prophecies of the NHS’s imminent privatisation? Prof Pollock already claimed in 2001:
“Labour has continued to sell off NHS hospitals and services with gusto […]
[P]rivatisation […] is now being extended throughout the NHS.”
In 2002, when the Blair government reorganised the healthcare commissioning process, Prof Pollock warned that this would set us on a path towards the US health system:
“The government’s modernisation plans for the NHS have all the hallmarks of the US model […]
If the government persists in […] importing US models of care, they will import the US care crisis and all the inequities which follow.”
In 2003, the New Labour government decided to give some NHS hospitals greater operational autonomy by giving them the status of Foundation Trusts. In response, Prof Pollock wrote an article with the self-explanatory title “Foundation hospitals will kill the NHS – Don’t be fooled by the rhetoric: this is about privatisation”:
“[T]his is simply a fig leaf for privatisation […]
Foundation status is part of a broader pattern of health service privatisation under New Labour. […]
Today MPs will vote on a bill, which, if passed, will effectively privatise NHS hospitals.”
In 2004, she published her book with the, again, unambiguous title NHS plc: The privatisation of our healthcare, in which she argued:
“What is occurring is an accelerating erosion, and increasingly a reversal, of what the NHS was created to achieve: making healthcare a right, and no longer something that could be bought or sold. [p. 15]
[…]
With each new insertion of private provision into the NHS the political clout of the private providers increases, and the dominant culture shifts still further into a private enterprise direction, while the structures of national control are being progressively dismantled. [p. 84]”
In 2005, Prof Pollock assured her readers that “Privatisation of the NHS is accelerating”, and in 2006, she warned:
“Market mechanisms must be abolished. […] If this does not happen, the NHS in England is destined to become no more than a logo attached to a group of corporate chains, while all the old health inequalities and fears return.”
In 2007, Michael Moore’s movie Sicko, an indictment of the US healthcare system, made a big splash. Supporters of the NHS could (and mostly did) use the movie as an occasion for being self-congratulatory about their own preferred system, but Prof Pollock used it as an occasion for issuing yet another privatisation warning:
“The film is very much made for a US audience. Moore does not go into […] the new, privatising project going on here. […] [T]he British government […] is actively trying to remodel the NHS along American lines. All the reforms carried out by the government over the past few years have been aimed at that.”
In 2008, this time for no obvious reason, Prof Pollock wrote:
“Lord Darzi, the unelected health minister, has signalled that Labour will continue to dismantle and privatise the NHS delivery system, its staff and services – handing taxpayers’ funds to multinational companies, and remodelling the service along the lines of US healthcare. […]
Darzi provides the clearest sign yet that Labour is planning to introduce charges for healthcare, crossing the final rubicon of NHS privatisation”
We could easily carry on in the same vein the whole day, perhaps in the format of a pub quiz, in which the reader is presented with a series of Pollock quotes, and has to guess what year they are from. But suffice it to say that a decade and a half after her book NHS plc: The privatisation of our healthcare had predicted the imminent privatisation of the NHS, Pollock went on to publish another book, The End of the NHS: Why the Government Wants to Destroy the Health Service. “The end of the NHS”, as it happens, is reminiscent of the subtitle of an article Pollock wrote in 1993, “The end of health for all?”.
I have no doubt that in a decade’s time, the NHS will still be there – and so will Prof Pollock, still warning us regularly about its imminent demise. Nor do I have any doubt that her readers will continue to lap it up.
7 thoughts on “Beware the false prophets of NHS “privatisation””
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Pollock’s articles are always completely ridiculous.
Her research consists of starting with her conclusions and then writing a narrative to fit them. It’s always the same tedious stuff.
Well done for exposing her, Kristian.
Dr Niemitz, I have a question that is, I fear, unrelated to the article. I have read with interest your work comparing the NHS to other systems. To me, a social insurance system seems a sensible alternative to the NHS model.
Nick Timothy responds to this by saying that the NHS is better at preventing queue jumping than social insurance systems. I have no idea whether this is true or not, but I wondered if you could comment? Or write a blog piece, perhaps!
I am not entirely sure about this – which is not to say that I have evidence to the contrary. You can, of course, queue jump by going privately (even without insurance – first consultation is not that expensive). Then the articulate can navigate the system more effectively than those who are not. I do have some examples of this, but it is only anecdote and not evidence that Nick Timothy is wrong. But, of course, this is true of all socialist systems. Soviet bread shops prevented queue jumping (except for veterans and, again, the well connected).
Hi Anthony,
if I remember correctly, Nick Timothy made that point specifically about the German health system. It’s not completely wrong, but it’s highly misleading. The German system has a very odd feature: Germany has two parallel health insurance systems. There’s the social insurance system (called the GKV system), which covers about 90% of the population, and a commercial private insurance system (called the PKV system), which covers the other 10%. People in the latter system are, on average, wealthier and healthier than people in the former. Therefore, they get more healthcare services, and faster access to them.
You could consider that a form of queue-jumping – but it’s important to note that that queue-jumping does NOT occur within the social insurance system. It occurs because of that split into two parallel insurance systems.
That split has its origins in the politics of the Bismarck era. If another country (say, Britain) introduced a German-style social health insurance system today, there is no way they would replicate that split. In fact, if Germany introduced its own system today, there is no way they would do it in that exact way again. So it’s disingenuous of Timothy to point to this historic oddity, and present it as a general feature of social health insurance systems.
I finally came back to check the answer to my question! Thank you so much for taking the time to answer it. That is very interesting (I love that it goes back to Bismarck – still making everyone jump to his tune!).
I guess, within the main German system, if health policies with higher premiums don’t buy faster access…the government must regulate that? Presumably then there is reporting within the industry to demonstrate that the gap between contacting a doctor and being treated does not vary with premium payment?
I only raise this because if I were campaigning to change the NHS, I would make a fuss of wait times and there may be data available to demonstrate how slow the NHS is. Not just to have my spleen removed or whatever is the offending part of my anatomy – for basic stuff. Seeing a GP, seeing a physio, face to face meetings even. Most of the people I know just roll their eyes at the notion of seeing a GP in a reasonable length of time. People no longer expect to get treatment for minor things in real time. That’s a lot of people who might be receptive to a different system.
On the off chance that you haven’t covered this extensively already, I thought I’d suggest the campaigning angle.
Thanks again,
Anthony
Whatever the UK does, please don’t follow the US! Few US citizens understand it. There is nothing free market or private about it. The state through the American Medical Association restricts the supply of healthcare severely for the sole purpose of keeping physician salaries as high as possible. Then the state through Medicare and Medicaid as well as employer subsidized insurance encourages unlimited demand. That’s why medical costs and healthcare insurance premiums are out of reach of most US citizens and major drivers of bankruptcies.
If you want a guide to better healthcare policies, study the US system before WWII. We had competing medical certification agencies (the AMA and others) so that there was real competition among providers. We had many competing medical schools. Most healthcare insurance was provided by private mutual aid societies. As a result, good healthcare was available to even the poorest with charity filling the gaps. The AMA and socialist policies destroyed a very good system.
A huge and constantly growing proportion of NHS service provision is in private hands FACT. Allyson Pollock is a highly knowledgeable expert in this field and this childish attempt to discredit her repeated warnings about this PROCESS does the author of this piece no credit. A semantic arguement about privatisation being a single event is simply another pathetic reuse in the game of grandmother’s footsteps dreamt up by the right as the only mechanism to achieve their aim in the face of such an impressive and much loved institution as a public ally PROVIDED health care system. Oh sorry there’s also the much more audacious second line of attack underfunding and internal chaos due to constant political medelling – an attempt to undermine public support before they are kicked out of office.
Credit where credit is due the two pronged strategy is worthy of Machiavelli, but this supporting criticism is pathetic.