NHS privatisation paranoia damages nation’s health, finds new report


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  • There has been moral panic about a secret plan to privatise the NHS for over four decades, yet the UK still has an unusually state-centred healthcare system.

  • The conspiracy theory — that there is a sinister plot to dismantle the NHS, sell off its parts to private companies and introduce a dystopian survival-of-the-fittest American-style healthcare system — is not restricted to the eccentric fringe, but very much mainstream.

  • Every time a specific theory about privatisation fails to come true, it is repackaged, updated with new details and pushed into the future.

  • NHS privatisation theories are wildly implausible because privatisation is supported by no major political party, would appeal to virtually nobody, and could not be done in secret.

  • NHS privatisation paranoia crowds out sensible and important debate about how to improve the UK’s health system.


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.”


ENDS


Notes to editors


Contact: [email protected], 07763 365520


IEA spokespeople are available for interview and further comment.


Repeat Prescription: The NHS and four decades of privatisation paranoia is under embargo until 00.01 Sunday 18 May. An embargoed copy of the paper can be found here: https://iea.org.uk/wp-content/uploads/2022/05/DP108_NHS_web.pdf


 

The mission of the Institute of Economic Affairs is to improve understanding of the fundamental institutions of a free society by analysing and expounding the role of markets in solving economic and social problems. The IEA is a registered educational charity and independent of all political parties.



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