The Great NHS Heist
The NHS is one of the great social achievements of the twentieth century — and it's currently under attack. If an incoming Jeremy Corbyn–led Labour government wins today's election, it will have to be serious about rebuilding Britain's health service.
Protesters hold up signs as they demonstrate in support of the NHS as NATO leaders attend a Buckingham Palace banquet on December 3, 2019 in London, England. Peter Summers / Getty
- Interview by
- Tommy Greene
This British general election campaign has been something of a trudge. If in 2017 the final days were marked by optimism for Jeremy Corbyn’s Labour, this time around, Brexit and a wider political fatigue have rather dulled the mood. Yet there are still issues that could weigh in the Left’s favor — most notably controversies over the National Health Service (NHS), a factor that could still swing key seats away from the Tories and deny Boris Johnson the narrow majority that polls today predict.
This is, then, just the right time for a new film about why the NHS is so endangered. The Great NHS Heist serves just this purpose, going beyond understandings that see the threat to the NHS — and such ills as charges and privatizations — only as a problem for the future. Rather, the film dissects a multi-pronged, piecemeal assault on the UK’s most cherished institution that has already been carried out by stealth for decades. It is thus one of the few accounts that sets out to do justice to one of the most misrepresented topics in the public debate.
Produced over the course of several years while its authors worked full-time, the crowdfunded documentary — which is free to view before UK voters go to cast their ballots — features in-depth interviews with figures like David Graeber, Yanis Varoufakis, Ken Loach, and Danny Dorling, as well as health workers from the earliest days of the NHS.
Bob Gill is a GP based in southeast London and an NHS campaigner. He first got involved with NHS activism when former health secretary Jeremy Hunt attempted to drastically reduce services at Lewisham Hospital in southeast London. Gill was on the campaign’s executive committee, helping organize two demonstrations of over 10,000 protesters along with a number of marches. Following the momentum generated by these mobilizations and a successful high court challenge, Hunt’s decision was finally quashed in one of the biggest single victories for NHS campaigners in recent years.
Gill spoke to Jacobin contributor Tommy Greene about making the documentary film, the immediate threats to one of the greatest social achievements of the twentieth century, and the challenges that a Corbyn-led Labour government could face over health.
You say your first experience of public health-care activism was the Save Lewisham Hospital campaign, and in 2014 you produced a documentary chronicling NHS privatization. What made you decide to make another film?
Not long after making the 2014 film, I felt there was a need to explain how far things had gone even since that point.
But also important was a conversation with the chair of our Clinical Commissioning Group [bodies that plan and commission health-care services for different localities], who was also a GP and former [Labour] MP for Dartford, Howard Stoate. He heard that I’d been upset about the worsening standards of patient care I‘d noticed in my day-to-day practice. I could see at the time that workers in the NHS were being cajoled and coerced into doing stuff that was against our own interests and against patients’ interests.
So he called me on the phone one evening to try and pacify me. And there were three comments he made that caused something to snap. The first thing he said was that I was “too sensitive.” The second thing he said was that whatever he’d heard about my patient care he hadn’t heard from anyone else in the area, so I must have just been “unlucky.” And the final straw was that I simply shouldn’t worry about this stuff because I’m not paying for any of it.
Now, if you see that sort of attitude from someone who was supposedly a GP there to protect patient care and representing the interests of everybody in the area, you know there’s a big problem.
So it was that conversation as well as — not only having lost Queen Mary’s Hospital acute services, which is covered in the film — but then there was this neighboring threat to Lewisham Hospital, which is just down the road from my practice. I thought to myself, “This is going to be catastrophic,” and that I had to try to do something about it.
Plus, I couldn’t ignore something that was so clearly and visibly crossing my doorstep on an almost daily basis. There’s not a week that goes past when a patient doesn’t come to [see] me with some form of damage or neglect or delay that is a clear consequence of the severe strains on the health service currently.
Medical professionals have traditionally been conservative and largely drawn from middle- or upper-middle-class backgrounds. Yet in 2016, worsening conditions prompted a historic walkout by doctors below consultant level. Did something fundamentally shift there? Or did the defeat of that strike, despite public support, represent the closing of a window of opportunity?
My biggest disappointment since I began this work has been the response from a considerable proportion of my colleagues. As you say, the background of many doctors plays a significant role here — and too many can be spineless, compliant wimps who toe the line regardless of what happens.
The junior doctors’ strike was a potential turning point. And the strike could have succeeded — it had public backing, as you say. However, the British Medical Association [the BMA, UK doctors’ main trade union] sabotaged its own industrial action.
There were two votes against the contract — that is, a call for more industrial action. But the BMA concocted a proposal that went further than most doctors wanted — a proposal for five days’ consecutive strikes, which split striking doctors. So they divided up the workforce and then put everything on hold until all the momentum was lost. Then, months later they backed down.
To my mind, the BMA has colluded with the main agents of this whole privatization push. In their public statements, they bleat on about cuts, but essentially they back privatization to the hilt. Measures that open up the service — or steer it toward a point where private providers can step in — are there in all the policy and legislation the BMA supports. The public statements are simply PR and form part of a wider media strategy.
They run a very slick operation in this regard that coaxes overstretched doctors — who don’t often have the time to read lengthy, jargon-filled new policy documents — to vote against their own interests. And they’re now trying to trumpet some minor concessions won back from the 2016 contract losses, which I’m sure the government is very happy about.
The result, sadly, is I think morale has been broken. People are drifting away from the fight. Many of the self-styled leaders of the junior doctors’ dispute in 2016 have gone quiet. A lot of the people who were allowed prominence then didn’t want to tie their own dispute over pay and unsafe hours with the fight against privatization.
On top of this, a lot of the messaging was controlled by the BMA. So, the fight from the medical profession has dissipated, and those people with the knowledge and the memory of how things were — how they could and should be — have faded out. Some of them are no longer junior doctors or they’ve left the NHS altogether.
Although it increased NHS spending, Tony Blair’s New Labour also left behind a damaging legacy of [public-private loan] PFI deals and swollen corporate bureaucracy that undermined trust in the party that created the NHS. What would a Corbyn-led Labour government have to do to turn back the dial on decades of privatization and to begin to push things in the other direction?
First, they need to win over the confidence of NHS staff by saying, “We know what you’ve been put through, we know the challenges, and we’re going to stop the rot — we’re going to return to a public service ethos.”
The second thing is to make up for some of the loss of NHS workers’ terms and conditions — to stop the hemorrhaging of staff and to help stabilize the service. And then it’s a very sharp look at the current leadership of the NHS — there needs to be a complete clearout. All the people who’ve been accelerating the privatization process need to go from day one — starting with NHS England chief Simon Stevens. The whole of NHS England is effectively a privatization board dominated by the Big Four accounting firms, management consultants and bankers. They have no place in a publicly run NHS.
Then, before more money goes in, you need to take a look at where it’s going currently. And stop all market-related activity. The internal market that has been created needs to be scrapped — that will free up significant resources. And hospitals need to be protected from onerous PFI debts. That doesn’t mean paying off the creditors — that means looking at the contracts and looking at them for potential fraud, because a lot of the agreements were brokered with Libor-rigged rates.
Another option with PFI could be to nationalize the negotiated Special Purpose Vehicle financial instruments — which would allow contracts to be opened up and scrutinized. There’s no way we should be paying the full value of the contracts. These creditors need to take a significant haircut, and some of them should potentially be prosecuted for fraud.
Finally, I think if any incoming Labour government is serious about the NHS, it will have to bring in robust statutory protections for whistleblowers — as well as strong legislation addressing corporate manslaughter. For the privatization process to succeed, whistleblowers have to be crushed, and it needs to be made sure that any blame for service failure is not linked to policy. The existing regulatory bodies don’t seek to get to the bottom of the problems in these cases — they’re part of a charade to maintain the impression that everything is functioning as it should.
You mentioned Simon Stevens, who obviously occupies a pivotal NHS leadership role, but who is also a figure very few people outside of the health service will have heard of. Could you explain how crucial people like Stevens have been and the role lobbyists have played in shaping the privatization process?
If you look at Simon Stevens’ career in the NHS, at his ten-year stint at United Health and now his return to the health service, you could be forgiven for thinking he’s been groomed for decades to do exactly what he is doing now. He was a special advisor to New Labour governments, he published the NHS Long-Term Plan, and he’s overseen the outsourcing of a huge degree of clinical care, the setting up of Foundation Trusts.
Those have all been key steps in the privatization process. And now he’s back to oversee a significant contraction in services that would end their provision as we know it, and also to reshape the NHS in the form of the American system of Health Maintenance Organizations, which is dominated by insurers and provider chains. Here, the poor patient is stuck in the middle, and profit is derived through the denial of care.
So he’s currently reshaping the structures and the workings of the NHS — and realigning the budgets that currently go toward general practice and the care of patients in such a way that groups like Optimum and United Health are firmly fixed in the money flow, so they will have control over how money is spent and allocated.
So, if things continue in the direction they’ve been moving these past years, could Simon Stevens be the man who hits the final nail in the coffin of the NHS?
Absolutely. He is the best-qualified person out there to do it. He was, after all, president of global expansion for a number of major insurers. He has campaigned for the US insurance-based Accountable Care Organizations model across the world — he even spoke at Davos to promote it. He was also a key actor in preventing Obamacare reforms from including a public option. So he has not only stymied reforms in the United States, but he’s now back here masterminding the demise of the NHS for his previous employers.
Another thing Labour will need to do is tighten up rules around lobbyists and the revolving door between the private sector and civil service. I have no doubt that Simon Stevens’s next job will be a very lucrative one in United Health group. And previous Labour health secretaries like Alan Milburn and Patricia Hewitt have profited massively from the same revolving door in recent years. It has to end.
One of the major events of this general election campaign has been Labour’s move to publicize documents it says proves beyond doubt the NHS would be on the table in future trade deal negotiations with the United States. The past week has seen counterclaims of the dossier forming part of alleged “Russian interference” with the election. Even if such claims have little basis in fact, they can erode public confidence and trust.
Similarly, major reforms are often made inaccessible by misleading spin and confusing jargon. In straightforward terms, what tangible consequences and reductions in care will people notice as NHS privatization accelerates?
The most obvious thing is growing waiting times to see your GP — you may have to wait weeks, it is increasingly likely you will have to see a doctor you don’t know, and you may even be fobbed off to a non-doctor.
If you’re unfortunate enough to be seriously sick, you’ll end up in a very crowded Accident and Emergency department waiting for hours, potentially in pain, potentially with a condition that is getting worse the later it is diagnosed. All that, only to see an overstretched — probably junior — doctor working under horrendous conditions, not able to formulate clear thinking because of the stress they’re under and probably not very well supervised, either. And if you’re sick enough to require a bed, it’s likely there won’t be one for you — so you’ll have to be sent home.
We’re currently seeing the biggest rise in waiting lists in decades. What that means is people who have conditions that are significantly impacting their lives will increasingly have to make decisions over whether they continue to wait in pain or have to pay out of their own pocket, tapping into life savings sometimes, or simply going without treatment altogether.
A straightforward example is one of my patients recently had to wait four months for chemotherapy, which led to her not being eligible for surgery that could have extended her life expectancy. This kind of thing is becoming more and more commonplace.
In the film, you talk about how the NHS is being “set up to fail.” Can you explain what you mean by this and how you think it’s likely to happen?
The first thing is to restrict funding. We’ve seen historically low funding settlements since [the Tories returned to power in] 2010 — the average prior annual spending increase was over 4 percent, which has been reduced to 1 percent since 2010. While this is happening, more and more money is flowing out of the system to pay for market reforms and repay PFI debts.
At the same time as that, austerity has dramatically increased pressures on the NHS. Rates of the so-called diseases of despair — alcoholism, drug use, and other ways people can try to cope with mental health problems — have all risen because of government policy, and meanwhile, the services to help treat these conditions have been cut in real terms.
So it’s a perfect storm. If you want to create a crisis, this is the way to do it. The results are plain for everyone to see — life expectancy has fallen, infant mortality rates have gone up, and one study has estimated that up to 130,000 people have potentially died as a result of austerity policies and cuts. We are, in effect, seeing a cull of the poor and the sick by our own government.
The media are also sitting on a bank of stories about a failing health service. When the time comes, we’ll see a dramatic increase in these kinds of stories splashed across the press as part of a coordinated campaign to destroy public trust. The final thing the privatization lobby needs is for the British public to “fall out of love” with the NHS, as well as for staff to be softened up for a “private-sector rescue” as working conditions diminish. By this point, of course, it would be fully corporatized.
But, before this, in order to pull off the scam, they have split up health and care. It used to be the Department of Health and Social Security, now it’s the Department of Health and Social Care, with the latter privatized — even though both are obviously linked. If there are no social care provisions for people, they’re more likely to get sick and to not have preventative care in their own homes. That obviously has a burden on the NHS, and once these people do end up in the NHS, there’s nowhere to send them to recuperate.
When we discuss NHS services being privatized, a lot of people tend to think of logo changes, outsourcing, and real estate being sold off. But could you say a bit about what NHS data represents for companies looking to gain a slice of the pie?
Even the plasma of NHS patients — that’s half of your blood, basically — was sold off to America in 2013 and then subsequently sold on to China in 2017. That gives you an idea of the ever-expanding frontiers of the NHS privatization assault.
As for NHS records, they’re quite happy, without much thought given to the potential ramifications of what they’re doing, to hand over and sell vast swathes of patient data. We mustn’t forget that the NHS data set is probably the most comprehensive of any health-care system in the world. So it’s obviously a gold mine for these big tech companies. Just today, we’ve heard Amazon has been given free access to our health-care information as part of a government contract.
The other issue here for me as a GP is confidentiality and consent. The confidence patients will have that what they tell me and what I document in their records remain private — and only be seen by people who are directly involved in their health — has gone out of the window. I have no confidence that this will happen, so why should patients?
What would a Conservative majority mean for the future survival of the NHS? And where do you see the fightback coming from at this point?
A lot of the election debate focus has been on the Labour dossier. But the Labour Party have far more ammunition they could use than just making reference to this dossier. You just have to look at the recent legislation. Look at [former health secretary] Andrew Lansley’s top-down 2012 reforms — that’s rock-solid proof of what’s happening, in five hundred pages of competition law.
The other thing the public needs to understand is that trade deals are not just about buying and selling manufactured goods. Trade deals open up public service budgets. And that’s what the corporations are after — they’re central to any trade deal.
Once a public service is not 100 percent publicly provided, it becomes eligible for a trade deal — which means the NHS as it is today is being put on the table. And if we have a Conservative government — which would be hell-bent on destroying the NHS — it would want to lock public-service budgets into trade deals with America as quickly as possible. This would be very expensive to get out of. And any disputes would take place in corporate courts that, more often than not, find in favor of big business. And this would be catastrophic for public services in this country.
Matt Hancock’s role in all this as the current health secretary is really just a ceremonial one. He has no day-to-day control over the NHS. He’s really just a glorified PR man. And from a PR perspective, he gives reasonably convincing performances. But the public needs to understand that he has blatant conflicts of interest. And the public statements he does come out with do not stand up to any scrutiny. So, it’s his job to misdirect and mislead and lie for as long as he’s in post — since the 2012 Health and Social Care Act removed the Health Secretary’s statutory responsibility for the health service, he really has no other meaningful role.
Campaigners can often get bogged down by the minutiae, but this is a marathon race. I’d obviously urge anyone that cares about the health service to organize politically, to engage with any possible public forum. To counteract the propaganda war that will be heating up as we get closer to the final straits of the privatization run.
I think it’s also important campaigners and activists link up with America, because it’s a crucial year for America — health care is the number-one issue now, and it’s obviously a crucial year out there. And we have some alliances to make there because that is our “Christmas Future.” So the more connections there the better.