Running down the NHS – the Tory commodification of healthcare

“The NHS has always been a test of socialism versus capitalism and this paper offers hard evidence of the failure of neoliberal capitalism inappropriately applied to the NHS. It should be cited repeatedly in responding to attacks against the NHS.”

Dr Dick Symonds, Thanet South CLP, looks at the latest evidence that the Tories are commodifying healthcare to the detriment of patients.

Most of us have a rough and ready view on aspects of our life. Some of us have socialist theory ready to meet new challenges. What is rare is the scientific evidence for a political view, but when it occurs, it is a powerful weapon against right wing rants. The example I have always given is on Inequality. Richard Wilkinson and Kate Pickett’s publications produce statistically significant research on how income inequality makes you more liable to a range of social and biological pathologies.

The latest example is from The Lancet, about the effects of privatisation in the NHS. We know instinctively that it is wrong to profit from others’ illnesses. Theory has it that private treatment is a commodification of human suffering packaged to produce profit, where a socialist society would simply open treatment to all, free when used, as did the 1945 government. But later came Thatcher, whose purchaser-provider model of an internal market in the NHS aped capitalist business practice and outsourcing to private companies started to appear.

The Coalition Government produced Andrew Lansley’s Health and Social Care Act 2012 which vastly increased the private outsourcing of facility and clinical services, and compelled ‘commissioners’ (purchasers) to buy the cheapest facilities, outlawing ‘anti-competitive practices’. ‘Patient choice’ (it’s your fault) and competition, the watchwords of right-wing theory, have been freely used. We attack this politics vigorously but are brushed aside by dodgy statistics and bland assurances.

There is some data from Italy, a country which went through a similar process and found that ‘incentivisation’ did not lead to ‘innovation’ but  increased  their mortality rates.

Now we have a crucial paper from Goodair and Reeves in The Lancet Public Health Journal. They collected an enormous database of financial and clinical information, 645,674 payments in total from every one of the 173 CCGs (commissioner groups) in England from 2013-2020, a total spending of £204 billion. They subjected their findings to some advanced statistical analysis. What did they find in the 10 years of the 2012 Act?

Spending on outsourcing to private companies increased considerably in this period, in business support, IT, health care, social work and health transport.

The key finding is that treatable mortality (deaths of patients which should not have occurred), a statistic which had been declining since 2000, actually increased from 2013. A 1% increase in outsourced private spending correlated with 0.38% increase in treatable mortality. A graph for 2000-2020 shows a damning U-shaped curve. Waiting times increased and satisfaction with the NHS markedly decreased.

They acknowledge that Tory austerity may have been partially responsible, but here is direct evidence that cost-cutting by privatisation means more but inferior services. They point to the practice of creaming off the easy patients and leaving the complex cases to the NHS, which makes perfect commercial sense. They do distinguish private outsourcing of services and facilities from treatment of private patients. They found that there is not a significant difference in mortality between private hospitals and NHS hospitals, so the clinicians are not to blame. Their finding is that private outsourcing increases pressure across the whole NHS, together with ‘creaming’ and management prioritisation of easily quantifiable outcomes rather than the standard of care.

The NHS has always been a test of socialism versus capitalism and this paper offers hard evidence of the failure of neoliberal capitalism inappropriately applied to the NHS. It should be cited repeatedly in responding to attacks against the NHS. The Guardian summary of this paper even calculated that the increased mortality amounted to 557 deaths which should not have occurred.


  • Dr Nick Symonds is a member of Thanet South CLP and a regular contributor for Labour Briefing.
  • This article originally appeared in Labour Briefing (Co-operative) magazine and is reproduced with permission. Subscribe by sending a £20 cheque with your address to ‘Labour Briefing Co-op, PO Box 78639, London N16 1LA
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