Class Matters by Charles Umney

Author:Charles Umney [Umney, Charles]
Language: eng
Format: epub
ISBN: 9780745337098
Google: pgT1MAAACAAJ
Publisher: Pluto Press
Published: 2018-01-15T04:11:09+00:00

Health

One thing I did not mention in relation to education was the idea of public services as a source of profitable investment for capital. While this does happen in education, it is arguably more sensitive in the case of health. Obviously, there are a lot of capitalists who would love to exercise some ‘accumulation by dispossession’ on the British health system. In theory, delivering healthcare can be very profitable. But from capital’s perspective, the last three decades in British health policy have been characterised by raised hopes and continuing frustration, because making money from the NHS is not always easy and often encounters resistance on the ground.

There have been various waves of efforts to extend private profit-making in front-line health services, particularly in England, with the most important tool being the purchaser–provider split, which has progressed through various different guises. This is where local health institutions (such as general practitioner (GP) consortia or hospital trusts) are re-envisioned as commissioning organisations who buy in care on behalf of the public, potentially from private companies. The Coalition government’s Health and Social Care Act was the most significant recent manifestation of this idea, pushing large chunks of NHS money on to Clinical Commissioning Groups (CCGs) – groups of GPs responsible for commissioning services in their area from any willing provider. This has led to an urgent discussion on the left about the possibility of wholesale privatisation of NHS services.

Proportionately, the amount of NHS services transferred to for-profit companies is comparatively small. Privatisation has been ‘gradual and inexorable’ rather than a rapid ‘explosion’; the amount of NHS money in private hands has gone from about 4 per cent in 2009–10 to about 8 per cent in 2015–16.32 It may well be that the government has had a premeditated strategy to privatise large sections of the NHS, but they have gone about it in a fairly blundering fashion. As Nick Krachler and Ian Greer show,33 the Health and Social Care Act encountered various obstacles which proved very difficult to overcome. For one thing, it was imposed at a time of austerity: the fact that there was so little money about meant a lot of private companies felt it wasn’t worth the trouble of taking over NHS services. For another, the institutions on the front line of privatisation (i.e. the CCGs) appear to be somewhat brittle and in many cases may not have the stomach to push through controversial privatisations in the face of public opposition. Government has generally failed to depoliticise the NHS and many retain a strong sentimental attachment to it, and consequently CCGs are very susceptible to pressure on the part of motivated and organised local campaign groups.34 If one wants to force through highly sensitive privatisations, you really need the iron fist of central government rather than little consortia of local doctors. This may help explain why Jeremy Hunt sought new legal powers to unilaterally shut down or restructure public hospitals.35

This latter point hints at a much wider issue, which is to do with capital as a whole rather than specific capitalists wanting to profit from healthcare.

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