Thursday, 5 July 2018

The Peculiar Politics of the NHS

Happy birthday the NHS. Yet, why are we doing this? Social media was replete with patients and medical staff toasting our most beloved of institutions good health, various folks were chiming in with stories about how much the NHS meant to them, how it helped them and their loved ones out, and what have you. And this week there's been more than enough programming celebrating the NHS, including Celebrities on the NHS Frontline. Yet compare this to 10 years ago. On the 5th July we had this documentary on the birth of the NHS, followed a day later by a Panorama looking at creeping privatisation. 20 years ago there was nothing on, at least as far as the BBC was concerned. Why the celebration of all things NHS now?

It's down to the peculiar way the NHS has become politicised. Of course, it was always politicised and always will be for as long as it exists. Here, amidst Tory Britain is an institution whose basic modus operandi is the antithesis of their twisted values. Free at the point of need is a principle successive governments, Thatcherite Tory and neoliberal Labour, have rolled back where other public services and social security support are concerned but here, at the NHS, they've only so far succeeded at nibbling away at it. Instead, what the Tories have accomplished is the effective scrapping of the NHS as an entity and its replacment with a taxpayer-guaranteed market in which public, private and third sector organisations compete for tenders to deliver medical services.

Despite living in an uncaring, dog-eat-dog world in which government and institutions tell us, "you're on your own", the stock of the NHS as something that does care, as an institution populated by workers who choose public service for selfless reasons has risen as marketisation, managerialism and atomism have disaggregated and broken up the old solidarities of the past. Coincidence? At a political conjuncture where uncertainty and precarity bestride the economic landscape, the NHS is a backstop, a layer of certainty knowing that if you have an accident or fall ill, something will be there to pick you up and try to put you back together again. This inchoate and seldom-articulated sense is something the Tories, and the architects of NHS marketisation under Labour, can never hope to understand for as long as their private health plans are up to date.

This is the foundation of its peculiar politicisation. In his gloomy prognosis for the future of capitalism, Wolfgang Streeck notes a widespread desire to ground a world that appears to be running away from us. The politics of nostalgia, the resonance of the Leave's campaign demand to Take Back Control were able to harness a popular malaise of unease and anxiety. If this can find political expression in opposition to liberal elites and right wing populism, there are non-party political outlets for it too. One of which has been the renaissance of the royals in recent years: it's permanent, stands above the fray of politics and the everyday grind, and is a marker for stability. The only other institution of the British state that occupies a similar place is the NHS. However, unlike the royals there is an awareness of a sense of threat surrounding it. Occasionally some right wing pundit gets airtime to call for its abolition, but it's less the efforts of professional propagandists but the experience people have of the NHS. The budget keeps going up, raising anxieties around affordability, which the Tory press do their damnedest to talk up. And there are the waiting times for operations, the over-subscription and closure of A&Es, the reduction of beds, ambulance services, and the closure of wards and hospitals. It might have stood for 70 years, but the sense of danger and peril around the NHS helps rally its support.

Yet, there is another spin off that resists easy explanation. It might be threatened, but the NHS as a political issue has never been a magic bullet for Labour. To illustrate, the NHS had the customary awful winter typical to Tory governments, yet it barely moved the polls. Considering older people are more likely to support Conservative, and are disproportionately users of the NHS, how can this circle be squared? Successfully, so far at least, and abetted by the Tory party's media wing, it's been displaced upon greedy doctors, indolent appointment-dodging patients, health tourists, bogus and trendy treatments, and staff who can't speak English. Groups who, in the right wing imaginary, easily map onto the folk devils it populates liberal Britain with. Because this is visible and tangible, and the real problems - marketisation - confusing and abstract, individual experience of older, Tory voters and its generalisation has so far not been accomplished. When, if it does, then the Tories could find themselves in severe difficulties.

It goes without saying the NHS needs to be fought for. Its marketisation already constitutes a major defeat, and its complete liquidation would have profound political consequences. Yet, by defending it the NHS should also be an object of critique. The markets are only one dimension, the other is its bureaucratisation, its secrecy and managerial cultures, the professional turf wars and bizarre hierarchy of fields of medicine. The biggest barrier to the defence of the NHS is its positioning as a service vis a vis us as passive service users who'll use it as and when, of it being a producer and patients interpellated as consumers. Time and again, if people, in this case staff, patients and potential patients, of which we are all, can participate in it in some way, the NHS can be further integrated into social life, transforming it in the process, eroding the bureaucracies that have held it back, and chasing out markets and replacing them with medicine and patient care produced in common. This is how you give people a stake in any institution, by opening it to their participation. That is the dream, an NHS allowed to outgrow itself to the point it is no longer an especial institution, reified, deified, and standing apart from everything else.


Boffy said...

The NHS has been called the closest thing to a state religion in Britain. It certainly has similarities to God. People are fearful of criticising God, because they retain a nagging thought in the back of their minds that they might in an hour of need be reduced to a prayer for their salvation.

Everyone has heard all of the horror stories about the NHS, some of which again have manifest themselves recently. Anyone who compares it with socialised healthcare systems in the rest of Europe, and increasingly other parts of the world, know it actually compares badly but we have all either ourselves had to resort to it, or someone in our families has done so. Even though in many of those cases, we have experienced its deficiencies, most people choose to only remember the positive outcomes. Again as with God where people choose to ignore all of the death, destruction, famine and so on and only give God credit for the odd salvation from such horrors.

For all the vain hopes the NHS is not "our NHS", but remains what it has always been, the chosen method of capital to provide mass healthcare on the cheapest available basis to supply the labour-power it requires, that frequently is based around the needs of large drug companies, construction companies, and equipment suppliers, as well as the top bureaucrats within the NHS to provide expensive hospitals, whilst primary care is effectively underfunded, and the actual causes of ill-health from the nature of work, from the nature of overcrowded poor living environments and so on are ignored.

If people want to "take back control" they should start with taking back control of these basic elements of our daily lives, rather than the illusion that they have lost control to Brussels bureaucrats.

Igor Belanov said...

As an NHS worker, I think you've hit the nail right on the head here. The major problem is that the NHS isn't politicised enough, and some of the NHS's defenders are responsible for this in turning it into a symbol rather than an institution that vitally needs greater participation and constructive criticism from its staff and members of the public.

Maybe I should have been pleased that the BBC was broadcasting Breakfast News from my workplace, but I was actually angry that they were simply repeating the usual clich├ęs and woolly feel-good sentiments while all the time failing to question the pressures and forces that are undermining the health system. I didn't watch the whole programme, but I suspect that nobody from Leeds Teaching Hospitals was asked about why they are proposing to transfer many ancillary workers to a 'wholly-owned subsidiary' company.