An Unhealthy State of Affairs

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Review of 'NHS plc' by Allyson M Pollock, Verso £15.99

I work in an NHS health centre. It is too small, poorly maintained and recently became rat infested. New premises mean a 'Lift' consortium involving a private company known for running penal institutions taking over NHS property, and charging the NHS and the practice for rent and services. Similarly, the only way our local district teaching hospital can rebuild its premises is through a Private Finance Initiative (PFI). The NHS leases back buildings and 'soft facilities' (eg workers), hence health money goes into profits. The hospital will be too small in order to cut costs. PFI's private partners withdraw when they can't make the money.

There is no national plan for providing health and social care where it is needed. Instead market principles and 'the survival of the fittest' prevail. In public services, star ratings facilitate privatisation either as reward (eg three star 'foundation trusts') or punishment (for failing management). Increasingly international companies are moving in, developing healthcare subsidiaries in the neoliberal post General Agreement on Trade and Services (Gats) world.

Allyson Pollock, public health doctor, professor at University College and Amicus member, analyses this and more in NHS plc. She describes the corruption involved in the privatisation of the NHS, and the muzzling and discrediting of opposition to government and global marketisation, telling how her evidence to the Commons Health Committee was suppressed by New Labour and her academic unit threatened.

The book deals with the NHS from its foundation in 1948. The Labour government's compromises also included keeping private practice. Pollock addresses the NHS's perpetual underfunding and the lack of an initial plan of resource distribution according to need. Enoch Powell, as Tory health minister, in 1962 provided the first plan for equitable distribution of health resources, prioritising disadvantaged groups and areas with a building programme. But the investment wasn't made. Cuts and closures followed.

There is a useful description of the changes in care for the elderly. Transfer from the NHS to means-tested local authority responsibility results in competing private providers depressing wages and skills, and impoverishes the elderly. Private domiciliary care has increased from 2 percent in 1992 to over 60 percent in 2002. Care homes are now an established industry. Older people are described as 'bed blockers' in hospital, and where possible moved into privately run nursing home beds.

Sadly, David Widgery, comrade, writer and GP, is no longer alive to contribute to the debate. His highly readable histories of Britain's health services drew pictures of the relationships between health, class and the struggles of 'workers, patients and citizens'. He told us, while highlighting the inadequacy of the NHS and the distortions of operating within capitalism, 'how every advance has come through a productive conflict between the iron laws of finances and the social needs of people'. He raised the dangers of commodification of healthcare and called for struggle (with some optimism) about the continued provision of quality care for need.

Allyson Pollock's book is an essential read for activists who need to understand how the forces of capital are transforming health and social care into commodities to be bought and sold for profit in a global market rather than public and free services providing for the needs of everyone. It provides the details needed to dispute the assumptions, and defend and extend publicly provided services, health and jobs. She states that to save the NHS 'what is required now is not reform but... a quiet... revolution'. The book is a weapon in the struggle. The struggle must go on and I think it can't be as quiet as she hopes.