I was lucky enough to hear Aislinn Macklin-Doherty speak about the NHS recently, and one of her metaphors for the crisis really hit home. She said that the NHS was like a large public ship, where everyone gets their own space, their own cabin, and their own life jacket. It is not fancy, but everyone has enough to get by. Now imagine the private health sector is a flashy yacht. It is resourceful and it is responsive but only the rich and powerful are allowed on it. Now imagine that both these ships are alone at sea, and that this small flashy yacht can only survive if it siphons off the resources from the public ship. At first it tries to woo some of the richer guests onto the boat- with promises of exclusivity- but after a while it gets too crowded. This new demand means it needs more resources. And so instead of trying to woo more people on- it actively tries to sink the big public ship. It fires missiles underwater at its hull, grabbing all the fuel and resources spilling out of the gut of the ship it can get its hand on. The normal people on the ship cannot see this happening and assume the co-existence of these two ships in the sea is peaceful. But it is not. The private health sector can only survive if it drains resources from the NHS. It can only survive if it takes its best doctors, nurses, and facilities. This is the challenge we are facing today, and this is the enemy we are up against.
While waiting times are rising to record levels, the private sector is booking out rooms and renting out NHS hospital beds across the UK. These beds usually lie empty- reserved for the occasional private healthcare patient- during the biggest NHS squeeze in living memory. It is this separation- this ability to receive healthcare anywhere and anytime at the expense of others- that allows private providers to charge a premium.
Yet there are more coercive forms of privatisation- whereby taxpayers’ money finances the provision of private health care, often for the most low-risk and profitable procedures (publicly financed-privately provided services now stands at more than 10% of the NHS budget). Even worse, the NHS now leases out its brand to third-party organisations like Care UK, meaning you can think you are being treated in a public hospital only to find out later that you weren’t. And it is not just domestically; in 2012 the government outlined plans to expand the NHS brand internationally, allowing hospitals to set up private operations around the globe e.g. Moorfields Eye Hospital now has a centre in Dubai.
Hospitals would not need to turn into profit making machines if the government funded them properly. They would not need to set up private overseas operations if their funding was more secure. And yet as more A&E departments close and health bodies predict a £30bn black hole by 2020, the government is picking a new scapegoat for this crisis. ‘Health tourists’- overseas patients who do not pay for NHS care- are being blamed for the pressures on services. Yes that’s right, the government is claiming that trying to recover the cost of ‘health tourism’, around £300m (or less than 0.3% of the entire NHS budget) will strengthen the NHS’ finances. By asking patients to show their passport before receiving treatment, they argue it will ensure health services go to those that deserve it most. Despite the farcical economic argument, the real motivation behind the passport policy is to shift blame away from underfunding towards undesirable foreigners. If we take up the ship and yacht analogy again, it is like blaming the theft of the ship’s fuel and resources on a clueless new passenger.
These ‘health tourists’ therefore fit into a wider narrative framed by the right: we do not have enough resources for everyone, and so we certainly do not have enough to share with outsiders. It is the politics of austerity mixed with the coded language of racists. America is now embodying this protectionism- literally trying to close its borders to large swathes of the (Muslim) world. The UK is following suit- creating new borders within the country- restricting access to the welfare state for disadvantaged and under represented groups. Re-classifying who is allowed access to public services and who is not, creates an ‘us’ and ‘them’. It re-defines who is a deserving citizen and who is not. This form of othering is used to strengthen and empower the white British majority. It is used to keep people fighting over local resources while global capital flows into our public services – corporatizing and privatising our NHS.
We need to fight back against these new borders within our country, and fight back against the re-definition of our welfare state for merely the white majority. Organisations like Docs Not Cops are resisting the introduction of immigration charges for ‘settled’ patients, and there is great work being done to resist the widespread collection of immigration data in hospitals and clinician centres. Local events, like Young Labour’s ‘Fight to Defend the NHS’ in Wandsworth’, informs young people of the issues at hand and gets them involved in projects in their area. The NHS Demonstration on the 4th of March will bring these groups together and be a chance for you to show solidarity for the thankless task NHS workers carry out every day. It will be a chance to voice your concerns about the future of the NHS, and show your anger at the way the government is framing the crisis.
The Conservative government regrettably won the argument over austerity, and they are now trying to win the argument over greater privatisation of the NHS. But health services are a public good, they cannot be left to the forces of the market. And we cannot let the forces of government scapegoat immigrants, especially when it fits so easily into their post-Brexit narrative. The NHS is consistently voted one of the most efficient, effective, and equitable health care systems in the world– it is not just a big public ship where everybody gets by, but an innovative, responsive, and treasured vessel for all. We cannot let it sink.
 https://www.theguardian.com/society/2017/jan/06/three-deaths-worcestershire-royal-hospital-nhs-winter-crisis + https://www.theguardian.com/society/2016/sep/08/nhs-perpetual-winter-waiting-list-record-bed-blocking