Dismantling the NHS is turbo-charged neoliberalism: Review of How to Dismantle the NHS in 10 Easy Steps

NHS activist Gill George reviews Youssef El-Gingihy’s book How to Dismantle the NHS in 10 Easy Steps

38 Degrees members deliver a petition of over 410,000 names to the NHS. Their message: Save Our NHS

The NHS is a milestone in history – the most civilised step any country has ever taken

The quote above is what Aneurin Bevin told the first NHS patient ever to be treated, back in 1948; and that’s how Youssef El-Gingihy frames his forensic analysis of how the Tories are destroying the NHS.

El-Gingihy is a GP in east London. His commitment to the NHS and the NHS ethos of compassion and caring shines through. Step by step, El-Gingihy takes us through the path to the destruction of the NHS, charted not just by the Tories but by New Labour as well. Margaret Thatcher started the offensive with the introduction of the internal market in 1990. The claimed purpose of this nonsense was to increase efficiency through market forces and competition. The reality was that the NHS began to grow its ever-increasing bureaucracy. Hospitals looked away from patient care and focused on their balance sheets instead.

Tony Blair embraced and built upon Thatcher’s legacy. Remember the public-private concordat and Independent Sector Treatment Centres? That’s when the private sector ripped off the NHS by being overpaid to carry out high-volume low-cost surgery. The NHS was left with more complex patients, and with the clinical (and legal) consequences of big business mistakes. For his next trick, Blair massively expanded PFI projects. PFI is akin to buying yourself a house on the most expensive credit card you can possibly find. The total PFI tab for the taxpayer stands at £301 billion for infrastructure projects worth £55 billion. Hospitals are now cutting beds and services to pay for these PFI scams.

GPs employed by Virgin and Atos, ‘payment by results’, Foundation Trusts, an ideology of profit and competition and balancing the books… the consequences of neo-liberalism are clear. When hospitals worry about their balance sheets instead of patient care, patients die. The horrors of the Mid Staffordshire hospital scandal weren’t because of uncaring nurses. There simply weren’t enough nurses, because employing them was deemed too costly.

And then we come to the massive attacks of the coalition government, and the Tory government that has succeeded it: the sell-offs, the carefully orchestrated smear campaign against the NHS, and the legislation to break up the NHS and hand out the profitable bits like sweeties to the Tories’ big business friends. El-Gingihy describes the process as ‘turbo-charged neoliberalism’, and he’s right. By stealth, the Tories have brought the NHS to the brink – completely in line with the plans of Oliver Letwin, John Redwood and ‘patient champion’ Jeremy Hunt way back in the 1980s.

This book is an accessible account of the complexity of 25 years of attacks on the NHS, and tremendously valuable for that. El-Gingihy probably underestimates the devastation now being caused by savage spending cuts, with the Tories’ farcical pretence that the NHS can find £22 billion a year of ‘efficiency savings’ and ‘productivity gains’.

The section on ‘What can you do?’ makes some useful suggestions, but doesn’t quite spell out the need to organise to defend the NHS in our own communities. All of us (except the super‑rich) need the NHS – and that creates the potential to build powerful broad-based campaigns that bring together communities and health workers in an alliance against cuts and privatisation. There have been real victories: the fights at the Whittington Hospital and Lewisham Hospital spring to mind, but smaller battles and smaller victories are taking place around the country. We have to build these fights and join them up.

When we fight for the NHS, we can win. Nigel Lawson, Thatcher’s former chancellor, once said the NHS is ‘the closest thing the British have to a religion’ – and Tony Benn predicted a revolution in the streets if the NHS were to be privatised. Now is a good time to start building that revolution.


This review was originally published in the Autumn 2015 issue of the rs21 magazine


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