NHS plc: The Privatisation of Our Health Care Allyson M Pollock 271 pp. Price £15 ISBN 1-84467-011-2 (h/b). London: Verso
Authors: John Butler
Journal: Journal of the Royal Society of Medicine (2005)

Allyson Pollock, well known for her trenchant and often brave criticisms of government policies about the National Health Service, has assembled an impressively well documented account of the steady encroachment of market principles and practices into the provision of a public service—a process that began in the 1980s and has gathered pace ever since. The result is a withering critique not only of the shameless transfer of cost-effective public services to the profit-hungry private sector but also of the betrayal of the central values of the NHS—integrated planning to meet defined needs, the provision of adequate services at all stages of people’s lives, equality of access to care, uniformity of standards and professional trust.

Pollock’s central message is simple but devastating: for the past fifteen years Conservative and Labour governments alike have encouraged the boundaries between publicly and privately provided healthcare in Britain to become increasingly blurred, allowing commercial companies to infiltrate the NHS. Alien values have been introduced, costly managerial technologies have proliferated, and a great deal of public money has seeped into the profit margins of the commercial sector. It has happened in the hospitals, in primary care and in long-term care and little of it has happened by accident or default. Indeed, there has been (in Pollock’s view) a virtual collusion between government and commerce to allow the private sector to take a growing share of taxpayers’ money in return for a lesser quantity and poorer quality of service provision. By way of documenting this assertion, names are named, confidences are shared, and a certain amount of gossip is leaked. One hopes that the publisher’s lawyers have done a good job with their proof-reading.

Yet Pollock’s book is far removed from the sensationalism that often pervades crusading journalism. It is a passionate book, certainly, but the passion is largely subterranean, only occasionally breaking through the measured and scholarly arguments in the shape of acerbic comments about the sale of hospital land to create new golf courses, the horse-trading in clinical services that takes place over comfortable dinners in London clubs and the activities of the subsequently disgraced MP, Jonathan Aitken, in skewing the provision of hospital services in East Kent. Such occasional barbs apart, the tone of the book is sober, the evidence is carefully documented, and the arguments are compelling. We find ourselves hopping with indignation at the bare-faced treachery of our political masters, wanting to call them instantly to account for selling out the NHS. How dare successive Secretaries of State from the 1980s onwards play fast and loose with the most popular public service that has ever been created in the free world? Why have they been allowed to get away with it? Why is Parliament so remiss in failing to see what is happening?

Allyson Pollock is to be applauded for allowing us to peer deeply into this particular Pandora’s box and she is to be admired for her courage in doing so. As she explains in the book, she has suffered personally at the hands of those for whom political spin is more important than evidence or truth. And yet, for all that this is a challenging and disturbing book, it does not wholly convince. The arguments flow unremittingly one way. Pollock sometimes sounds like an unreconstructed Bevanite, yearning to turn the clock back to a time when everything in the NHS garden was pristine, promising and public. Half-hidden like a watermark on every page of her book is the neo-Orwellian mantra ‘private bad, public good’. In the innocent and optimistic days of the 1950s and 1960s, services were planned in a rational and coordinated manner, general practitioners provided 24-hour care for entire families, hospitals were built with public capital, and values such as public service, political integrity and social justice were taken seriously. Yet Pollock gives scant attention either to the reasons why the old-style NHS was ultimately seen to have failed or to the possible benefits of the new mixed economy of health. The final judgment on the Private Finance Initiative, foundation hospitals and primary care trusts might yet go her way, but we need to hear the case for the defence before making up our minds.

It is here, perhaps, that Allyson Pollock’s campaign begins to falter, for the clock cannot be turned back and the errors of the past (if such they were) cannot be undone. At the very end of the book she observes that ‘if the NHS had been funded since its inception on the scale of other EU health systems, the public discontent that the privatisers were able to exploit could have been averted’. That may well be true; but the NHS wasn’t funded on the scale of most other healthcare systems and public discontent hasn’t been averted. The NHS has to move on from the position in which it actually finds itself, not some imagined position that we would ideally like it to be in. Pollock’s prescription for the future, in the final sentence of her book, is rousing: ‘What is now required is not reform but revolution—a quiet, collective revolution of the sort that brought the NHS into being in the first place’. Many will say ‘amen’ to this clarion call. Yet where is the momentum for the ‘quiet revolution’ to come from? Who is there waiting in the wings to become a latter-day Bevan? How can governments be beaten when the game is played by the rules that they themselves have set? On these questions Allyson Pollock is silent.