RS: You’re a campaigner I have always admired and I’ve enjoyed doing a few things with you on the Twittersphere.
This viral video – seen more than 600,000 times – was one of our joint efforts in warning of the dangers of NHS privatisation, (granted, you did all the hard work).
I think we’ve all got our stories, so what’s yours? How did you become an activist?
NC: I’ve been an activist in several areas – so much is wrong isn’t it! But, like for many, the 2012 Health and Social Care Act got me more involved with NHS campaigning.
Also, long years with a loved one in hospital makes you wonder why care isn’t always the priority. You dig, ask questions, and I read up a bit on the significant but largely undiscussed changes to our healthcare.
Then the election of Jeremy Corbyn (the one doing the real work in that video!) signaled the chance to challenge that in the mainstream, then in government.
RS: The de-funding, outsourcing and marketisation of our NHS has… squandered billions and billions of pounds.
Successive ‘reforms’ have gone ahead without any meaningful scrutiny. The Tories remain ideologically determined to continue their deadly objective of a fully Americanised health system.
Looking at the current political landscape, is it too late to save the NHS, or can another way be found to stop and reverse the neoliberal assault on our vital public service?
NC: I’d tweak that lens a bit: we’re losing the actual services making up our NHS, which money alone cannot replace. (We see the US spends twice as much as Britain does for maldistributed healthcare.)
Our problem is that the politics of putting big business first created an anti-NHS consensus among all major parties (even though many MPs are told differently), fully committed to this US model, currently called “ICSs”, which shrinks back state service for business to expand. This is something the complete NHS coverage had prevented.
It’s probably no bad thing Starmer has ditched the pretence of Labour being a middle-of-the-road, social democratic party, because false hope anaesthetises you against taking action. The hope now is that more people notice the need to act against that consensus.
Similarly, today’s ICSs have been policy for eight years and plainly those institutions you’d imagine prioritising defence against this commercial US influence have failed to even include it in mainstream debate.
Looking more closely, this speaks to the corporate sector’s power in influencing that debate.
So to understand and act you need the serious left analysis of that influence, knowing no institution will challenge it, unless forced to by popular demand.
US corporate healthcare influence dangles daily in front of our noses, dressed up as pragmatic responses to unavoidable circumstances, but it can be seen if you know where to look.
In a series of short videos, I try to translate what specific aspects of US healthcare ‘Americanisation’ genuinely refers to and what this has meant for the NHS. The series is just starting and the process is far advanced, but the subject still needs to be widely known.
RS: Much of your campaigning over the last decade has been focused on the Labour Party. You’re on the Central Council of the Socialist Health Association, and you’re a popular contributor with our good friends at @SocialistTelly
Can you see Keir Starmer’s Labour Party – Wes Streeting in particular – adopting a socialist plan for our NHS, when it appears there is very little room in their party for socialists?
NC: As Michael Foot said, in this country you can’t kill socialism without killing the NHS.
Streeting won’t break ranks to embrace a socialist institution as neither would Heidi Alexander or Jon Ashworth. There’s a reason campaigners have for years had to try and nudge Labour to do so: Institutionally, it doesn’t want to.
Private sector narratives are so embedded that few people have the resources to identify who created them or who they serve. In many cases, people echo them for lack of an audible alternative.
By narratives I don’t mean provocations by outriders like the IEA, but a whiny, ‘reasonable’-sounding story of increasing demand and diminishing resources that forces you, with a heavy heart, to abandon the NHS goals of the best complete care for all. In specific ways that just happens to benefit private sector growth. (What that story leaves out also matters a lot.)
This banter is so dominant, it’d take a real maverick, with a real understanding of the politics of that shrinkage, and backed by strong, enlightened social movement, to free themselves from that influence and actually defend those NHS goals.
I really think the big opportunity for that was in recent years. Using it would have meant understanding and confronting Labour’s own commitment to dismantling services for profit under ICSs.
If you listen carefully, Starmer’s crew have signalled alignment with that trend: less unprofitable acute care and generally using service-shrinkage as a chance to expand business.
In other words, their plans go against the NHS’s founding purpose.
RS: We had a fantastic opportunity with Jeremy Corbyn to begin the process of delivering a public NHS. It always felt we could’ve gone much further with our plans for reversing NHS privatisation, but we would often hit a difficult obstacle, which hindered any chance of progression – not that I’m pointing any fingers.
What did you think of Jon Ashworth’s performance as shadow Secretary of State for Health and Social Care, and was he willing to listen to and engage with activists?
NC: The first step to reversing that privatisation had to mean using Labour’s unrivalled platform to force the full extent of it into the limelight, where the public could see it. But the question during Jeremy’s leadership was always whether Labour would institutionally break with cross-party support for those US-style, state-healthcare limits.
Had Labour won in 2015, (or the Libdems in 2019, or had the party right had its way under a Corbyn government, etc) we’d likely have had legislation not substantially different from the current bill. Those involved in policy on the right know that full well but the wider left probably underestimated it.
Diane Abbott had in fact led in opposing NHS England’s closure and downgrade programmes (Its ICS onslaught, then called ‘STPs’) committing instead to rebuilding an NHS following the NHS Reinstatement Bill, a narrative subsequent shadow health teams should have built on.
So, not to over-personalise, yes, there was a willingness under Ashworth to pat activists on the head to keep us at bay. But a) it was to further the right’s existing direction, not just his and b) this was helped by an unwillingness among left sectors to face down the right’s unpalatable policy goals, maybe because of the ‘Labour’ label.
He did once farcically challenge the government to come clean about some “secret privatisation plans” he knew was bullshit, while on the record continuing Labour’s support for NHS England’s actual corporate changes that were raging away.
Again, in terms of responsibility, all this should have been widely challenged and wasn’t. The more the challenge, the more people could have become aware there was something to challenge.
RS: The Health and Social Care Bill will turn the NHS into a publicly funded, privately-controlled and delivered corporate cash cow.
Many of us fear patients being denied the care they need, because they cannot afford to generate profits for an integrated care system.
How close are we to having a fully Americanised healthcare system, and something that resembles the Affordable Care Act (better known as Obamacare)?
NC: The first thing about the bill is it shouldn’t be treated like a normal democratic bill as its policies have already been carried out over eight years. That long, elaborate coup needs revisiting and rejecting!
Patients are already being denied the care they need. Similarly to its pro-ICS Erdington candidate today, Labour fielded a candidate in Hartlepool whose private company limited GP referrals. This is that US system: reducing non-lucrative hospital care.
So, without predictions, we need to understand what’s already being copied from the US and learn to recognise it where it’s not called what it is. And yes, ICSs (or ‘ACOs’) are the system used in Obamacare.
For example, the CEO of an experimental Obamacare ICS business in Massachusetts is helping lead this transition at the NHS England and NHS Improvement quangos.
Again, it’s about seeing it where it’s already happened: the post-2014 dismantling has involved New Labour figures: Simon Stevens, Michael MacDonnell, Chris Ham, Paul Corrigan, and so on, running influential ‘independent’ thinktanks or those powerful, unaccountable quangos created by the 2012 act.
In opposition, David Cameron ran a massive campaign to usurp the mantle of ‘party of the NHS’ which he knew Blair had abandoned. He kept hammering home Blairite minister Ara Darzi’s (explicitly US-modeled) determination to end the local district general hospital. What did Cameron’s government do? Expanded the ICS service closure programmes we have today and stuck Darzi in a quango.
Current ICSs build on pilot projects New Labour set up with US corporations, with Labour support that never budged. Like others, (ex-NHS England CEO and lord) Simon Stevens, a veteran of those early experiments, has for example harked back to one, Torbay, as the model for today (despite its disastrous CQC ratings).
This is not very well-known so I’m hoping campaigners can pick up that this corporate project is decades-strong Labour policy. To me it’s one of the core reasons neither party could stomach the idea of an actual NHS supporter like Corbyn as PM. Far too big a danger we’d end up keeping an NHS and God knows what else!
RS: You’re an experienced and active NHS campaigner, your knowledge of private sector involvement in our NHS is second to none, in my experience.
Most of the public hold our NHS in high regard – and rightfully so – and poll after poll tells us the general public support a publicly owned NHS.
So why do you think the public keep voting for governments that are ideologically hellbent on privatising everything down to the very last pair of forceps?
NC: The public’s position matters because the actual fight is over the familiar, comprehensive, physically close, accessible GP and acute hospital services for everyone. And only public provision can bring that.
ICSs have been removing that provision, creating a vacuum for private sector expansion.
I’d consider the question afresh: 1997 and 2010 brought in governments promising to scrap the (both actually US-inspired) damage done by their predecessors. (Just as the current bill claims to roll back the 2012 one.)
In both cases, no major party could call out the falsehood because both were up to their necks in it.
Despite the electoral process, Blair and Cameron had lied, kicking off two decades of the same damaging restructuring, sometimes run by the same people, as we’ve seen.
In 2019, a government was elected promising to build 40 new hospitals and to legislate for ‘the NHS own plan’ which actually means the current bill, making all the US-imported damage by NHS quangos into law.
Was the public told? No. Labour’s then shadow health secretary is on record supporting the whole process.
Was it told the “40 new hospitals” echoed the existing reduction to just one acute hospital for each ICS, scrapping two or three? No.
Corbyn had offered the NHS something much better than just more funding: genuine commitment to restoring its function as a public service. But this powerful message was not what most people heard.
We’ve seen the lengths taken to remove the threat of an actual choice at the ballot box.
We all have to fight for it despite the very institutions that fought to deny us such a choice.
RS: Local elections will be held in May this year. I won’t be voting Labour because I do not trust them. I could only ever vote for a party that believes the private sector has no long term future in our NHS.
I’m obviously not alone in feeling let down by Starmer’s Labour.
Political homelessness is a huge problem on the left, although smaller organisations are beginning to work together to offer a socialist alternative at the ballot box.
Can you suggest a couple of NHS campaigning groups that readers can look to get involved in please, now that they no longer campaign for the Labour Party?
NC: Above all I suggest digesting the evidence-based work on the actual US influence that’s been disfiguring the NHS.
I think many campaigns have included some people who’ve prioritised fighting that, but those voices haven’t always prevailed. Where there is a democratic opening, one way to get involved is strengthening those voices wherever they are.
Few campaigns have really sounded that alarm like 999 Call for the NHS; for a short period: the SHA, and Unite. Ultimately it’s where the grassroots can take a campaign beyond ‘leaders’ who seem not to have not caught up!
RS: And finally…
What does the NHS mean to you?
NC: Loving and caring for each other made social, enshrined in law and applied in practice, as national policy. Respect for our shared humanity. A startling exception to – even a rebellion against – this country’s harsh, cruel history of greed. Showing it doesn’t have to be that way, as Jeremy said, though corporations would like it to be.
RS: Nico, thank you very much.