Can ENGLAND'S National Health System Reforms Overcome the Neoliberal Legacy?

Abstract

England’s National Health Service (NHS) is in the process of major reform as old institutional structures based around an internal “market” are being replaced with integrated care systems. The changes represent a significant shift in ethos away from commercialisation to collaboration between health providers. But the way that these policies unfold will depend on the context within which they are implemented, and three decades of neoliberal reforms have left their mark on the structure of the health system. This paper shows how a powerful, politically-connected financialised private sector has evolved alongside a weakened public system, depleted further by the pandemic. While the share of overall public health spending reaching the private sector has not increased greatly over the past decade, private financial investors are strongly embedded in some segments of health delivery, particularly mental health services where shareholder returns are boosted by financial engineering. The boundaries between private and public are increasingly blurred with the NHS treating private patients and self-payment for health services is increasingly normalised. Rather than traditional privatisation, the health system is facing a more subtle and pernicious erosion of public services across different dimensions which seems likely to continue despite the new reforms.

Data-driven research and healthcare: public trust, data governance and the NHS

“…Later, the Health and Social Care Act 2012 further fragmented the service, inviting more private companies into the healthcare space by introducing a tendering process for the commissioning of health care services under the principle of competition [ 30 , 42 ]. More recently, the Health and Care Act 2022 represented a significant shift away from competition and towards collaboration between health providers [ 43 , 44 ]. As some argue, whether these reforms will manage to halt the erosion of public services and the further involvement of private interests in the NHS depends on how and the context within which they will be implemented [ 43 ].…”

“…More recently, the Health and Care Act 2022 represented a significant shift away from competition and towards collaboration between health providers [ 43 , 44 ]. As some argue, whether these reforms will manage to halt the erosion of public services and the further involvement of private interests in the NHS depends on how and the context within which they will be implemented [ 43 ]. In any case, such changes can have a significant impact on the relationship between the public and the healthcare institution [ 30 ].…”

“…The fact that different governments even within the UK have chosen to adopt different strategies when it comes to managing health data demonstrates that coopting a solidarity-based public healthcare system to support a wealth-generating agenda is a political choice rather than a socio-economic inevitability [89]. This change unites the pursuit of universal healthcare as a public good with the aims of successive UK governments to derive wealth based on a particular neoliberal model of bioeconomy [43,90]. As such, and to return to Warren's analysis of public trust, it mixes an impartial public and trusted institution with a partial one that seeks to secure its political goals using the former as its means [29].…”