A revealing exposure of the destruction of health care in the UK

By Joan Smith

In his 57-minute documentary, filmmaker Peter Bach reveals the extent to which the National Health Service (NHS) has been privatised since the introduction of the internal market by Conservative prime minister Margaret Thatcher in 1989-1990.

Bach was first approached by a group of doctors in 2013 and asked to make the documentary. Over the course of several months, he interviewed the doctors about their jobs and the ways in which privatisation policies have affected them and their patients. He brings in the comments of several others, including a lawyer, journalists and activists, to widen his exposure of the constant attacks on the NHS.

His shots are mainly close-ups of the people speaking, capturing their facial expressions in detail. Shots of London, where the documentary was filmed, include scenes of Bach outside St. Paul’s Cathedral, site of the 2011-2012 Occupy protest, and by the Thames, where Dr. Peter Brambleby is interviewed. Other interviews take place in GP (general practitioner) surgeries and other health care settings.

Split into 10 sections, the film’s aim is to make the public aware of the “tsunami of structural changes” and the huge level of privatisation that has gone on behind closed doors, as well as the steps taken to keep the public in the dark. All the professionals interviewed passionately contribute to exposing the steady dismantling of health services. The aim is to replace the NHS with an “American model” that enriches the private health companies.

The documentary compares the NHS with the US for-profit health care system. The US spends $8,233 per person per year on health care while the UK presently spends $3,433. Yet, it is well established that the NHS is the most cost-effective and best health service in the developed world. By breaking up the NHS, which has been a model for publicly funded health care for more than 60 years, the private sector is attempting to set a precedent for other countries and to open up new profitable markets.

In the segment on Accident and Emergency (A&E) closures, health policy analyst Lucy Reynolds comments on how patients are now dying in ambulances in places where A&E centres are few and far between, meaning longer journeys. While Reynolds is talking, the camera focuses on an ambulance trying to squeeze its way through traffic.

Segment two deals with Private Finance Initiatives (PFIs) that were introduced in 1992 by the Major government and expanded after the Labour Party came to power in 1997. PFI Hospitals are built with loans that have to be repaid at almost 20 percent interest. As a result, many hospitals have to close departments and sell off certain sectors in order to keep running. Even if the hospital closes, the loan has to be repaid. Bach tells us that from the “£11 billion borrowed to build PFI hospitals, over £79 billion has to be repaid.”

Professor Allyson Pollock makes the point that “for the amount they have to pay back for building one hospital they could have had three hospitals open and running, that includes staffing.”

For example, “Coventry University hospital cost £400 million to build and has a repayment plan of £3 billion.”

While hospitals are saddled with massive deficits, the main beneficiaries of PFIs are the “banks, bankers and private investors.” The documentary points out: “From 1997 to 2009, during [prime ministers Tony] Blair and [Gordon] Brown’s New Labour government, 101 out of 135 hospitals were built using PFI loans.”

The film exposes the bogus promises to defend the NHS by the Tories before they came to office and their hiring of corporate lawyers to write the Health and Social Care Act. This act, that laid the legal basis for a rapid escalation of privatisation in the NHS, is vividly exposed in segments three and four.

Dr. Lucy Reynolds provides other revealing observations: “British Railway was run down for some years systematically before the privatisation. In fact, that is the standard privatisation strategy to make it easier.” Showing the viewer Conservative MP Oliver Letwin’s 1988 book Privatising the World, Reynolds points out that he sets out tactics “for governments who are trying to privatise public services against the wishes of their population.” One key step “is to restrict the budget, so that the public service gets worse and worse and worse. Then privatisation can be represented as a step up.… It is a deliberate policy.”

Segment five discusses the media as an extended arm of the government that has played a key role in preparing the narrative to justify creeping privatisation. Propaganda and negative coverage of NHS services, originating from the government and the Department of Health, are regurgitated by the media to “make the NHS look bad.”

In segment six, the doctors are interviewed about the setting up of Foundation Trusts, which were promoted in order to make every hospital an independent business entity by the Labour government. Hospitals were forced to compete with one another for funding, opening a back door to private enterprises. Foundation Trusts are allowed to earn up to 49 percent of their income by providing treatment to private patients, creating a two-tier system.

The segment on intimidation is particularly revealing. Dr. Brambleby tells us that when he started raising issues about patient safety he was told his duties were to the corporate team, not the wider public. He was threatened by a press officer of the Strategic Health Authority, who told him that he should “reflect on the fate of the late Dr. David Kelly.”

Every doctor appearing in the film has experienced intimidation.

Despite the documentary’s powerful coverage, it can offer no real answer for those seeking to oppose the destruction of the NHS, other than urging the public to pressure the media and politicians to reverse their decisions. Dr. Clive Peedell, one of the doctors interviewed, is the co-founder along with Dr. Richard Thomas Taylor of the National Health Action Party, which campaigns solely on NHS issues. Dr. Bob Gill is a member of the same organisation and is running as a candidate for the party in May’s general election.

In an interview with RT’s Max Keiser, Bach reveals the limitations of his perspective when he claims that the NHS was set up due to a compassionate ruling elite. This is false. Following World War II, the British ruling class faced a militant and socialist sentiment amongst broad layers of workers, who opposed any return to the “hungry ‘30s”, and revolts in its colonies abroad. Fearing social revolution, the bourgeoisie were forced to make concessions. Universal free health care, state-funded education, national insurance and social housing were established. It is not a “compassionate” ruling elite to which the UK population owes the NHS, but to the working class that struggled for the right to a decent standard of living.

There is widespread opposition to the attack on the NHS. Millions of people have joined protests against the closure of hospitals, children’s heart units, and maternity units, and the closure or downgrading of A&E units. It is the trade unions that have played the lead role in dissipating these actions, as they have done with so many others. The trade unions have not only avoided any generalised mobilisation of working people against the dismantling of NHS, but wherever struggles erupt they have kept them fragmented. Despite the party’s record of attacking public health care when last in office, the unions maintain that only the election of another Labour government can reverse the attacks on the NHS.

The Socialist Equality Party established the NHS Fightback campaign in 2012 to defend the NHS on the basis of a socialist perspective of class struggle against capitalism.