Theme: Public Policy | Content Type: Book review

Review: NHS under Siege. The Fight to Save it in the Age of Covid, by John Lister and Jacky Davis

Colin Crouch


Owen Harding

| 6 mins read

Britons of all persuasions routinely describe their country’s institutions as the best in the world and would insist that its levels of corruption are the very lowest. The evidence of how government tackled the coronavirus crisis in NHS under Siege. The Fight to Save it in the Age of Covid by John Lister and Jacky Davis suggests that the latter needs some review.

As MP for Newmarket, Matt Hancock (then Secretary of State for Health) received thousands of pounds in political donations from the racing fraternity. Newmarket racecourse is owned by the Jockey Club. Eyebrows were thus raised when Hancock appointed Baroness Dido Harding, on the board of the Jockey Club, to head the critical Test and Trace programme. Baroness Harding had no training in public health. Subsequently Randox Healthcare was awarded an uncontested £133 million contract to produce and process Covid testing kits. Randox was paying Tory MP Owen Patterson £100,000 to lobby on their behalf. Harding’s appointment as head of Test and Trace was subsequently ruled ‘unlawful’ by the High Court.

The major fact, well described and analysed elsewhere in this book, is that Harding’s Test and Trace programme refused to make use of the existing, experienced epidemic tracing capacity of the country’s public health services. Instead, large contracts to private firms were awarded, many of which had no experience in health monitoring, spending up to £37 billion on a weak programme. Here and elsewhere during the Covid crisis, it was extraordinary to witness the fervour with which ministers suspended all proper contracting procedures to award contracts to associates and potential political donors.

The Sharks Emerge: Starvation & Privatisation

All governments from that of Margaret Thatcher onwards bear some responsibility for the crisis in the NHS, a crisis about which these authors have been warning in earlier books and which the pandemic has thrown into startling relief.

There are two charges. First is the general starvation of funds, of which only the New Labour governments can proudly claim to be innocent. Second is the selling out of the NHS to private firms, in which New Labour joins all Conservative administrations in guilt. The Thatcher government initiated, and New Labour uncritically inherited, the view that private providers were superior to public ones. Therefore, the more private firms brought into the NHS, the better the quality.

The only reason for such belief is that private firms compete in a pure market. But in health there are no such markets. Even when the tendering process is not derailed like during the Covid crisis, these contracts are awarded following intense corporate lobbying. Also, contracts to run, say, a local general practitioner network, cannot be reallocated every year or so; time is needed to establish a service. The market only comes into play from around every five to twenty years, when contracts are up for renewal. Public service contracting is not part of a true market economy. That is why it is so easily corrupted.

Advocates of the involvement of private firms in the NHS might argue that they bring in new resources to supplement those of the public sector. However, as argued extensively, the key resource in health delivery is highly skilled labour, which is in short supply. This supply is largely determined by government policy and can respond only slowly to demand. All private health firms can do is pay medical staff a little more than the NHS and lure them away from it. This merely reduces the allocation of resources to patients based on medical need, replacing it with ability to pay.

The Sharks Remain

Beyond recent Covid contracting, why the enthusiasm of all major UK parties for private involvement in the NHS? There is one explanation: if the (usually) more prosperous can be lured from public provision with the offer of private services for payment, there will be less political pressure to do anything to improve the public sector. For politicians, if the same process also gives them the chance to attract funds from corporate donors, what’s not to like?

Whereas studies of policy disasters normally conclude with recommendations addressed to one or other political parties, Lister and Davis end their own part of this book with a discussion of the various public health campaigning groups in Britain. There follows a second part in which an impressive list of health leaders and campaigners describe their own experiences in the struggle to sustain a public health service. Even if the Labour Party has now returned to being a true ally of a public health service, the heavily funded corporate lobbyists will continue working on it. To counter them, the campaigning groups must work even harder to make their own shoe-string operations effective.

NHS under Siege. The Fight to Save it in the Age of Covid, by John Lister and Jacky Davis. Merlin Press. 289 + xiv pp. £10.75

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    Colin Crouch

    Colin Crouch is a past editor, and past chair of the board, of The Political Quarterly. His most recent book is: Post-Democracy after the Crises (Polity Press, 2020).

    Articles by Colin Crouch