In the UK, the NHS is widely regarded as a national treasure. It ensures that every member of the population, regardless of their level of wealth, has access to healthcare when they need it – and it is free at the point of use. In many countries, healthcare bills can be a serious concern. In the US, for example, by far the number one cause of personal bankruptcy is medical bills.

Many members of the current Cabinet are market fundamentalists: they believe that the best solution to any problem is a private-sector solution. And during the Covid epidemic, we have seen how this belief has translated into action:

  • at the beginning of the pandemic, when personal protective equipment (PPE) was in short supply, the government circumvented the normal rules of procurement – and ignored many of the normal PPE providers – in order to give contracts to often unqualified businesses linked to the Conservative party. In many cases, nothing usable was delivered;
  • more recently, exchanges between the Prime Minister and Sir James Dyson showed the same pattern of behaviour – the Prime Minister was prepared to bend rules and regulations in order to encourage Dyson to manufacture ventilators, again overlooking several far better qualified companies, and again receiving no usable products in return;
  • and perhaps most significantly of all, in what the government insists on branding as ‘NHS test and trace,’ they have largely circumvented the NHS both in terms of reporting lines and funding – and the result is a system which is both extraordinarily expensive and underperforming badly.

The Prime Minister has suggested that members of the public undervalue the NHS because they do not have to pay for it – but fortunately there is no suggestion at the moment that he is planning to act on this belief.

The government has recently published a White Paper setting out plans for integration of health and social care. Some elements of this paper may be beneficial, but others risk giving increased power to ministers to take decisions such as those mentioned above without scrutiny, and an increased role for the private sector in NHS decision-making and policy.

This suggests that there are three distinct risks to the NHS:

  1. most fundamentally, but least probably, that it ceases to be free at point of use;
  2. that an increasing proportion of delivery of services is carried out by private sector organisations – and, as the examples above indicate, this is no guarantee of efficiency or effectiveness; and
  3. that an increasing amount of control and decision-making power will be shifted to the private sector – which inevitably means that profit maximisation rather than the health of society will be the driving force.

If these risks materialised, the UK system might start to perform much more like the US system. And as the chart below indicates, while this is good for maximising profit opportunity, it is bad both for the efficiency and effectiveness of the healthcare system.


To protect against these risks in the long run, the 99% Organisation has set up a specific project to protect the NHS by analysing the implications of the White Paper and supporting other organisations in campaigning against its worst features. If you would like to be involved in this project, please let us know.

In the short term, privatisation of the NHS is continuing. A notable recent example is the purchase of 49 London GP practices by the American healthcare company Centene.

You can help today by signing the petition here and by writing to your MP to ask him or her to oppose this sale and to resist further privatisation of the NHS. This website makes it easy for you to do that and if you are not sure what to write, you could base your lettter on this Letter to MPs re NHS privatisation.

If you would like to help more, join our Project to Protect the NHS and sign-up  and join the 99% Organisation.