The National Health Service (NHS), which provides healthcare to everyone in the U.K., free at the point of use, is one of the crowning achievements of the socialist movement in the United Kingdom. The main architect of the NHS, Aneurin Bevan, was a socialist firebrand who based his politics around two questions: “where does power lie in Great Britain, and how can it be attained by the workers?”

One cannot answer these questions without reference to the issue of healthcare. If workers know that their access to healthcare isn’t tied to their employment conditions, they’re much more likely to organize and challenge their working conditions. No wonder the NHS has been under attack for decades from the political right. 

Bevan had been raised in a small mining town in South Wales and became involved in the labor movement from a young age. His father, who worked in the mines, slowly died of a dreaded illness, black lung, while the mining companies tried to prevent workers from unionizing. 

He realized that one of the main barriers to building working-class power was the difficulties workers faced in accessing good healthcare. They were caught in a catch-22. Without income from work, they would be unable to access healthcare and all the other things they needed to survive. But their jobs often made them sick, requiring them to spend more of their money on their health. 

In Bevan’s home town, the community came together to develop a solution to this problem. Community health organizations like the Tredegar Medical Aid Society pooled money from workers to provide healthcare to everyone in the community—an early form of local social insurance. 

But Bevan’s ambition was to create a truly national health service—one in which both risk and resources were pooled across the whole of society to ensure that good healthcare was available to everyone, everywhere. 

When he was appointed Minister for Health and Housing in the wake of the Second World War, he saw his opportunity. Bevan fought against entrenched opposition from doctors and Conservative politicians, but eventually won enough support to announce the creation of the NHS in 1948. 

The NHS was created as a publicly-funded single-payer healthcare system that was comprehensive, universal, and free at the point of use. Within a decade of its launch, infant mortality had fallen by 50 percent and life expectancy had increased by 12 years.

But the NHS wasn’t just good for the people. It also represented a profound challenge to the capitalist economic model. 

For capitalist systems to function effectively, workers have to be scared of losing their jobs. Scared, disorganized workers are much easier to exploit. Managers can set pay and conditions without worrying about workers organizing to demand labor rights or higher wages.

The threat of unemployment is one of the best ways to keep workers scared and scattered. For instance, a freedom of information request recently revealed that U.S. Treasury Secretary Janet Yellen, then a member of the Federal Reserve’s Board of Governors, celebrated unemployment as a “worker discipline device” in the mid-1990s.

But unemployment is only truly terrifying if your survival depends upon your wage. Social democracy, which brought the United Kingdom expansive public services and social security, reduced the terror associated with unemployment—and that was a big concern to bosses intent on exploiting workers for profit. 

If you could rely on social security and good public services in the event that you lost your job, then you’d be less scared of losing it. And if you’re less scared of losing your job, you’re more likely to join a union and demand better pay and conditions alongside your fellow workers. In other words, social democracy—particularly universal healthcare—made workers feel too powerful.

In part, this explains the long-term neoliberal plan to dismantle the NHS. As I wrote in Tribune last year, NHS privatization has been a goal of this movement—which has representatives in both the Conservative and Labour parties—for decades.

When she was Prime Minister, Margaret Thatcher always claimed the NHS was “safe” in her hands. But in reality, she sought to expand the role of the private sector in the provision of health services in a way “that would, of course, mean the end of the National Health Service.”

Thatcher’s extreme privatization plan was rejected by other members of her government. But she still sought to encourage middle-class patients to take up private insurance, and supported the expansion of private healthcare providers. 

Thatcher also pressed ahead with reforms that paved the way for the creation of an “internal market” within the health service under Tony Blair’s New Labour government, in which the providers of NHS services were forced to compete with one another for government funding. These reforms made the NHS less efficient, and paved the way for the introduction of private providers. 

Ever since Thatcher’s plan for full-blown privatization foundered, neoliberal groups have sought more subtle ways to undermine the NHS. One neoliberal think tank, the Adam Smith Institute, released a report in 1988 detailing how Thatcher’s privatization agenda could be advanced even further. Just eight years ago, the Institute of Economic Affairs—another neoliberal think tank—published a policy program entitled “How to abolish the NHS.” 

Rather than attempting to privatize the NHS wholesale, which would encounter significant public resistance (84 percent of people in the U.K. think the NHS should be run in the public sector), the idea is to force the service into crisis, leading to greater levels of outsourcing and encouraging wealthier patients to take up private insurance. 

As Noam Chomsky observed, the “standard technique” of privatization is: “defund, make sure things don’t work, people get angry, you hand it over to private capital.” In other words, classic disaster capitalism. 

With the NHS in the midst of a deep crisis, this plan is proceeding apace. Since 2010, the NHS has undergone the longest funding squeeze in its history. Health spending increased by just 1.5 percent annually between 2009-10 and 2018-19, compared to 3.6 percent per year on average.

The results are now clear. Waiting lists for hospital treatment rose to a record level of nearly 7.8 million in September 2023. The proportion of patients waiting more than four hours in Accident and Emergency (A&E) departments is now at 45 percent, just below the pandemic high of 50 percent in December 2022. Thousands of people are now waiting more than 12 hours for admission into A&E. 

The proportion of patients waiting under 62 days for cancer treatment has fallen to 59 percent next to a target of 85 percent. And waiting times for ambulances have risen to an average of 36 minutes, compared to a target of 18 minutes. This has led to many avoidable deaths, such as the case of an East Sussex man named Martin Clark who died at age 68 from a cardiac arrest after waiting 45 minutes for an ambulance.

As a result of the massive strains on the NHS, one in eight British people have opted for private alternatives. In a 2023 YouGov survey, a further 27 percent of people stated that they would have gone private if they could afford it. 

And private providers are profiting from the chaos in other ways too. Record numbers of eye, hip and knee operations have been outsourced to private providers by the NHS—about a third of such operations are now carried out in private hospitals. Private health companies are also increasingly bidding for NHS contracts —between 2013 and 2018, Virgin Health won £2bn worth of NHS contracts. 

Private healthcare has an increasingly significant hold over public policy thanks to lobbying and political donations. According to Open Democracy, the Conservative Party has taken more than £800,000 in donations from private healthcare companies over the last decade. 

But it’s not just the Conservatives. Keir Starmer has claimed he is committed to keeping the NHS public. He stated in a recent TV debate with Rishi Sunak that he would never use private healthcare, even if he was on a waiting list for surgery. But he has appointed Wes Streeting as his Shadow Health Secretary, who stated: “We will go further than New Labour ever did. I want the NHS to form partnerships with the private sector that goes beyond just hospitals.”

Streeting has received at least £175,000 worth of donations from donors linked to private healthcare. After he was confronted by campaigners who oppose his drive to privatize the NHS by stealth, Streeting lashed out, calling them “keyboard warriors on their ideological hobby horse.”

Bevan is reported to have said that the NHS would only exist for as long as people were willing to fight for it. When, as the vast majority of pollsters expect, the Labour Party wins the next election on the 4th July, socialists all over the U.K. are going to have to fight to defend his legacy.