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A Movement to End Outsourcing

The contracting-out of key NHS functions to private profiteers has eroded public healthcare — we need a movement to end it for good.

Guy Smallman / Getty Images

When the NHS was founded after the Second World War, the country was in approximately £27 billion worth of debt. The Labour Party had been voted into power by a working class that was determined not to be poor anymore. The NHS and other social welfare reforms were demands that were conceded under widespread popular pressure.

The NHS provided prompt, first-class care and treatment for everyone who needed it. Suddenly working-class families were no longer reliant on patchy healthcare provided by churches, benevolent individual doctors, or charities.

Mass vaccination was introduced alongside a raft of measures, such as secure social housing, which improved the overall health of families. The working class was no longer condemned to die in agony of curable diseases or treatable injuries.

Despite the longstanding campaign to dismantle the NHS, it had remained a progressive organisation in 1990 when I started my training as a nurse. Student nurses enjoyed subsidised accommodation and were paid a wage to train. Young migrant workers like me had a fighting chance to make something of our lives and build a career.

Domestics and porters were all directly employed by the NHS. They enjoyed the full NHS Whitley Council terms and conditions, and they had the opportunity to train as nurses themselves if they wanted. We formed close-knit communities within our hospitals, helped and supported each other, and provided the high standard of care, nutrition, and sanitation necessary for patients to survive and recover.

The NHS wasn’t perfect, of course; the system was hierarchical and the work was hard for junior staff. However, delivering the highest standard of patient care was at the heart of everything. We had the staffing levels and resources to do it. We looked after patients and the NHS looked after us — it gave us a wealth of interesting opportunities, decent pay and work conditions, and pensions.

Cuts and privatisation have constituted the policies of every government since Thatcher. The 1983 Griffiths Report outlined a host of reform measures, including the introduction of ‘modern’ management processes that undermined democratic structures and accountability.

The growth of free market ideology within the NHS led to the executive teams of NHS trusts and councils reducing services, shutting down wards and hospitals, and tendering out parts of the NHS to the private sector. False promises were made to the staff and their unions that restructuring of services would allow for better, more efficient, modern care.

Stories spun by profiteers painted a picture of an NHS that was lumbering, old-fashioned, bureaucratic, and ‘not fit for purpose’. Politicians and the media repeated the lie that there was no more money to invest in frontline services, as hospital land was flogged off to be converted into expensive residential flats.

The campaign to demonise public healthcare was relentless. Patients were reported to be misusing A&Es, some of which were gradually downgraded, merged, or shut down. Under the banner of ‘choice’, patients were told that they could get their own pot of money, personal budgets that would enable them to buy and pay for their own care.

This allowed councils to shut services such as day centres and withdraw from their duty of care to people with chronic disabilities. Patients were given the title ‘bed blocker’ when they required hospital care but were not at death’s door. Care in the community was the holy grail to achieve for everyone, even if their living conditions were substandard and the impact of poverty was a factor in their illness.

Patients increasingly came to be referred to as ‘clients’ or ‘service users’. Ironic, given that the services they relied upon were increasingly pulled from under them. I witnessed the closure of the psychiatric emergency clinic at the Maudsley Hospital. In the same NHS Foundation Trust the inpatient addictions unit was shut down and the contract was handed over to the private sector.

There was little resistance from the trade unions, and patients didn’t even realise what had been taken away until it was too late. This tragedy was replicated up and down the country as NHS services were either contracted out or lost forever.

Opposing the Drive to Outsource

As a trade union representative, I tried to lead opposition to the closure of an eating disorders unit in Bickley, Kent. It was a therapeutic, safe space for young women, many of whom had been sexually abused in childhood, which was shut down despite opposition by the workforce and the patients.

Throughout those years we were told that the old hospitals were falling apart; and instead of investing in repairs, companies were commissioned to roll out rip-off Private Finance Initiatives (PFIs) to build far smaller facilities and ensure a windfall for the private sector.

The outsourcing of contracts went hand in hand with PFI as the ancillary services, including portering, catering, and cleaning, were carved out and flogged off to the highest bidder. NHS chiefs deny that standards dropped or workers suffered — but everyone with an intimate experience of the service knows otherwise.

It should be no surprise that outsourcing, combined with years of pay restraint, is forcing skilled and experienced workers out of the NHS. The relentless drive to demoralise the workforce is part and parcel of the privatisation agenda: downbanding, deskilling, redeployment, and redundancy are now commonplace across the NHS, when earlier it used to be one of the most stable employers in the country.

The relentless drive for profit is slowly stripping working-class people of the necessities of life: decent food, secure housing, warmth in the winter. This is leading to a rise in chronic health problems at the very time that the NHS is starved of funding and quality healthcare is becoming the preserve of a wealthy few.

Organising and Fighting Back

What has happened up to now, horrendous as it has been, pales in comparison to the privatisation we will see in the years to come unless we organise against it.

In May, more than 100 striking outsourced ISS workers from South London and Maudsley NHS Foundation Trust marched to protest outside ISS offices at Canary Wharf. During the protest, an observer was overheard asking, ‘who are these people?’ This comment neatly sums up the class struggle in this country.

‘These people’ are the ones who kept the country going during the Covid-19 pandemic: the low-paid cleaners, porters, catering staff — the so-called ‘working poor’. These workers have the most to lose from the race to the bottom and the most to gain from fighting back against it.

It was workers like these who, in the late nineteenth century, rose up and built the general industrial unions that we know today. They struggled to secure the rights that are now being rolled back by stealth.

The recent strike wave shows that the working class is once again stepping onto the pages of history. This time, it is fighting not just for terms and conditions but to save our NHS and public services.

If we are to win, our movement will need clear objectives. The most important is to oppose all cuts and privatisation, and to demand that all outsourced work be taken back into public hands. This will directly challenge the profiteers and the political class in this country.

It will also mean that unions need, as a matter of necessity, to co-ordinate their campaigns in defence of the public sector. It’s time to take those campaigns into our communities and social movements — and build the widest possible resistance to the destruction of our National Health Service.