The Real Foreign Takeover of the NHS
The government’s willingness to demonise migrant workers is a sign of its increasing moral degradation. Meanwhile, like their New Labour role models, Keir Starmer and Wes Streeting are supremely relaxed about multinational involvement in the NHS.
Prime Minister Keir Starmer and Secretary of Health Wes Streeting at the London Ambulance Service Dockside Centre, October 2024. (Credit: Simon Dawson via Flickr.)
Last month the Prime Minister delivered a piece of rhetoric that will define his tenure. In his ‘island of strangers’ speech, Keir Starmer echoed the words of one of British political history’s most divisive figures, Enoch Powell, ahead of the government’s white paper on immigration. One of the key policies announced was the scrapping of the social care worker visa. At the same time, perhaps to appease the growing tide of voters shifting towards Reform UK (and to try to impress resident doctors before they ballot to strike), Health Secretary Wes Streeting revealed that he is likely to revive the policy of prioritising British doctors over ‘foreign’ ones.
The irony is that even Powell understood the importance of immigration and the impact it has on healthcare in Britain. During his tenure as health secretary (1960–1963), it was actually Powell’s policy to increase migration of doctors and nurses from South Asia to fill labour gaps in the NHS. In a debate on the issue in the House of Lords during this period, Lord Cohen of Birkenhead said that ‘the Health Service would have collapsed if it had not been for the enormous influx of junior doctors from such countries as India and Pakistan’.
The legacy of immigration and its impact on healthcare in Britain is chronically underappreciated, and it continues to be degraded by the language used by the contemporary Labour Party, which is often broadly of a piece with that of Reform and the Tories. Taken together, such rhetoric is creating an environment in which rioters target GP practices and anti-immigration protesters attack NHS hospitals. In a sign of the times, earlier this month in the north of Ireland an image went viral of one household displaying the unionist Ulster Banner, along with the Philippines national flag, and a printed-out sheet proclaiming ‘I work in a care home’ in an attempt to repel racist rioters.
The health sector has continually relied on migration to keep it and Britain afloat for almost a century. Yet somehow politicians like Reform MP Richard Tice are convincing portions of the public that immigration is a threat to the NHS (Tice described immigration as having unleashed an ‘unquenchable demand’ for doctors, nurses and hospital beds). Studies have debunked this idea time and time again. But politicians and right-wing journalists continue to promote the paradox that immigration simultaneously sustains the NHS and undermines it.
Profiteers and Scapegoats
The perverse rhetoric around immigration has focused on the wrong international issue. In fact, the real foreign threat to the NHS is its continued use of multinational private corporations. Last year, Tribune reported on health workers protesting at the London HQ of Palantir after the company was awarded a £330 million contract by NHS England for data management services. The protesters were rightly angry about Palantir’s commitment to the Israeli government’s active genocide in Gaza (which has, among other evils, specifically targeted hospitals and healthcare staff).
But they were also alarmed at the risk it poses for NHS patients. Palantir’s contract licensed them to create a new data platform. However, as Democracy for Sale has reported, 18 months on from the announcement, few hospital trusts have taken up the software because it is apparently not up to scratch. The Department of Health and Social Care subsequently spent an additional £8 million on a contract with KPMG, to help ‘promote the adoption’ of a federated data platform by NHS trusts and integrated care boards (ICBs).
It is fair to say that such contracts have hardly been a resounding success. But the stain they leave on the blue lozenge logo of the NHS is lasting. A particular concern is the repeated disdain Palantir founder Peter Thiel has shown for the NHS (Thiel has been reported as claiming that the health service ‘makes people sick’). Meanwhile, Palantir has denied profiteering from anonymising and selling patient data abroad, though how can we be so sure, when the original contract had 417 out of 586 pages redacted? It took a legal case from the Good Law Project to get some clarity on the matter — yet still a lot of information around data protection remains hidden. Critics have argued that Palantir’s software integration could lead to unfettered influence over the NHS’s healthcare infrastructure.
While visiting President Trump earlier this year, Keir Starmer found himself rubbing shoulders with his US ambassador Peter Mandelson in the Palantir base in Washington D.C. It would seem likely therefore that Palantir will have even greater influence in the health system in future. Meanwhile, former PM Tony Blair has been reiterating the idea that NHS data should be sold in order to fuel a tech boom; something Starmer will likely acquiesce to, given that he is cosying up to tech companies and flirting with the idea of attempting to make Britain an AI powerhouse. Even the health secretary, who has denied wanting to sell patient data, has warmed to the idea of ‘data access’.
NHS for Sale?
Palantir is not the only cause for concern. United Healthcare, whose AI systems have been at the heart of a scandal across the USA, are currently facing a class action lawsuit due to flaws in its system’s algorithms. It is designed to predict how long patients should stay in hospital, but when staff deviated from targets relating to this, it led to them being disciplined. United Health’s subsidiary Optum has contracts with almost half of all ICBs in the UK. What is of concern is that John Armitage — a hedge fund manager with a $500 million stake in United Health — has donated to the health secretary on multiple occasions. Streeting has repeatedly claimed that the NHS is not for sale. But as the above shows, parts of it clearly are.
Streeting has gone further this month, doubling down on his interest in further outsourcing of private clinics in the NHS. There are whispers that there will be a deeper commitment to this in the forthcoming NHS 10-year plan (due imminently), and that the current government will go ‘further’ than New Labour did in this area. But sustained reliance on private outsourcing should not be considered a success: it is the hallmark of an expensive addiction.
The current government’s rhetoric on the NHS points to a ‘New Labour on steroids’ approach, but this should not be viewed as a return to form. Yes, New Labour’s target-driven care led to improved outcomes and improved waiting lists. But the control freakery and the wider culture of the Blairite health system was out of control. In any case, many of New Labour’s policies in this area were far from successful. For example, the Private Finance Initiative (PFI) — introduced by the Blair government — whereby NHS trusts financed new infrastructure partly via private corporations (many of whom are not based in Britain), has been a disaster.
Because of PFI, NHS trusts are now paying millions of pounds every year in debt repayments, at a time when Streeting is forcing them to make severe cuts in order to boost efficiency. This is money which should be spent on medications, equipment, and staff. Some of these repayments will be going on until 2050, expected to total a staggering £82 billion. In companies like Innisfree — which has the second largest number of PFI projects — investors hold their shares using offshore tax havens in Guernsey. This is hardly a legacy to make you feel nostalgic for the days of New Labour.
Reclaiming Our Health Service
But there is something even more insidious going on. Many of us will have noticed the spread of new private hospitals around Britain in recent years, often spearheaded by American companies such as HCA Healthcare and Cleveland clinic. Novara Media reported last year on the rise of services being outsourced to the multinational corporation Diaverum to provide dialysis clinics away from traditional, thoroughbred NHS clinics. Diaverum has a questionable record, with a CQC report one of its dialysis clinics ranking it as inadequate. It is reassuring that Diaverum have said they will take this feedback seriously. But an ominous feeling remains about the fact that Diaverum has now expanded to over 38 clinics in Britain — and about what this could mean for the future of the NHS.
There is a strange irony to all this, in a nation which has been so tense about the idea of wanting to ‘take back control’ and reclaim ownership of its ideas and laws in the wake of the 2016 Brexit referendum. The NHS is under attack from foreign corporations, not from the innocent immigrants who have helped keep the health service afloat since 1948.
A deeper question is also at stake here: why is Britain incapable of supporting its health service from within? The NHS came into being because of a vision of a more just future and the courage of risk-taking Labour politicians. It is going to take a similar kind of courage to make it the envy of the world once again.