NHS Privatisation, Necropolitics, Intentional Killing

With the 75^th anniversary of the NHS on the scene, it is a prescient reminder of how important the principle of free healthcare is. Detractors are quick to use the argument that healthcare is never free and it is true that at some point we have to pay to keep the service free at the point of use. The detractor’s argument is simplistic and childish in its attempts to justify the acceptance of privatised healthcare as if there is no difference between paying into a publicly funded service and a for-profit private service. The former facilitates healthcare for all regardless of who they are. The latter facilitates healthcare only to those who can afford to pay the astronomical amounts that private healthcare really costs. It is here, lurking behind this system of for-profit healthcare that lies a truth that few, in any, are willing to admit; that privatising NHS healthcare is intentional killing.

Choices

In the neoliberal system, the language of choice is king. However, it is an illusion of choice. Neoliberalism holds that poverty is a result of bad choices, the use of foodbanks is a personal decision, and that privatisation brings new choices and empowers consumers. Despite everything being a choice, for some strange reason, privatising the NHS is a necessity and not a choice. This contradictory lie uses a discourse of imperatives, that something HAS to be done in order to ‘save’ it and this something is to carve it up for private profit. This is a violent lie that hides the truth that it is a political and ideological choice and it is violence that lies at the heart of this issue.

The NHS has been undergoing slow privatisation since Margaret Thatcher introduced internal markets in the early 1980’s. In 2010 however, under the convenient cover of the fallout of the 2008 crash, the NHS has come under significant attack through ideological choices hidden behind ‘no choice’ imperatives such as austerity (a form of violence in itself). NHS funding has continually been cut whilst presenting the illusion that it has increased. This illusion is created by presenting the raw monetary expenditure on NHS services which masks the fact that, when inflation is accounted for, the raw monetary value given to the NHS is actually cut. It is the same principle as recent cost-of-living crisis pay ‘rises’ which are actually pay cuts because the ‘rise’ is lower than inflation. Further, years of underfunding, austerity measures, hostile environments, Brexit, managerialism, and (deliberate) waste have created a manufactured crisis. Together, these make the NHS ripe for privatisation and justify the ‘no choice’ narrative. All of this is rooted in political decisions and choices.

Necropolitics

Achille Mbembé (in Mbembé & Meintjes, 2003) talked of a ‘necropolitics’. The term ‘necropolitics’ refers to the concept of a politics of death, a social and political power over who gets to live and who gets to die. Value is attributed to lives making some lives worth more than others but the ultimate expression of sovereignty, Mbembe argues, is the power to make those decisions. Mbembé’s sovereignty is expressed through institutions powered by the state, of which the NHS is certainly one. In other words, through the necropolitical, we can argue that power is expressed through healthcare in terms of who gets to live and who gets to die. Although this exists in some minor forms under a publicly funded NHS, such as the decision to switch off life-support systems, this type of situation tends to be decided on medical expertise. The privatising of NHS healthcare, which is predominantly driven by the political and ideological, premeditatively intends to block access to treatment based on the ability to take part in the ritual exchange of money.

Grzinic (2012: no pagination) provides further relevance at the ideological level:

Necropolitics precisely defines the forms taken by neo-liberal global capitalist cuts in financial support for public health, social and education structures. These extreme cuts present intensive neo-liberal procedures of ‘rationalization’ and ‘civilization’. Their outcome is privatization of all public services.

Intent to Kill

To quickly summarise thus far, privatisation of the NHS is a political and ideological choice. Those making the choice to privatise are exercising a form of necropolitics by deciding who gets to die (those who cannot afford private healthcare) and those who get to live (those who can afford private healthcare). The intentional killing aspect arises in the fact that those who are making these choices know that people will die through being unable to afford private healthcare. They know that life sustaining treatment will be made inaccessible and yet still intend to cut people off from that treatment. As they know that people will die, and continue on the same trajectory regardless, then they are taking part in the intentional killing of those unable to pay; they intend for them to die if it means profit can be made through private healthcare.

Prior to ambulance strikes in December of 2022, the Conservative Health Secretary Steve Barclay stated that:

Ambulance unions have made the conscious choice to inflict harm on patients by going ahead with strikes

In this statement, the withdrawal of ambulance services is framed as a conscious choice and therefore an intention to inflict harm. If this is the case, then withdrawing publicly funded NHS services and replacing them with privatised NHS services is also a conscious choice with the intent to inflict harm on those unable to pay. In the case of ambulance strikes, they are a result of the manufactured crisis which is itself a part of the violent privatisation process. In theory, a strike is temporary whereas privatisation would be permanent. Therefore, the intent to harm becomes manifest in the permanent realm of privatised NHS services. The intentional killing does not have to be immediate either. It can be a long, protracted killing.

Living Violence

Returning to Mbembe, they talk of the ‘death-world’:

forms of social existence in which vast populations are subjected to conditions of life conferring upon them the status of living dead.

It is perfectly conceivable then, in a privatised sphere, that those unable to pay private healthcare charges become locatable in this ‘death-world’; living and dead at the same time, Schrödinger’s patients. This slow killing over time suspends the individual in a state of poor health when a condition may be easily treatable and would have been treated in a publicly funded NHS. This suspension holds people in a position where they are given time to think about paying, or to conjure the money from somewhere to pay up or die; again a long drawn out violence of ransoming an individual’s life. This drawing out is noted by Sandset (2021: 1412):

Part of the necropolitical regime of health care is that certain health care systems have created an environment not conducive to life but to slow death

Even in treatment, this suspension of life can be operated through patients being deliberately mislead about what treatments they need. For example, rather than being advised on the most efficient solution to their problem in health terms, they are instead offered profit-making, long-drawn-out treatments that incur repeated charges. In fact, the idea of curing patients of any condition is typically antithetical to the profit-making motive of privatised healthcare. Beyond this, there are still more forms of violence present.

Theft

The NHS is funded through taxation. It is free to use because it has been paid for through the collectivity of tax payers. It is only through this type of system that everybody can be treated for sickness, disability, or mental health issues without having to pay additional costs. It is an example of a system in which humans collectively work together for the benefit of humanity and human life. The tax system literally preserves life through this collective process. Further violence lurks in the fact that, despite the public paying for it, the NHS is being privatised without the permission of those who actually paid into it. In other words, it is literally being stolen and those who paid for it are going to be prevented from using it unless they pay again. Even more so, the NHS is a system of infrastructure that has been built up over more than seven decades, built on the backs of those who came before, and paid for over generations of lives to become the sprawling universal service that it is.

As such, it constitutes the theft of 75 years of public investment in the alleviating of suffering for the sake of ready-made profits for a small handful of people. Further, this theft is a continual process and does not stop at the point at which the NHS becomes private. It is very probable that, like other privatised services in the UK, public money will continue to be transferred to the private sector in order to run the healthcare system whether that is through tax breaks, incentives, maintaining infrastructure, or greater rewards for treating unprofitable patients. But along with this theft is the theft of your access to life sustaining healthcare, again reflecting that intent to kill. They take what is not theirs to take and they lock you out of the very thing you paid for and then hold your life to ransom under the threat of death. This is intentional killing.

Ignorance

The intent to kill manifests yet again in the withholding of information regarding the truth about how much private healthcare actually costs and how little coverage health insurance provides. By withholding this information, it allows privatisation to occur without the public being able to maintain informed consent. The absence of public knowledge being disseminated by those in charge of privatisation is an act of lying by omission and thus unveils their intent for people to be killed by removing the ability for them to object to privatisation on the grounds of its true nature. To close this article, I will leave you with a couple of videos which give some insight into what the actual cost of a privatised NHS would be.