The neo-NHS: How neoliberalism has been transplanted into the heart of the British health service

Abstract

In 1948, Britain established a free health care system that was to be ran by the government, called the National Health Service (NHS). This led to the growth of a large public institution that was accessed by millions and became the country’s largest employer. It is central to the British welfare state, which was implemented in the aftermath of the Second World War, as part of the ‘Keynesian policy paradigm.’ In the 1970s, a succession of economic and social crises delegitimised the Keynesian paradigm and led it to be replaced by ‘neoliberalism.’ This ideology heralded the era of the small state, free market economics and the ascendancy of the private sector. The neoliberal prognosis was that the welfare state was too expansive and needed to be reformed. This asked the question of whether the government could maintain something as large as the NHS. Over forty years later and the NHS is still in place, however, it has been subject to change. This thesis will study the NHS over this period to examine how neoliberal policy has led to the reform of the health service, whilst maintaining the principle of free health care provided by the government. I will try to find evidence of marketisation, privatisation and cuts, as they represent the core principles of neoliberal policy.