Neoliberalism and the crisis in health and social care

Health and social care provision around the globe is in crisis. Over a decade of neoliberalist health policy has reduced services to near breaking point. In the UK the pace of the attacks on the practice and principles of the NHS has accelerated markedly over the past three years, culminating in Tory manifesto promises to slice off great slabs of it for immediate privatisation. Two Health and Social Care Acts (2012/2015),1 a Care Act (2014),2 the Five Year Forward View (2014),3 “vanguards”, “MCPs” and “PACS” are all already undermining its foundations, seeking to speed up the process of bringing health and social care services together into smaller numbers of much bigger, privately-run conglomerates. This article will explain these terms and developments, and examine their implications for our future struggles against NHS privatisation. The article is broadly structured by a comparative study of health provision in the UK and the United States.

The social care workforce in the UK is huge with, in 2012, 1.63 million workers. Social care is labour intensive and currently an area of capital accumulation that private capital is finding it difficult to generate profits from. Potentially, problems for the non-statutory sector will worsen as, from 1 April this year, the national minimum wage has been set at £7.50 per hour. This will have a massive impact on social care provision, an employment sector with low and widely differing levels of pay. When the new rate came in, 43 percent of care workers, 341,000 people aged 25 and over, were being paid less. In a dozen local authorities, over three quarters of care workers were on below this rate of pay.4 “This is good news for the notoriously underpaid social care sector”, said Richard Humphries of The King’s Fund, a health think-tank: “The question is: could it have unintended consequences?”.5 The central consequence to which The King’s Fund alludes is the very real possibility of the hike in wages sending so called “independent sector” organisations (which include both private and voluntary sector care providers) out of business altogether. As the journal Community Care shows, 47 major care providers closed in 2014-15 alone and this trend is likely to have accelerated over the past year.6 A recent care provider conference in Oxfordshire estimated that during the first part of 2017 four or five providers went bust each month in the county alone, causing a crisis that saw council administration staff being sent in to some residential homes to provide care themselves.7

The care crisis is also affecting provision in the US. The new administration’s widely trumpeted American Health Care Act (AHCA) has, at the time of writing, passed its first legislative hurdle, having been passed by the Republican-dominated House of Representatives after initially stalling. The AHCA, laughingly called “Trumpcare”, aims to replace “Obamacare”—the Affordable Care Act (ACA), which enabled tens of millions of Americans to buy health insurance after its implementation four years ago.8 As the Washington Post reported: “Independent arbiters such as the Congressional Budget Office say [the AHCA] would increase the number of uninsured by millions, cut Medicaid by $800 billion, and raise premiums and deductibles—especially for those with pre-existing conditions”.9

– International Socialism

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