How to Dismantle the NHS in 10 Easy Steps
by Dr Youssef El-Gingihy
Published by Zero Books (updated 2nd Edition) RRP £10.99,
Printed Matter and Bookbuster price £10


The title suggests a how to guide for wanna-be corporations looking to gain easy access to parts of our NHS – and, in essence, that is what has already happened, so this is speaking retrospectively. We start with the turning of our NHS into an ‘internal market’, firstly dividing the NHS up into Primary Care Trusts (PCTs) and NHS hospitals trusts. Under John Major, PCTs became the purchasers of services, and NHS hospital trusts became the providers of services, and thus hospitals had to start competing with each other as we were told that the public sector was far too inefficient, and that the private sector brings innovation and cost saving measures.

This public-private partnership continued as Tony Blair, despite pledging to abolish the internal market within our NHS, went even further with New Labour’s ‘NHS Plan 2000’ and ‘NHS Improvement Plan 2005’. Both Plans brought more privatisation and saw more services offered out to tender – for example, an MRI scan would sometimes be carried out by a private operator, who would then bill the NHS. Those services which were outsourced were still allowed to use the NHS logo, so giving the illusion that treatment was being carried out by the NHS.

New Labour adopted John Major’s Private Finance Initiative schemes (PFI’s), using them to build roads, prisons, schools and of course, hospitals. The message once again given out was that schools and hospitals were badly run-down due to being in public-sector hands. So the projects were tendered out – to bankers, construction firms, and other assorted management consortia (the PFI model was later exported globally). Instead of borrowing money from central government at zero/low interest, these loans for PFI constructions were borrowed at high interest rates with high charges for repair and maintenance costs. These high costs went on to bankrupt some hospitals, or forced them to lay off staff, reduce services, merge with other hospitals, or close down completely and sell off the NHS land.

Dr El-Gingihy is a GP who trained at the Royal London Hospital, which is part of Barts Health Trust. He writes: “This is the largest trust in the country and accordingly has the most expensive PFI scheme, which is one of Innisfree’s flagship projects. Innisfree – a fund management company in the City of London – is one of the biggest players in the PFI market”.

The great big sell-off of our NHS is has been finessed by dividing it into two further categories: Primary Care (GP and other Community Services), and Secondary Care (our hospitals). Whilst reading this book you will come across dozens of acronyms and the easiest way to view these is to understand them all as a way of deliberately obfuscating and basically carving up and selling off more and more of our NHS. Primary Care became a way of buying in services such as GPs, medical examiners etc. from outside companies – through private firms such as United Health, Atos, Virgin, Serco, G4S, Harmoni, Take Care Now (I kid you not) – including many of the Out of Hours services.

From 2003, Foundation Trusts were set up so our hospitals could act as semi-independent businesses allowing them financial and other freedoms. Time and again the likes of Serco, Harmoni and Take Care Now
had been falsifying data and overcharging for services provided. Polyclinics emerged as a way of combining services with Primary Care, such as mental health, maternity care, diagnostics and more – however, they are all inextricably linked to private finance, have become very expensive to run, and are running into financial trouble.

All of this privatisation would not have been possible without the revolving door of health ministers with links to the private sector. Alan Milburn went on to become an advisor for Bridgepoint Capital; Andrew Langlsey went on to advise pharmaceutical giant Roche and others; Patrica Hewitt went on to advise a private equity firm, Cinvern, which bought 25 of Bupa’s hospitals, and then became a special consultant to Alliance Boots… Over 200 parliamentarians have had recent financial links to private healthcare providers.

To make privatisation easy, you would need to run a smear campaign against our NHS. In the wise words of Noam Chomsky, “That’s the standard technique of privatisation: defund, make sure things don’t work, people get angry, you hand it over to private capital”. The smear campaign has been running for decades saying that public healthcare is too expensive, services are inadequate, the public sector is too inefficient, so best to hand it over to private capital for efficiency and competitiveness. Dr El-Gingihy demonstrates that our NHS is in fact the least expensive and one of the best in the world, and the envy of the world. It’s the deliberate under-funding and unnecessary debts that have been its biggest burden.

Another step: legislating to dismantle our NHS. After a 2010 Conservative manifesto stopping a top-down reorganisation of our NHS, stating “the NHS is safe in our hands”, the Conservatives went into coalition with the Liberal Democrats and imposed ‘The Health & Social Care Act’. This piece of legislation has been described as the “biggest act of privatisation ever seen in our NHS”.

To plot against our NHS is step seven in this book. The plotting has been going on since the early 1980s where a Central Policy Review drew up plans to bring in an insurance-based health service, whereby the bulk of medical facilities would be privately owned and run, and those who need it would pay for it as in the USA.

Step eight is to help brew the perfect storm to make all this happen. Never let a good crisis go to waste: and the financial crisis of 2008 was perfectly timed to bring in austerity measures. Those measures have allowed maternity ward closures, walk-in centre closures, GP surgery closures, A&E closures, recommendations of axing 10% of the NHS workforce – 135,000 jobs. We’ve seen ward closures, a 50% cut of district & community nurses since 2010, and one in five hospitals threatened with closure and the land sold off.

Step nine? Redesign the workforce. Between 2015-2016 junior doctors took part in demonstrations to oppose the imposition of plans to remove safeguards from working excessive hours, reducing their pay, increasing their hours, and punishing them for taking time off work – mostly aimed at women. This unrest enabled the government and certain parts of the media to demonise the doctors claiming they were putting the public’s health at risk.

Last but not least, step ten is the introduction of US-style healthcare in the UK. As the chapter heading suggests, this has been on the agenda since 1982 and is now being put into practice. The profitable parts of our NHS have been handed over to private companies during these years – and still are – whilst the non-profitable bits will be met by the public purse.

The afterword by the author says all of this is reversible but it needs the political will. More people need to know this is all going on: awareness of this wholesale privatisation should be imperative, whatever your political persuasion, if we want to save our NHS – after all, we’ve paid for it (and continue to do so) with our National Insurance contributions, as have our parents and grandparents.

• There is a website,, if you want to find out more, and on April 26th the Electric Palace is showing a film, ‘The Great NHS Heist’.

• Available from Bookbusters, Queens Road & Printed Matter Books, Queens Road.

We hope you have enjoyed reading this article. The future of our volunteer led, non-profit publication would be far more secure with the aid of a small donation. You can also support local journalism by becoming a friend of HIP. It only takes a minute and we would be very grateful.