• Helen Shallow

How to dismantle the NHS

The NHS has become the most important issue on the doorstep. Every political party claims to be the protector of the service, the government denies intentions to further privatise it and the current leaked report on Shrewsbury and Telford maternity services further undermines the public’s trust. This election may well turn out to be a watershed moment for the NHS after which privatisation will either become accepted and accelerated or reversed.

In our last blog we discussed the likely negative impact of Brexit on the NHS. This time Helen Shallow compares her own experience with her reading of the brilliant, insightful and compelling book, How to Dismantle the NHS in 10 Easy Steps.

‘El-Gingihy’s book (2019) resonated with me because I have lived and worked through the era that he explores; from having my babies in the 70s to working in the NHS for over 30 years. He sheds light on why, despite the positive rhetoric about choice and control for women, we are ever further away from effective care in pregnancy and childbirth for all mothers and babies. El-Gingihy exposes the scandal of the private financial initiative (PFI) and the incalculable harm that private financing has caused to many Trusts as repayments have quite literally and deliberately bankrupted services. I know this to be true, as I experienced it first-hand: PFI hospital-builds with more single rooms than usual, as a welcome to future private patients, alongside work-spaces for staff with no windows or natural light,

The conservative political narrative about the NHS has been that we cannot afford it, we must cut back and make efficiency savings. The population is getting older, fatter and poorer and the NHS is imploding under the pressure. Current health services are said to be unsustainable. Like Alison Pollock (2005), El-Gingihy exposes this as false. Policymakers obscure the reality of neoliberal market-force strategies to bring in corporate business/insurance companies to take over ‘failing services’ which have been starved of the resources that had made our NHS the greatest, and still the most cost effective, health service in the world. Unlike public services, ‘private companies only have one legal obligation which is to their shareholders…their aim is to maximise profits usually through cutting staff and other costs… and so can be seen to be more efficient’

At the millennium I led on work for a feasibility study to set up a new birth centre in Yorkshire (Shallow 2003). I interpreted the NHS plan as a way forward for so-called ‘intermediate care’ for well women accessing birth centres in local maternity services. I believed the language of transformation and innovation; never for one minute realising that all the changes afoot were to prepare for the biggest sell off in a century. Like so many, I was seduced by language that hid the real truth. Policy makers are deliberately, but covertly undermining services and setting the NHS up to fail.

We started to hear of Alternative Providers of Medical services (APMs) as Virgin took over sexual health services in our area quickly making nurses redundant. El-Gingihy exposes the threads that bind politicians, businesses, global markets and auditors such as KPMG and Deloitte, together in a web of behind the scenes deals and sell offs. He clearly demonstrates the vested interests of each to the other and the way we have all been hoodwinked. I vividly remember the visit from the American integrated managed care consortium, Kaiser Permanente, who used very clever rhetoric, to introduce us to improving patient safety. At the time I knew nothing about an ‘integrated managed care consortium’, what they were or what their aims were, so why would we not get on board with improving safety? What we did not know was how their own company are, ‘infamous for dumping patients in down-town Los Angeles, when their insurance policies have expired’. I felt that we were being duped but I could not put my finger on why I could not trust these people, who were intent on winning our favour by sweet talking us into reciprocal visits to the US. Suffice to say, I did not go.

Politicians knew they could not overtly ‘touch the NHS’, so their plans to decommission the NHS had to be carried out ‘by stealth’. The mother of all reconfigurations was unveiled in the white paper ‘Liberating the NHS’. Many midwives, doctors and nurses will tell you that the resulting Health and Social Care Act has been an unmitigated disaster.

As I turn the pages of El-Gingihy’s book, I am aware of the sadness I have felt for some time at the prospect that our NHS is not safe, or secure and I am not alone in this: many people are now questioning the private provision of public services. Experiences in many different services, probation, justice and education for example, have created widespread doubt about the wisdom of entrusting vital public services to organisations whose priority must be their shareholders not the well being or safety of the public',

This election gives us a chance to determine the future direction of the NHS.


DoH. (2012). The Health and Social Care Act, D. o. Health, (ed.). City: Stationary Office: London.

El-Gingihy, Y. (2019) How to Dismantle the NHS in 10 Easy Steps: The blueprint that the Government does not want you to see, Zero Books Winchester UK Washington USA ISBN 978-1-78904-178-1

Naylor Review: NHS Land and Buildings Sell Off, https://keepournhspublic.com/need-to-know/naylor_sell-off/

Pollock, A. M. (2005) NHS plc. 2nd edition London & New York: Verso

Shallow, H. E. D. (2003) The Birth Centre Project In: M. Kirkham, (ed.) ,Birth Centres: A Social Model of Care, England UK: Books For Midwives Press.

#politicalcontextofbirth #NHS #politics #capitalismandbirth