All in this together: the corporate capture of public health

Society has changed fundamentally over the past 30 years. Citizens have become consumers with status proportional to purchasing power, and former public spaces have been enclosed and transformed into private malls for shopping as recreation or “therapy.” Step by step, private companies, dedicated to enriching their owners, take over the core functions of the state. This process, which has profound implications for health policy,1 is promoted by politicians proclaiming an “ideology” of shrinking the state to the absolute minimum. These politicians envisage replacing almost all public service provision through outsourcing and other forms of privatisation such as “right to provide” management buyouts.2 This ambition extends far beyond health and social care, reaching even to policing and the armed forces.

Superficially, a case can be made for privatisation. Economic theorists argue that the creative energy of private companies will unlock innovation. Freed from state bureaucracy they will find new, clever ways of doing things better and cheaper. Yet the reality is often different. They appear more “efficient” than the public sector providers they replace, but they achieve this efficiency only by cutting wages or by failing to deliver what they promise. The list of failures grows daily, from the very public failure of the security services company G4S at the 2012 Olympics to the local problems of Serco’s out of hours general practitioner service in Cornwall.3

So how is it that this new model, which often costs more (when all costs are considered) but delivers less, is allowed to persist? One obvious reason is political support. In part, this is ideological, but the ideology is encouraged and sustained by the temptations arising when politicians and senior civil servants know they will be …