Taking the National(ism) out of the National Health Service: re-locating agency to amongst ourselves

Reframing the public/private debate on healthcare services: Tracking boundaries in the National Health Service

“…Whilst there are many good arguments against allowing investors to take profit out of a communal healthcare system, the prerogative to take sides—public or private–has substantially narrowed the discussion on how healthcare should or could be delivered in the UK. Whilst those trying to ‘save the NHS’ are attempting to keep a healthcare service that provides equitable healthcare for all, there are also dangers that this campaign to ‘keep the NHS public’ can create an exclusionary shared identity which stifles much needed space for critique in the healthcare service (Arnold‐Forster & Gainty, 2021; Cowan, 2021; Stewart et al., 2022).…”

“…As scholars of care suggest, there are other ways to make boundaries that pay more attention to affect and the emotional boundaries needed to keep patients, staff, and carers alike feeling safe (Allan & Barber, 2005; Dowrick et al., 2021; Lakshmi Piepzna‐Samarasinha, 2018). Some of these boundaries are already being redrawn, assemblages are being actively reordered by staff who often have to rebel, or use the times and spaces of disruption, to make change (Cowan, 2021; Dowrick et al., 2021). Focusing on these different boundary making practices might mean patients’ personal stories could be sheltered from conference halls and public accolades.…”

“…Privatisation of healthcare is not the answer if the shared objective is still equitable care. However, social scientists have increasingly pointed to the ways in which campaigns to ‘keep the NHS public’ reify a particular nationalistic ideal, bringing about a shared identity which can be exclusionary of those who experience discrimination or other negative experiences within healthcare (Arnold‐Forster & Gainty, 2021; Cowan, 2021; Stewart et al., 2022). Attempts to ‘save the NHS’ from what campaigners suggest is ’neoliberalism’, can therefore stifle much needed critique—such as the whole discipline of medical sociology which looks to the ways medical power operates over bodies (see, for example, overviews in Scambler, (2018), Will, (2023), and Nettleton, (2020)).…”

The delivery of health services as resistance

“…When we look elsewhere, we find that healthcare systems have been labelled a range of things: hierarchical, 2 oppressive, 3 patriarchal, 4 violent and coercive 5 and even 'systemically and institutionally deaf, bullying, defensive and dishonest.' 6 To contrast this, we can also see healthcare systems labelled as empowering and patient-centred.…”