Under The Knife: Documentary tracks the dismantling of the NHS

Susan Steinberg's new documentary Under The Knife exposes how the NHS is being picked apart by a government obsessed with the privatisation and marketisation of public services. Sheffield Save Our NHS have organised a free screening at Abbeydale Picture House on 16 October. We spoke to campaign member and retired GP Jack Czauderna to find out why the film is so important.

Tell us about Under The Knife.

The film Under The Knife tells how the founding values and principles of the NHS have been opposed by those with vested interests from the very beginning. Since then, the processes of managerialism, market competition, privatisation and underfunding have been steadily applied. These processes have accelerated in the last ten years, leaving the NHS grossly underfunded, understaffed and demoralised. It goes on to demonstrate recent changes that are preparing the way for a US-style healthcare system.

What has happened to the NHS over the last decade?

During the New Labour years, the proportion of GDP funding for the NHS was improved to approach the European average for health spending. However since the ConDem government of 2010 this proportion has dropped dramatically. The NHS budget needs to increase by 4% per year just to maintain existing services. This figure was 1.1% from 2010 to 2015 and has barely risen to above 2% since then.

Andrew Lansley's 2012 Health and Social Care Act accelerated the process of marketisation and privatisation of the NHS. It abolished the responsibilities of the Secretary of State for the provision of the NHS and moved public health provision from the NHS to local authorities where, because of drastic cuts to council spending, public health budgets have been slashed.

There has been systematic underfunding, understaffing and demoralisation among NHS staff, removal of bursaries for nurse training, a junior doctors' strike in pursuit of better working terms and conditions and a defence of the NHS, and considerable disrespect for overseas NHS staff without whom the service would have collapsed.

How has privatisation affected the NHS?

Up to 10% of the NHS is privatised. The cost has risen from about £2 billion in 2016 to almost £9 billion by 2016. Since the 1980s, most support services like cleaning, catering, laundry, security, car parking, patient transport and some clinical support services like pathology and imaging have been privatised.

In terms of clinical care, cuts in bed capacity have forced NHS acute trusts to outsource care to the private sector, so that the private sector share of NHS spending rose from 2.8% in 2006 to 7.7% in 2016, but has dropped slightly to 7.3% in 2017/18 as the profits from clinical care have dropped. Some private providers have 'walked away' from contracts that have not been profitable. However, in mental health up to 30% of hospital capacity is in the private sector, and even worse in Child and Adolescent services at least 44% of spending goes to private providers.

Although GPs have traditionally been self-employed independent contractors and not salaried employees, their work has been guided by a public sector ethos and is not profit-driven. However in recent years primary care has become marketised, and companies like Virgin and Babylon Health now hold significant contracts. Digital primary care services like 'GP at Hand', run by Babylon Health, have been accused of poor quality care, cherry-picking patients, destabilising local healthcare economies and de-skilling GPs.

Privatisation erodes the founding principles of the NHS - a free at the point of use health service. It erodes universal access to healthcare prefiguring a time when care may be withheld due to an inability to pay. Some groups like refugees and people from the Windrush generation have been denied treatment.

As underfunding has continued in the NHS, waiting times have increased and people have increasingly considered 'going private'. Many private hospitals fail to provide adequate care. Driven by the profit motive, they do not provide sufficient staff and capacity particularly in urgent care. In the event of an emergency they transfer to NHS facilities. It's estimated that it costs the NHS up to £250 million extra to pick up the pieces. The NHS is cost effective and efficient compared with the private sector. Perhaps the challenge emerging is no longer to actively privatise the NHS, but to create NHS structures which could be privatised in the future, particularly with Brexit.

Does the NHS have a future?

The answer of course depends on what politics you have! Right-wing politicians will always want to dismantle it because it represents the core of socialism. They continue to try in any way they can while denying they want to destroy it because the public value it so much. Socialists want to return the NHS to its founding principles of a service free at the point of delivery, paid for by progressive taxation, universal, equitable, comprehensive, high quality and with the NHS as the provider.

What action can ordinary people take to protect the NHS?

Firstly, come to see the film Under The Knife. Join their GP practice's Patient Participation Group. Be aware of Healthwatch, a statutory body which serves the interests of people who use health and social services. Each area has a local Healthwatch. Support a local campaigning group like Sheffield Save Our NHS, or similar in other places. The national body which has local campaigning groups is Keep our NHS Public. Raise concerns with political parties and trade unions.

Under The Knife is screened at the Abbeydale Picture House on 16 October. Register for a free ticket on Eventbrite.