Academic journal article Capital & Class

NHS LIFT and the New Shape of Neoliberal Welfare

Academic journal article Capital & Class

NHS LIFT and the New Shape of Neoliberal Welfare

Article excerpt

1. Introduction

This paper discusses the NHS LIFT (local improvement finance trust) programme as an indicator of current trends in neoliberal welfare. LIFT, a new form of public-private partnership (PPP), offers an even more radical vision of service privatisation than does the private finance initiative (PFI). The company originally tasked with rolling out the LIFT programme, Partnerships for Health, claimed that LIFT would represent 'a true partnership in every sense of the word'. A senior manager at the organisation told me in an interview that where PFI had created adversarial relationships between the public and private sectors, LIFT gives corporations a seat at the 'planning table'.

LIFT, like PPP more generally, forms part of the neoliberal welfare reconfigurations in the UK and elsewhere, creating new exclusions and new elites. Its birth and rapid growth are rooted in corporate power and the state-supported development and consolidation of new markets. When the UK National Health Service was created in 1948, elite consultants were seen as the major countervailing power and were generously compensated for the encroachment on their business. Now, multinational companies--pharmaceutical firms, insurers, private medical providers, construction and service companies--tower over increasingly embattled publicly run health services and the clinicians operating within or even outside them. LIFT is a key organisational form allowing these companies unprecedented access to public-service provision, and theorising LIFT helps us to understand the changing face of neoliberal welfare in more general terms.

This article discusses five major issues surrounding neoliberal welfare as exemplified in the shift to LIFT-type models. These are:

1. The development of new elite networks and identities. This is important in allowing a shift away from a traditional ideology of civil service neutrality and towards a discourse that celebrates 'double-hatting'--the possession of multiple roles. The new discourse of leadership justifies a revolving-door culture that no longer attempts to clearly demarcate representatives of the state from those of capital.

2. Conflicts of interest between large and small capital (including, in the latter, GPs). LIFT represents a corporatisation of welfare, rather than simply a shift from the formally public sector to the formally private sector. GPs, with their (however problematic) embeddedness within local health systems, are replaced by multinational corporations organised into consortia. This creates proletarianising pressures upon clinicians.

3. The multiple meanings of 'privatisation' (and the related terms 'commodification' and 'marketisation'). LIFT must be defined as representing both commodification and privatisation; however, LIFT companies led by large banks replace rather than create competitive markets. Public services are being remade in the image of--and interests of--financial institutions.

4. The status and meaning of 'flexibility', innovation, and risk-taking within these new power complexes. Service privatisation is often justified by the equation of private companies with these neoliberal virtues. However, LIFT's model blocks local initiatives and entrepreneurship, imposing instead a remote, bureaucratic and inflexible outsourcing.

5. The changing but still troubled relationship between capitalist accumulation and the legitimation of the capitalist system. LIFT's ineffective structures create renewed legitimation problems, and the system cannot easily be steered. Research into LIFT found high levels of private discontent within local NHS management.

The article concludes by linking these themes, and by considering their implications for activists challenging neoliberal welfare. Additional themes not considered here include the topic of surveillance and that of welfare as punitive--as yet less prominent within LIFT, but of deserved interest to critical analysts. …

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