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on 16 June 2011
Everyone should read this book.

The authors amply illustrate the moves that successive governments have made to introduce the market into the NHS.

These moves started when Labour were in power and Alan Milburn was Health Secretary. The links between Labour and private healthcare providers were so strong that when the former health minister Alan Milburn resigned he went to work for a private healthcare company.

Labour and Tory politicians, in league with private health companies, have been planning and slowly working towards the destruction of the NHS. This is partly motivated by ideological neo-liberalism and partly because these businesses hope to make vast profits from sucking money from the NHS. And that is what Andrew Lansley's reforms represent: the privatisation of the NHS - admitted as such by Vince Cable on 'Any Questions' - and the enrichment of a small number of businesses. The losers will be the users of the NHS and those who work for it.

The authors are particularly good at unpicking the network of people driving the privatisation and marketisation of the NHS pointing out the game of musical chairs that they enjoy as they move from ministerial adviser to policy drafter at the Department of Health to private health company to insurance company to think tank to lobby group and round again - the worst case being a spokeperson for a private health provider welcoming a government report that he himself had written when at the Dept of Health.

The evidence compiled by the authors is well researched and referenced and the case that our NHS is under grave threat is compelling.
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on 4 June 2011
Its sickening to read how big business and psychopathic politicians are trying to privatise by stealth,the only institution Britain can be proud of.At least they have come a bit unstuck at the moment as they tried to push through the last bits of the privatisation programme,hopefully the Southern Cross fiasco,shows what we can expect from the 'free markets'.Excellamnt book but it does make your blood boil +++
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on 8 May 2011
I am a GP in Tower Hamlets. Sometimes politicians and anonymous Department of Health planners create policies which make it difficult to do my job well. I have been sometimes bewildered: why would they want to do that?? This book sheds quite a lot of light on it all: now the policies begin to make sense, in a perverse, twisted way.
Like another GP who has commented on this book, I also value British general practice highly: it is a treasure. The current 'reforms' threaten to destabilise it all.
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on 12 May 2011
Well done to the authors.

This book lays out quite clearly how the NHS in the UK is on the brink of privatisation and how that will lead to higher costs for healthcare and threaten the founding ethos of the NHS.

As a GP I know what a superb system we have in the UK and we must cherish it.

If anyone wants to know what the politicians are up to then read this book. It is clear, concise and very easy to digest.

Dr David
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on 27 March 2012
The National Health Service, created in the aftermath of six years of total war and during a period of crippling austerity, has succummed to a twenty odd year campaign by private interests, aided and abetted by a multitude of mendacious politicians from every major party, to be finally re-engineered from an institution crucial to civilising this country, into what will essentially be a feeding trough for the private sector. Lay and Players "The Plot Against the NHS" is a short (though at 179p its not as short as the 128p that amazon claim!) and sharp account of that campaign and the prosepects for the NHS after Andrew Lansleys recent Parliamentary Bill takes effect.

The story they tell is depressing. Tentative moves to privatise the NHS under Thatcher and Major gain speed during the Blair/Brown era. Miserable specimens of humanity such as Alan Milburn and Patricia Hewitt drive that agenda forward step by step in tandem with all manner of mendacious statements that serve to veil their actual intent. Notions such as democratic and public accountability are emasculated, the performance of private health care in the NHS is measured with all the care that the "coalition" employed counting civilian bodies in Iraq. Ministers and civil servants flit between the public and private sector with lightening rapidity. Companies with histories that include a whole host of crimes ranging from fraud to the buying and selling of human organs are presented as suitable partners for the NHS.

An under regulated economy serving the interest of private capital collapses. The Tories and the so called Liberals are elected and use the aforementioned collapsed economy as the excuse (ala Naomi Kleins The Shock Doctrine) to turn the NHS into an under regulated cash cow serving the interests of private capital. This, argue the authors, will in time bring the NHS in England to a end: costs will grow hand in hand with the inefficiencies that a fragmented "market" will clearly bring, pressure will increase for patients to pony up for an increasing array of now free at the point of use treatments. The eventual outcome will be a system that reflects the experience of the United States, and the country will be paying over the odds for a health care system that does not deliver the goods except in black ink on corporate accounts.

This book deserves and needs to be widely read and acted on, sooner rather than later, as there is always an alternative to the destruction of public institutions and the priviliging of private interests over our collective well-being: this being a point the authors explore with regard to developments in post-devolution Scotland and Wales, whose respective administrations have held back from moving in a similar direction. In short this is a well written book, that narrates the story of "The Plot Against the NHS" along with an analysis of the marketisation inflicted on it thus far, and the prospects for it during the unfolding Cameron/Clegg era. Totally recommended.
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on 13 September 2015
I am writing this review on the day that Jeremy Corbyn was elected leader of the Labour Party. This book makes it very clear why we desperately need such honest people in government with integrity and the good of the people in their hearts. Alan Milburn is my bête noir. I remember when he was fighting the shipyard closures here in the North East. He feather-bedded changes in the structures of the NHS (along with Patricia Hewitt and the avuncular Alan Johnson in their time) to move forward on privatisation, not even competition - privatisation. And all we the public got was spin, spin, spin. Meanwhile American health companies, private equity and a few home grown sharks have been handed billions of our money to make the NHS worse by making all its millions of different parts compete with and mistrust each other instead of working together as we need them to.No one voted for this. No one wants this. This is corruption on a massive scale. And Tony Blair and his new Labour successors cannot understand why they are held in such contempt and why anyone would want to vote for a dinosaur who actually cares about ordinary people? The Tories? well we expect no better than for them to oil wheels for their city cronies and perhaps also to be as grievously incompetent as Lansley. Is it incompetence or do they simply not care about real people as long as they get their lucrative positions? This book names the names of the dozen or so people who have really wielded the power over health policy. Very few of them elected by anyone but more than able to smarm, bribe and manipulate those that are elected. And Milburn? Now on the board of several private health companies and earning more than the prime minister. Disgusting. The tone of the book ( unlike me) is very measured and sticks to the facts with the merest of dry asides to convey the authors' opinions. I hope they write a follow up soon.
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on 31 July 2011
I can say I was there for most of the issues described in this powerful and accurate description of what has essentially been a self serving conspiracy carried out by a tight group of mates with a common Market favouring ideology.
Heartbreaking in the description of how they took both the public and politicians for a ride!
Mr Britnell's tour de force "Necessity not Nicety" deserved mention since it reinforces the very points made in this excellent book.
Why ever isn't the Labour opposition using these exposes? I guess because they feel ashamed of their own role in it all.
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on 11 August 2011
I'm an NHS psychiatrist, have been for 25+ years - as a tiny cog in a massive machine it has been deeply dispiriting to watch David Brent-type Alan Sugar worshipping apprentice-wannabes slithering into the organisation - they insinuate themselves poisoning the language with 'modernisation', and other disguises until one day we wake up and bingo ! NHS is a kite mark awarded to multi-national profit-driven operators and say - 'hey who nicked our health service ?' .....sorry about the punctuation but this book is so good, so horrible, that it is alot more scary than a thousand horror books....makes my blood boil helplessly.
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on 5 November 2011
A tremendously punchy and hard-hitting book, though sadly none of the thousands of individuals and organisations vigorously promoting the fragmentation of the NHS will ever read it. The last section is slightly poignant but utterly realistic: the 10 year tragedy of the NHS played out by New Labour's NHS Plan of 2000 is similar to the process that broke up the railways, and not that different to the way universities have been forced (though not always unwillingly) to yield to multinationals, mega-consultancies and neoliberal managerialist mantras. The initial phase, as Leys and Player point out with great insight, has been the proliferation of small ventures, often with entrepreneurial GPs at the money-making helm. Eventually, though, this will make way to a consolidation phase focusing on corporate asset-stripping and profit-making, and dominated by sell-outs, mergers and acquisitions. Since the corporate goal is long-term profiteering from illness across millions of individual lifespans, seizing control of the patient population is the critical issue, not so much whether the initial enterprises were particularly successful. Many weren't. The authors recall them in detail, culminating in a fine diagram (`The Marketizer Network') of the often murky and reciprocal relationships between government, the Department of Health and an array of the familiar (big pharma) and less familiar (UnitedHealth, Care UK etc) big players. (Over the same period, the major universities have developed parallel corporate acquisitional tastes: within a very few years, the London population north of the Thames will have their healthcare dictated by one of only two organisations: Imperial and University College. HMOs and others must be drooling at the prospect.)

Although the authors are not clinicians, their marvellously detailed analysis repeatedly demonstrates that they don't just study policy documents. They have brilliant insight into the new authoritarianism of the `clinical leadership' movement, and this is the first time I have seen a description of the summary abolition of the truly independent Community Health Councils in 2003, replaced by toothless corporately-controlled and unfunded Patient and Public Involvement Forums, themselves disbanded and replaced by ever-more ill-defined bodies with little authority to criticise anything more important than hospital car-parking charges.

This is a fine and unhysterical analysis, a worthy successor to Alyson Pollock's `NHS plc' (2005; we urgently need a new edition). It's about as up to date as a book can be, with references as recent as early 2011. But this is a tortuous and continually evolving tale - which is itself, of course, part of the plot. Without the public being more than fleetingly aware of it, programmes for the relentless commercial healthcare `revolution' have been going on for more than a decade. Some, for example UnitedHealth's 'Evercare' Program, and Practice-Based Commissioning, bolstered by FESC (Procuring External Support for Commissioners) were signally unsuccessful, the former because UnitedHealth had no idea of the importance of primary care services in the UK that were already doing a great deal to prevent recurrent hospital admissions, the latter largely because many GPs felt they had more important things to do with their time, such as looking after patients, than write documents on commissioning. New Labour harrumphed with indignation, and no doubt were planning their commercial revenge when the coalition came along to ensure that no such mistakes could happen again. Brilliantly, and with no mandate, they have compelled all GPs to take part in the new commissioning bodies, and all hospitals to become semi-autonomous Foundation Trusts. This time there can be no going back, certainly not to the dark days of the Mid-Staffs Enquiry (another evidently superb Foundation Trust), nor to mealy-mouthed neo-socialist nonsense that concluded Robert Francis QC's launch of the Inquiry Report:

"People must always come before numbers. Individual patients and their treatment are what really matters. Statistics, benchmarks and action plans are tools not ends in themselves. They should not come before patients and their experiences. This is what must be remembered by all those who design and implement policy for the NHS".

Some hope.
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on 15 July 2012
As an NHS GP I have been bewildered by the years of seemingly unrelated and nonsense like changes to the NHS. I now realise that there was a plan all along. I could never tell whether it was all a complete mess or whether there was a brilliant plan. I realise now that I only had the jigsaw pieces and could not make sense of them as I did not have the picture. This book gives you the picture - I get it now and it all makes sense. The Govt wants the NHS 'off its books' and the private sector want a slice of the action. Obvious really. You really do need to read this book. I was hoping that the last chapters might point us in the direction of how to fight back but I was disappointed. Its rather depressing really.
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