HISTORY shows that the meaningful and lasting components of neoliberalism always come from the left.

Though political history will hardly rank Wes Streeting’s proposed dismemberment of the NHS alongside Francois Mitterand’s abandonment of his 1981 Union de la Gauche, Bob Hawke’s 1983 Prices and Incomes Accord with trade unions in Australia, Clinton’s 1996 Personal Responsibility and Work Opportunity Reconciliation Act or Gerhard Schroeder’s 2003 Hartz IV reforms in Germany, for British politics Streeting’s ambitions go further than Tony Blair’s 1995 attack on Clause Four.  

As much as currently possible, this piece seeks to provide a political Ordnance Survey map of how he seeks to overcome its contours.  

Nuffield Trust detailed analysis shows that in 2021/22 86 per cent of elective care was provided by the NHS, with only 6.2 per cent provided by the private sector though funded by the NHS. 

But for hip and knee replacements, though the delivery split between NHS and private sector was 50/50, 75 per cent was funded by the NHS. 

But Streeting’s professed affection for the private health sector means that his political plans for dismantling the NHS go far further, with many of his chosen lieutenants and deliverers already in place. 

It hardly needs saying that, based on previous performance and delivery, little of this will be of benefit to those receiving or providing NHS services. 

Streeting admits to his regular tutelage under Patricia Hewitt and seems poised to follow in well-trodden 1997 and 2001 New Labour footsteps. 

Since Hewitt’s previous role in public service outsourcing and dismantling the NHS is often overlooked, a brief Labour history is necessary. 

After her famous 2001 pre-election purdah taxi ride with Jonathan Bland, who later converted a combination of London Co-operative Training and London ICOM into a more loosely defined Social Enterprise London, she set up the Social Enterprise Unit in the Department of Trade and Industry, soon to be followed by her July 2002 Social Enterprise Strategy, which insisted that all these organisations were businesses. 

In September 2002, Paul Boateng’s Treasury cross-cutting review of voluntary and community-sector service delivery offered a detailed funding manual for their delivery of public services. 

This was followed by 2004 legislation for community interest companies to enable payment of external dividends to investors in many of these organisations. 

Later, as secretary of state for health, in January 2006, in white paper “Our Health, Our Care, Our Say,” Hewitt introduced bidding for these “alternative providers” to deliver NHS services, based on payment by results. 

In 2008 she commenced a series of Right to Request initiatives to promote these same third-sector structures in healthcare delivery. 

Under David Cameron’s coalition government, by the time Francis Maude in November 2010 announced his Right to Request programme, half of his claimed “100 new mutuals” had already been initiated under New Labour. 

Alongside Hewitt at the Department of Trade and Industry and Department of Health and Social Security, in April 2000 Gordon Brown as chancellor set up a social investment task force (SITF) under venture capitalist Ronald Cohen to devise ways for using private funding to deliver public services. 

The final SITF report in 2010 claimed: “If 5 per cent of the £86.1 billion estimated to be invested in ISAs (individual savings accounts) were also directed to social investment, this would generate a flow of an additional £4.3 billion. Taken together, these four sources — philanthropic foundations, institutionally managed assets, grant funding and individual savings accounts — could generate £14.2 billion for social investment.”

New Labour’s Dormant Bank Accounts Act 2008 allowed proceeds from bank accounts of deceased individuals to be transferred to a new Reclaim Fund. 

In 2022, the fund’s coffers were increased to include the assets of dormant charities. Cohen played a key role in using these bank accounts to set up Big Society Capital in April 2012 as a social investment wholesale bank, to attract external and private funding for delivery of public services, with its role shown in its latest media release: “Under the new brand (Better Society Capital) aims to attract new players into the social investment space, including local authorities, pension funds, wealth managers and charities… to more easily approach potential new partners who don’t have prior knowledge of its history or its aim to grow the social investment market.”

In May 2023, in its consultation on allocating a further £880m of Reclaim Fund dormant assets, the Financial Conduct Authority reported that £745m had already been made available through the Dormant Assets Scheme for “social and environmental initiatives.” 

So access to the Reclaim Fund means that anything proposed by Streeting won’t cost him very much. Currently, the fund’s money is distributed to Big (now called Better) Society Capital, the Access Foundation for Social Investment, the Youth Futures Foundation and Fair4All Finance — all organisations which supplement or replace delivery of mainstream public services. 

For service delivery there has been an expansion of up to 29,000 community interest companies, including private companies limited by shares or with “B Corps” registration. 

In December 2022, the executive director of B Lab UK acknowledged that B Corps numbers had doubled in the previous year — now at 2,000. 

For their fee to B Lab, he claimed: “For-profit businesses can show their B Corp certification label proudly by honouring shared social values like environmental protection and ethical labour practices.” 

All this means that third-sector delivery has been transformed from agents of community self-defence in the 1970s and ’80s to become “mission-led” private companies, subsidised by the Reclaim Fund and often funded by foundations and other devices to minimise their owner’s tax liabilities. 

Since Duke University’s publication in 2007 of The Revolution will Not be Funded, there have been many warnings of this “non-profit industrial complex.” 

The efforts of Better Society Capital and the Reclaim Fund are already augmented by Social Investment Financial Intermediaries like Social Investment Business and Social Investment Scotland, offshoots from Tech for Good (with its Israeli anchor) and substructures like Bethnal Green Ventures, which specialises in investment in healthcare and social care and “only invests in for-profit companies limited by shares.”

Streeting’s plans seem destined to follow a similar path, with his cast list almost complete. Matthew Taylor, currently chief executive of the NHS Confederation, won’t need much persuading. 

The hallmark of his 15 years at the Royal Society of Arts (RSA) was an outpouring of publications for diluting public service delivery as “public service reform.” 

Taylor had previously been head of the Institute for Public Policy Research and Blair’s No 10 Policy Unit where he was familiar with Hewitt’s outsourcing. 

Under Taylor the RSA published “Enterprise Solutions: Public Service Mutuals” in 2014, which included encouragement to local authority staff to break away from their local authority: “As an independent mutual you can seek out new business beyond your ‘parent’ local authority. Delivering contracts for more than one local authority may lead to efficiencies and opportunities to expand your team and take on new work that you believe has social value. If you establish yourself as a charity, you may be able to attract grants and donations that would previously have been barred to you. As a local authority service your remit was largely defined by your parent authority. You may wish to become a more diverse type of organisation, bringing together different functions and services.”

The culmination of Taylor’s ongoing “trusted insider” status was his stint as chair of Theresa May’s “Review of Modern Employment,” which published his “Good Work” in July 2017, with recommendations even less progressive than that European Commission’s recent considerably diluted Platform Services Directive. 

His “Good Work” report included: “Platform-based working offers welcome opportunities for genuine two way flexibility and can provide opportunities for those who may not be able to work in more conventional ways. These should be protected while ensuring fairness for those who work through these platforms and those who compete with them.”

The watered-down EU Directive is stronger: “Member States will establish a legal presumption of employment in their legal systems, to be triggered when facts indicating control and direction are found.”

Despite dilution to accommodate differences between 27 EU member states, the EU’s Platform Directive at least seeks to determine the correct employment status of platform workers, with the onus on the digital platform to refute this. 

With his experience in Downing Street, IPPR, the RSA and problem-solving for Theresa May, Taylor should be able to slip seamlessly into a new role assisting Streeting in NHS and other public service dismantling. Most of the funding, templates and predecessors are already in place. 

Leslie Huckfield is a lecturer and researcher at Glasgow Caledonian University and the Open University. He is a trade union and third-sector activist, known for his work on social enterprise and co-operatives. He was Labour MP for Nuneaton from 1967-83 and an MEP from 1984-89.