Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

Economic crisis and national health system

The text analyzes the impact of the economic crisis in some critical aspects of the National Health System: outcomes, health expenditure, remuneration policy and privatization through Private Public Partnership models. Some health outcomes related to social inequalities are worrying. Reducing public health spending has increased the fragility of the health system, reduced wage income of workers in the sector and increased heterogeneity between regions. Finally, the evidence indicates that privatization does not mean more efficiency and better governance. Deep reforms are needed to strengthen the National Health System.

The Art of Change Movement: an anti-oppressive Social Work initiative

This article presents the Art of Change Movement (Movimiento Arte del Cambio), which has developed out of a project of the Association of Social Workers Without Boundaries (Asociación Trabajadores/as Sociales Sin Fronteras), with the collaboration of the Faculty of Social Work at Universidad de Granada and of education professionals, incorporating theatrical creativity and musical expression as pedagogical and social intervention tools. The aim is for the initiative to become another instrument in the fight against oppression. Through a laboratory for collective creativity involving students and professionals from social work and other social science disciplines, the movement seeks social transformation through artistic expression, based on political commitment and sustainable development that empowers participants.