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.

Rethinking Care Through Social Reproduction: Articulating Circuits of Migration

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Of Marx and Makers: an Historical Perspective on Generative Justice

In Marxist frameworks “distributive justice” depends on extracting value through a centralized state. Many new social movements—peer to peer economy, maker activism, community agriculture, queer ecology, etc.—take the opposite approach, keeping value in its unalienated form and allowing it to freely circulate from the bottom up. Unlike Marxism, there is no general theory for bottom-up, unalienated value circulation. This paper examines the concept of “generative justice” through an historical contrast between Marx’s writings and the indigenous cultures that he drew upon. Marx erroneously concluded that while indigenous cultures had unalienated forms of production, only centralized value extraction could allow the productivity needed for a high quality of life. To the contrary, indigenous cultures now provide a robust model for the “gift economy” that underpins open source technological production, agroecology, and restorative approaches to civil rights. Expanding Marx’s concept of unalienated labor value to include unalienated ecological (nonhuman) value, as well as the domain of freedom in speech, sexual orientation, spirituality and other forms of “expressive” value, we arrive at an historically informed perspective for generative justice.