'Protecting the NHS' - and its limits

Abstract

There are limits in articulating political struggles around the NHS and the imagined geographies of the nation: struggles based on nostalgia for the post-war welfare state risk co-opting the NHS for an exclusionary, nationalist politics. In tracing the times and spaces of the health service the article asks: when was the NHS? and where is the NHS? The idea of universal healthcare - and changing ideas of nation, state and welfare - are articulated in particular political conjunctures. The whereabouts of the NHS is more than a question of devolution and territorial politics in an increasingly disunited Kingdom; there are also questions of borders, and of workers who are trained and drawn into the NHS from overseas: it is impossible to imagine the NHS without grappling with the ways in which colonialism is integral to the formation of the post-war national welfare state. As both a residual of the national welfare state, and as an emergent site of political and cultural work, the NHS is continuously reworked within dominant politics; while it also offers an emotionally powerful political resource to galvanise popular public support that resists such tendencies. We therefore insist on the need to get to grips with the complex and partial embedding of private interests and market logics within the organisation of healthcare - often framed, rather crudely, in terms of the 'Americanisation' of the NHS. But we also warn of the analytical limits, and political dangers, of framing political struggles around national spatial imaginaries when seeking to 'protect' the NHS in these times of crisis.