Healthcare

 A mum diagnosed with cancer at forty-six, an NHS that didn't ask for a penny, and a question that wouldn't go away. How did we build the most civilised healthcare system in the world, and who has been quietly picking it apart ever since? 

Transcript

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Healthcare I haven't been in hospital much in my life, and for a long time I refused to go to the GP because I didn't want to waste his time, which looking back is a very British thing to say, but that was how I felt. I've mentioned one hospital visit already, but there's another one that changed how I see things. At forty six years old, my mother was diagnosed with breast cancer. That is something no one ever wants to hear, and my dad really struggled watching my mum go through treatment. He kept saying it should be me, not her. He's probably right if we're being honest. He smoked, he drank, loves his cakes and takeaways. But my mum doesn't really do any of those things. She was always busy cleaning up or off with the witnesses or horse riding, very active, and she still is. I often say please don't do too much, but it's in her nature to keep things clean and organised and looking lovely, and I don't think anyone could knock her for that. When you hear those words, I've got cancer, it feels like you stop in time for a minute. It's almost too much to process. But this is when I saw my mum for who she really is. She's a fighter and she's unafraid. I mentioned she can be a bit highly strung, but it's the little things that stress her out. When she went through treatment, she was stoic and resilient, and I just knew she'd beat it. I don't know why or how, but it just wasn't right. It was like a bully who'd picked on the wrong person thinking they might be an easy target. About two years later, after various operations and treatments, she was put in remission. I think about how much she's been there for me, and how things could have been so different if it wasn't for who she is, and if it wasn't for the job the NHS staff and nurses did. They saved my mum's life and didn't ask for a penny in return. Not all institutions are bad, but not all are built the way the NHS was, and here's an interesting bit of information I only found out recently. The NHS was started not by politicians or economists or policy experts, but by a group of coal miners in a small town in South Wales called Tredegar. They set up a medical aid society where workers pooled a small amount of their wages each week, a few pennies, and in return they and their families got free health care, a doctor, a hospital, prescriptions, the lot. The whole community is looking after each other with no profit motive and no insurance company sitting in the middle taking a cut. A boy called Anurim Bevan grew up in that town. His father was a miner. He saw poverty and disease up close from childhood, and he saw what the Medical Aid Society could do when ordinary people decided to take care of one another. He became a politician, got elected as an MP, and when Labour won the 1945 election in a landslide after the war, the new Prime Minister Clement Attlee gave Bevan the job of creating a national health service. He was 47, the youngest member of the cabinet, and what he was being asked to do was take what those miners in Tredegar had built and extend it to the entire population of Britain. He said it himself in 1948. All I'm doing is extending to the entire population of Britain the benefits we had in Tredegar for a generation or more. That's what it was. A miner's son scaling up a miner's idea to cover 60 million people. The opposition was fierce. The British Medical Association, which represented the doctors, described the proposed service as so grossly at variance with the essential principles of our profession that it should be rejected absolutely by all practitioners. The Conservatives voted against it at second and third readings in Parliament. Doctors were terrified of becoming government employees and losing their independence, and six months before the planned launch, it looked as though the whole thing might collapse through lack of support from the medical profession. Bevan made concessions, the biggest being that doctors could remain private contractors rather than salaried employees and could continue doing private work alongside their NHS duties. He famously said he'd won the consultants over by stuffing their mouths with gold, which was his way of saying he let them keep their earning potential in exchange for cooperation. It wasn't elegant, but it worked. On the 5th of July 1948, the National Health Service was launched at Park Hospital in Manchester. Britain became the first Western country to offer free medical care at the point of use to its entire population, not based on insurance contributions or ability to pay, but funded through general taxation and available to everyone who needed it. Nurses, doctors, pharmacists, dentists, and opticians were all brought together under one organization for the first time, and over 2,500 hospitals were nationalised overnight. The first patient treated was a 13-year-old girl called Sylvia Diggory, who had a serious liver condition. Bevan was there and told her it was a milestone in history, the most civilised step any country had ever taken, and she later said he was right and that she remembered it for the rest of her life. Bevan's principles were simple, free at the point of use, available to everyone, paid for out of general taxation, and based on need rather than ability to pay. He put it plainly when he said no society can legitimately call itself civilized if a sick person is denied medical aid because of lack of means. That sentence should be carved into the wall of every hospital in the country. Now at almost exactly the same time this was happening in Britain, President Harry Truman was trying to do something similar in America. In September 1945, just weeks after the war ended, Truman told Congress that millions of citizens did not have adequate access to health care and that the time had arrived for action. He proposed a universal national health insurance program paid for through payroll taxes, and polls showed 59% of Americans who knew about the plan were in favor of it. The American Medical Association killed it. They launched the most expensive lobbying campaign in American history at that point, spending one and a half million dollars and branded universal healthcare as socialism. They produced pamphlets linking it to communism and Lenin, and they recruited 1,800 organizations as allies, including the American Bar Association and the American Legion. The creation of the NHS in Britain actually made things worse because it gave the AMA a real-world example of state-run healthcare to use as a scare story, telling Americans this is what happens when the government takes over. Truman called it the biggest disappointment of his presidency. It wasn't until 1965, 20 years later, that President Johnson managed to get Medicare through for the over 65s, and he travelled to the Truman Library to sign it with Truman sitting next to him, calling him the real daddy of Medicare. But America never got what Britain got in 1948. And to this day, medical debt remains the leading cause of personal bankruptcy in the wealthiest country on earth. Two countries coming out of the same war, both with populations who'd sacrificed enormously, both with leaders who wanted universal health care. In Britain, the medical establishment tried to stop it and one man refused to back down. In America, the medical establishment tried to stop it and won. The difference between millions of people having free health care and millions of people going bankrupt from medical bills came down to one stubborn miner's son from South Wales, who wouldn't take no for an answer. So what happened to this thing that Baven built? The cracks appeared almost immediately, costs exceeded expectations within the first few years, and by 1951 charges were introduced for dentures. Bevan resigned from cabinet in protest because the principle of entirely free care was already being eroded within three years of launch. But the NNHS survived and grew, and for decades it was genuinely the envy of the world, a system that treated you based on what was wrong with you rather than what was in your wallet. Then came Margaret Thatcher. In 1982, Thatcher stood up at the Conservative Party Conference and told the country, let me make one thing absolutely clear, the National Health Service is safe with us. That line helped her win re-election by a landslide, but documents released 30 years later revealed that her cabinet had actually been considering radical reform of the NHS that same year, including introducing compulsory private health insurance, and the cabinet paper itself acknowledged that some of the options would represent the end of the NHS for the majority of the population. She faced a revolt from within her own party and backed down publicly, but the Safe With Us line wasn't a declaration of support, it was damage control. What she actually did was go around the side. She started outsourcing non-clinical services like cleaning, catering and laundry to private contractors from 1983 onwards, which led to worse standards and is widely linked to the spread of hospital infections. She encouraged people to take up private insurance, introduced tax concessions for it, and kept raising prescription charges. Then, in 1989, she created what was called the internal market, where NHS hospitals were forced to compete against each other for patients, turning a public service into something that behaved like a business. Administration costs doubled from around 6% to 12% almost overnight. And when she was asked why she personally used private healthcare instead of the NHS, she said, I exercise my right as a free citizen to spend my own money in my own way, so that I can go in on the day, at the time, with the doctor I choose and get out fast. She didn't kill the NHS, but she definitely opened the door. John Major walked through it. His Chancellor Kenneth Clarke stood up in front of the Confederation of British Industry in 1993 and described what they were doing as privatizing the process of capital investment in our key public services. He actually said it out loud. This was the Private Finance Initiative, PFI, and the idea was simple. Instead of the government borrowing money to build hospitals, which it could do cheaper than anyone else, private companies would borrow the money, build the hospital, and lease it back to the NHS for 25 to 30 years at massively inflated rates. The NHS would stop being the owner of its hospitals and become the tenant. By 1994, Clark was telling the CBI that the Treasury would only provide capital as a last resort after private finance has been explored. But progress was slow and frustrated business leaders warned that PFI could fail without more action. Then something remarkable happened. Labour, who was supposed to be the opposition, announced they were going to rescue PFI. Their shadow Treasury Minister said, This idea must not be allowed to fail. Labor has a clear programme to rescue PFI, and the rescue of PFI was included in Labour's 1997 manifesto, right alongside promises to scrap the internal market. They kept PFI and broke the other promise. Tony Blair took PFI and went all in, building over a hundred hospitals through private finance deals. For just£13 billion of actual investment, the NHS was landed with a bill of over£80 billion in total repayments, and that figure comes from government's own data confirmed by the IPPR think tank and the National Audit Office. Even when fully repaid, the public won't own the hospitals. The first wave of PFY hospitals had on average 30% fewer beds than the buildings they replaced, and the annual repayments were index-linked to inflation, meaning they went up every year regardless of whether the NHS budget did. To put that in perspective, Sherwood Forest Hospital's NHS Foundation Trust spent more than double on PFI repayments,£45.8 million, than it spent on drugs for patients,£22.6 million, more money going to private finance companies than to medicine. And the PFI companies themselves made£1.9 billion in pre-tax profits from 99 NHS contracts between 2004 and 2021, with another£1.07 billion paid out in dividends and£47.6 million in directors' fees. We'll come back to debt in more detail later, but it's worth sitting with those numbers for a moment. In 2000, Blair's Health Secretary Alan Milburn signed a concordate with the private sector that brought private provision of medical services into the NHS for the first time, contracting out routine surgery and diagnostic tests to private treatment centres at greater cost than the same procedures on the NHS. After leaving government, Milburn became a well-paid advisor to Bridgepoint, a venture capital company closely involved with NHS privatization. Another Labour Health Secretary, Patricia Hewitt, took a similar path. Blair's health advisor Simon Stevens later became NHS chief executive under David Cameron, having spent the years in between as president of United Health Europe, a major American health insurance company. Then came David Cameron's Health and Social Care Act of 2012, which went further than anything before it. It removed the Secretary of State for Health's legal duty to provide health care for all, handed responsibility to a series of new kwangos, and opened all major NHS contracts to the private sector. The man who promised before the election that there would be no top-down reorganization of the NHS delivered the biggest restructure since its creation. Think about what the NHS does for free and then think about what the same thing costs in America. Having a baby in the US with no insurance will cost you around$30,000 for a straightforward birth and up to$50,000 for a cesarean section. Even with insurance, the average total bill is over$20,000, with nearly$3,000 of that coming out of your own pocket. A hip replacement costs$30,000 to$50,000. Chemotherapy runs anywhere from$1,000 to$12,000 a month just for the drugs. And if you need four sessions a year, that's up to$48,000, which is roughly the average American annual wage, your entire year's income just to stay alive. A Bloomberg investigation in 2025 found that one generic chemo drug cost$134 at a clinic and$13,560 at a hospital down the same street. Same drug, different prices. Cancer treatment in its first phase alone averages$28,000 for prostate cancer and over$68,000 for lung cancer. Medical debt is the leading cause of personal bankruptcy in the wealthiest country on earth. My mum's cancer treatment, the operations, the consultations, the chemotherapy, the follow-up care, all of it would have run into tens of thousands of dollars in America. On the NHS, it didn't cost our family a penny. Now ask yourself where your tax money is actually going. In 1980, when the NHS was still fully public, virtually every penny of the budget was spent within the NHS itself. Staff, buildings, equipment, medicine, all publicly owned and publicly run. There was no private provision of clinical services, no internal market, no PFI. The money went in and it stayed in. By 2009, nearly 4% of the NHS budget was flowing out to private providers. By 2019, that had almost doubled to 7.3%. And the Centre for Health and the Public Interest says that figure is a significant underestimate, putting the real number at closer to 18% when you include all the spending that flows to private companies through local authorities and social care. On top of that, you've got over£2 billion a year going out in PFI repayments, plus£1.9 billion in profits those PFI companies made from NHS contracts between 2004 and 2021, plus another£1.07 billion in dividends, and nearly£47.6 million in directors' fees. So a system that was designed so every penny went towards making people better is now sending billions to people whose only interest is making money. And now we arrive at Palantir. Palantir is a tech company founded in 2003 by the Silicon Valley billionaire Peter Thiel with original funding from the CIA. Most of its business has come from providing surveillance software to the US military, intelligence agencies, and police forces. Thiel co-founded PayPal, was the first outside investor in Facebook, donated$35 million to Republican candidates in the 2022 midterms, backed Donald Trump in 2016, and joined his transition team. He described the British public's relationship with the NHS as Stockholm syndrome and has said the NHS makes people sick and that the country should rip the whole thing from the ground and start over. Despite all of that, in November 2023, the NHS awarded a Palantir-led consortium a contract worth up to£330 million to build a data platform linking up patient data across NHS England over seven years. The foot in the door came during COVID when Palantir's software was used in the vaccine rollout for a fee of just one pound. Internal emails later revealed that Palantir's UK chief had sent a message to colleagues titled Buying Our Way In, suggesting that hoovering up existing NS suppliers could take a lot of ground and take down a lot of political resistance. The company poached at least three former NHS data experts, including the head of artificial intelligence, for the NHS, who had helped launch the very COVID data store that first brought Palantir into the health service. 35 MPs signed an early day motion raising concerns about giving contracts to a company whose founder has repeatedly been shown not to be in alignment with British democratic values. And the software itself, by the end of 2024, fewer than a quarter of England's 215 hospital trusts were actually using it. Leeds teaching hospitals said adopting some of the tools would lead them to lose functionality rather than gain it. The government then paid KPMG£8 million to go around hospitals promoting Palantir software, which raises the obvious question: if it's so good, why does it need an£8 million sales campaign? And even the numbers around the contract don't add up. NHS England publicly announced it as£330 million over seven years, but the official contract award notice listed a lower figure of£182 million ending in February 2027. And that discrepancy has never been explained publicly. So we don't even know the real cost of the thing. Now as I'm writing this in early 2026, the situation is moving fast and it is not looking good for Palantir. The science minister Lord Valance has told MPs that future tech contracts will prioritise British companies, which is a pretty clear signal of direction, and the contract itself includes break clauses that MPs are actively urging ministers to exercise. Every senior NHS tech leader who oversaw the Palantir deal has either left or is leaving. The CIO gone in March 2025, the chief data officer gone in April, the CTO gone this month, the people who brought Palantir in are all walking out the door. The British Medical Association, the Doctors Union, has passed a formal resolution calling for the contract to be cancelled outright, saying it threatens to undermine public trust in NHS data systems and pointing to the firm's track record of creating discriminatory policing software in the US and its close links to a US government which shows little regard for international law. They've told doctors to limit their engagement with the platform. The Green Party leader Zach Polansky personally delivered a termination notice to Palantir telling them to pack your bags and get the hell out of the NHS, calling them a Trump-supporting military surveillance outfit with no place in Britain's most important institution. Greater Manchester, which manages health services for 2.8 million people, has again refused to sign up and is the only integrated care board in England to hold out. Saying NHS England hasn't addressed its concerns about the risks. There is something that should be highlighted. NHS England itself is being abolished. The government plans to fold it into the Department of Health by April 2027, which is exactly when the Palantir contract has its break clause. So the organisation that signed the deal won't even exist by the time the contract comes up for review. Privacy campaign is a warning that the platform could allow other government departments like the Home Office and Police to access confidential patient data, and given what Palantir is doing elsewhere in the world right now, those warnings feel very real. As I write this, reports have emerged that Palantir is working on a tool for US immigration and customs enforcement that populates a map with potential deportation targets, brings up a dossier on each person, and provides a confidence score on their current address. ICE has been acting like a personalized paramilitary police force under Trump, and Palantir is providing the targeting software. This is the same company with access to NHS. Patient data for 60 million people in England. And it goes further than immigration. In Gaza, the same corporate platforms that help to generate kill lists, optimise bombing campaigns, and feed AI-assisted targeting systems during the conflict are now being positioned for the reconstruction, woven into proposed civilian infrastructure for housing, welfare, policing and borders. The technology that was used to destroy is being repurposed to rebuild and control, and Palantir is right in the middle of it. As of early 2026, the company operates across five continents, holds contracts with more than 30 governments, and its annual revenue has hit$4.5 billion. The NHS contract isn't the endgame, it's a foothold, and patient data for 60 million people is the product. A healthcare system inspired by Welsh miners looking after each other, built by a miner's son who refused to back down, free at the point of use, paid for by the people for the people, the most civilized step any country had ever taken. Within 50 years, the private sector was being invited in through deals that cost billions more than necessary. Within 75 years, the patient data of the entire nation was being handed to an American surveillance company whose founder thinks the NHS makes people sick, whose technology is being used to target immigrants, and whose platforms help generate kill lists in an active war zone. Someone builds something with good intentions, an institution forms around it. Power finds a way in, and the original purpose gets hollowed out. We've seen this before and we'll see it again.