'THE PLOT AGAINST THE NHS'
The process of 'marketisation' is described in a book by Colin Leys and Stewart Player: The Plot against the NHS, Merlin Books, published in 2011, contemporary with the Andrew Lansley reforms. But for Leys and Player the main thrust occurred under New Labour, in particular under Alan Milburn and John Reid, not under the Conservatives. They outline the immediate problems faced by "the chief marketisers in the government, especially Tony Blair and his senior health adviser, Simon Stevens [currently - 2019 - head of the NHS - PB]; Alan Milburn and his main adviser, Paul Corrigan; and Dr Penny Dash, Head of Strategy and Planning in the Department of Health" in their ambition to open the NHS to private providers on a significant scale:
"First, openings had to be created for private companies to provide health care - clinical treatments - for NHS patients ...
"Second, NHS organisations had to be reorganised into competitive businesses. In the 1990s under John Major most NHS bodies had been made into trusts, run by boards of governors and chief executives, which 'sold' their services to 'purchasers' in a different part of the NHS. But this so-called internal market was not a real market. The contracts made between NHS hospital trusts and local Primary Care Trusts (the so-called purchasers, or commissioners) were not legally binding. There were no major penalties for hospital trusts that failed to deliver all the treatments they had contracted to provide, or underestimated what it would cost to deliver them. If they ran into debt the management would be criticised, or might even be replaced, but money would be found to keep the trust going.
"So the financial discipline that comes with the fear of going bust was missing: the needs of patients could still be seen as more important than the bottom line. If NHS hospitals and other NHS organisations, from mental health trusts to ambulance services, were to be ready to compete in a real market (and if private health companies were to be willing to compete with them ), this had to change.
"Third, a growing percentage of the NHS workforce had to be made ready to transfer - voluntarily or otherwise - to private sector employment. All three steps were implicit in the NHS Plan. All of them were put in hand by Alan Milburn, who ... presided over the Plan's drafting." (all the extracts I'm giving in this article come from Chapters two and three)