Cultural material also passed comment on the universal principles behind the NHS. In her 1974 novel Second-Class Citizen, Nigerian-born novelist Buchi Emecheta captured the experience of using the service as a person of colour. The protagonist, Adah, feels marginalised because of her class and race on a London maternity ward where everyone else is white. As in real life, gossip spreads easily on communal wards. Yet, for all the challenges she faces, Adah expresses gratitude for the companionship that such spaces could engender in the NHS. The convivial atmosphere of a maternity ward, where women \u201cseemed to have known each other for years and years\u201d, encourages Adah to adopt a \u201cnew code of conduct\u201d and gain the confidence to leave her abusive husband.<\/p>\n

Films, TV shows and novels helped cement the NHS\u2019s status as a pivotal part of British life <\/blockquote> <\/div> <\/div> <\/div>\n<\/div>
Emecheta\u2019s novel spoke to the connection between decolonisation and the NHS. When the service was launched, Britain\u2019s colonies were beginning to secure independence, including India and Pakistan in 1947, Malaya in 1957 and Nigeria in 1960. Thousands of people from the nations of the reimagined \u2018New Commonwealth\u2019 journeyed to Britain to work and build lives, and the NHS employed and cared for many such immigrants. In fact, the service\u2019s guarantee of universal healthcare would not have been possible without them: thousands of doctors, nurses, technicians, cooks, porters and cleaners from overseas performed essential tasks during the postwar labour shortage. By the start of the 1970s, for example, almost a third of all NHS doctors had trained overseas, most in India and Pakistan.<\/p>\n
Despite their invaluable contributions, such employees were sometimes subjected to racism from colleagues and patients. In rare cases, patients sometimes even asked to be treated by a white doctor or nurse instead of someone of colour \u2013 and, shockingly, on occasion NHS hospitals acceded to such requests. As patients, some people from the Commonwealth were met with hostile refusals of their \u2018right\u2019 to access NHS services, regardless of their status as British citizens. And in his \u2028infamous 1968 \u2018Rivers of Blood\u2019 speech, Conservative MP and former minister of health Enoch Powell claimed that hospital beds \u2013 along with council housing \u2013 were being overrun by Commonwealth immigrants.<\/p>\n
As the NHS became increasingly understood as a distinctly \u2018British\u2019 achievement, discussions about who belonged in the service and who did not became more sharply polarised. The idea of \u2018our NHS\u2019 built support for the institution \u2013 but could also lead to the exclusion of those who were not white or who had arrived from beyond Britain\u2019s borders.<\/p>\n
Shock to the system<\/h3>\n
The NHS, along with other parts of the welfare state and public industries, faced serious challenges during the economic \u2028and political turbulence of the 1970s and 1980s. The oil crisis of 1973 shook the industrialised world, resulting in record fuel prices, soaring inflation and job losses. Successive Conservative and Labour governments struggled to get a grip on the economy in the years that followed, and various political projects migrated from the fringe to present new solutions. The politics of neoliberalism \u2013 characterised by a belief in free markets and competitive individualism \u2013 gained greater purchase on debate and policy, with politicians, businesses and intellectuals advancing free-market priorities.<\/p>\n
By the 1980s, Margaret Thatcher\u2019s government was following this political approach. But the prospect of privatising the NHS \u2013 which now rivalled pensions as the largest recipient of government welfare spending \u2013 represented a major challenge. Indeed, the size, practices and values of the health service comprised an enduring emblem of social democratic politics. The fact that the institution\u2019s prominence wasn\u2019t successfully undermined was not due to a lack of desire or effort. The prime minister\u2019s famous 1982 remark that the service was \u201csafe with us\u201d obscured a longer history of opposition to the NHS.<\/p>\n

Thatcher\u2019s remark that the NHS was \u201csafe with us\u201d obscured a longer history of opposition <\/blockquote> <\/div> <\/div> <\/div>\n<\/div>
During the 1960s, Thatcher and key members of her government had belonged to important health policy groups within the Conservative Party that advocated marginalising or even abolishing the health service. On the eve of the 1979 general election, one such group stated that the NHS was \u201cbetter discarded altogether and a fresh start made in light of knowledge accumulated and experience gained\u201d. In line with free-market principles, this group maintained that a health system based on private health insurance would encourage greater choice and self-reliance, raising more money to spend on medical care in general.<\/p>\n
In the early years of Thatcher\u2019s government, an internal committee in the Department of Health and Social Security explored such ambitions. They met little success, though, because of the difficulties of replacing a system as large as the NHS, instability within the private health insurance market, and soaring popular support for the existing nationalised system as a uniquely \u2018British\u2019 achievement. For the champions of markets within healthcare, reforming the internal structures of the service \u2013 rather than its total removal \u2013 seemed a viable alternative option. If fortress NHS could not be besieged from without, then perhaps it could be compromised from within. The policies that followed this shift in approach included outsourcing work such as hospital cleaning or laundry to private companies, the introduction of management principles in the NHS that were comparable to the private sector and, in 1990, the implementation of an \u2018internal market\u2019 to ensure greater competition.<\/p>\n
Premature diagnosis?<\/h3>\n
This marketisation of the NHS\u2019s functions from the 1980s escalated an atmosphere of crisis. For many, the legislation that enabled companies to take over catering contracts, or the slick managers employed to help the service follow \u2018business principles\u2019, marked a betrayal of the service\u2019s founding values. The government\u2019s stringency with the NHS\u2019s budget increases during the 1980s compounded concerns over its capacities.<\/p>\n
To be sure, these policies never went as far as anticipated by their neoliberal promoters in think tanks and businesses. At the start of the 21st century, most of the NHS\u2019s workers remained employed in-house, and it still delivered the overwhelming majority of healthcare to Britons. For all of the newspaper headlines heralding a private sector \u2018takeover\u2019 of the nationalised service, companies often struggled to make headway because of the difficulties involved in complex procurement processes, or the pro-NHS campaigners who quickly seized upon any of their perceived failings.<\/p>\n
$\""Princess\"$ <\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/source><\/picture><\/div>