Neoliberalism has various meanings, but many commonalities (Hall, 2011). Nurses in the UK’s NHS, alongside their colleagues elsewhere, may not be familiar with the term but they will be familiar with its effects on service delivery, patient care and of course their own working conditions (Abramovitz & Zelnick, 2010; Gonçalves et al., 2015; Horton, 2007; Reiger & Lane, 2013; Wright, 2014). Stuart Hall outlines the main ideas underpinning what he calls the ‘neoliberal revolution’ (Hall, 2011). This is useful for nurses in order to first understand and then to act.
The main ideas according to Hall (2011) are:
- It is grounded in the idea of the ‘free, possessive, individual’; a concept understood in classical economics as ‘homo economicus’ – the rational actor in a market weighing up costs and benefits of consuming decisions according to price signals. Therefore:
- The State must not govern society or dictate to individuals how to dispose of their private property.
- The State must not regulate the free market.
- The State must not interfere with ‘God Given’ rights to make profits or to amass personal wealth.
- The State is tyrannical and oppressive.
In the health service it means:
- The State should not really be running hospitals. Instead private sector companies, and health care professionals should offer their services for a fee. These providers should compete in a market
- Patients are not really patients but consumers of health care services and so should decide what they want, when they want it and where they want it.
- The State should not tax the public to pay for health services, instead there should be private health insurance or provision by family, charity and friends.
- The NHS gets in the way pf private sector companies money making services by distorting the market.
- There should not be any national pay and conditions for service providers, that should be decided by the market, so where demand outstrips supply the price (wages) should go up.
Abramovitz, M. & Zelnick, J. (2010) ‘Double jeopardy: the impact of neoliberalism on care workers in the United States and South Africa’. International journal of health services : planning, administration, evaluation, 40 (1). pp 97.
Gonçalves, F., Oliviera-Souza, S., Gollner-Zeitoune, R., Leite-Adame, G. & Pereira do Nascomento, S. (2015) ‘Impacts of neoliberalism on hospital nursing work’. Texto contexto – enferm., 24 (3). pp 646-653.
Hall, S. (2011) ‘The neoliberal revolution’. Cultural Studies, 25 (6).
Horton, E. (2007) ‘Neoliberalism and the Australian Healthcare System (factory)’. Proceedings 2007 Conference of the Philsophy of Education Society of Australasia. Wellington. Available at: http://eprints.qut.edu.au/14444/1/14444.pdf (Accessed: 7th December 2015).
Reiger, K. & Lane, K. (2013) ”How can we go on caring when nobody here cares about us?’ Australian public maternity units as contested care sites.(Report)’. Women and Birth, 26 (2). pp 133.
Wright, S. (2014) ‘Cash v compassion: underpaid care workers expose the battle between the profit and the service ethos, says Stephen Wright.(Reflections)’. Nursing Standard, 29 (1). pp 26.