The following text was sent to us by an anonymous fellow worker. It concisely summarises the current situation and atmosphere in the NHS. While the big picture might seem bleak, it’s in small battles that we can start to change it. Whether that is against cuts and closures of services, small attempts at privatisation or for better working conditions. Feel free to send us your thoughts and reports from where you work.
The NHS: Inside the Machine
I’ve been working in the NHS for years now, and I’ve finally decided to write about what it is really like inside this so-called “national” health service. People see the NHS as this neutral, caring institution, but that’s a complete lie (Once upon a time it was to some extent). What I’ve witnessed is a system designed to divide workers, exploit both workers and patients, and slowly destroy itself from within, all while the imperialist ruling class profits from the chaos.
The NHS wasn’t some gift handed down by the caring government in 1948. It was taken from the hands of the ruling class by organised working people after World War II. They gave us healthcare not out of kindness, but because they were terrified of a revolution. The NHS was essentially a payoff, a way to keep the working class quiet while they rebuilt their empire. And here’s the kicker: they only tolerated this “socialist” contradiction as long as it served their interests, keeping workers healthy enough to exploit and stopping us from getting too revolutionary.
Well, guess what? They’ve stopped caring about even those limited benefits for a couple of years now.
Let me paint you a picture of how this place actually operates. NHS trusts aren’t run like public health services, they’re run like corporations, complete with all the hierarchy and backstabbing you’d expect. And it is not by accident. This is divide and conquer in action, every single day.
* The hierarchy and divisions
This goes really deep? Just watch what happens during lunch breaks. I’m not kidding, it is like a cafeteria in some dystopian high school. Doctors sit at their table, nurses at theirs, therapists do the same, healthcare assistants and support workers get pushed to the margins, and domestic staff? They barely get acknowledged. We’re all supposedly working for the same goal, but the system makes damn sure we never actually unite.
The admin structure makes it even worse. Decision-making flows through layers of non-clinical bureaucrats who’ve never touched a patient in their lives. These people the bourgeois health executives, petty bourgeois managers, and labour aristocrats hold more power than the workers on the floor doing the actual work. it is a perfect class divide: those at the top extract value from our labour while we fight each other for scraps.
And don’t get me started on the banding system. it is designed to keep us in our little professional boxes, preventing any real collaboration while dumping work downward. The system punishes you for stepping outside your narrow role, so “That’s not my job” or “the lower banding can do it” becomes the default response, not because people don’t care, but because that’s how the structure forces us to operate.
There’s a culture of giving the lower bandings all the heavy jobs physically, and how is appreciation shown? They get paid a lot less. The whole system creates these artificial barriers that stop people from working together effectively.
Here’s something that really gets me: most of our trust executives come from finance/corporate/ and Ex- Military backgrounds. Think about that for a second. We’ve got people who’ve never seen a patient, never worked a ward, never held someone’s hand while they died, making decisions about healthcare and people’s lives.
These executives exist for one purpose: implementing “efficiency measures” that translate to budget cuts and job losses (redundancy packages, redeployment etc). They talk about streamlining services while destroying the very foundations of care. And they do it all while pulling down salaries that could fund entire departments.
I’m not saying putting a clinician in charge would magically fix everything under capitalism, even clinicians get paid off and become part of the system. But at least they’d understand what we’re dealing with on the floor.
* The blame culture
The atmosphere in on of the trusts has become genuinely oppressive. Workers are living under constant surveillance, and I mean that literally. They monitor break times through clinical documentation systems, or systems meant to dispatch workers. Managers ask staff to spy on colleagues. The paranoia is real, and it is deliberate.
The blame culture is toxic beyond belief. When something goes wrong and things go wrong constantly because the system is falling apart, they always find individual workers to scapegoat. Never the understaffing, underfunding, privatisation of the NHS and never the impossible workloads. it is always the workers who get thrown under the bus.
I’ve seen good people destroyed by this culture. Fear of litigation, fear of being “called out,” fear of making mistakes when you’re covering twice your safe workload, it dominates everything we do. You spend more time covering yourself than actually caring for patients.
The professional divisions in healthcare aren’t natural they’re manufactured to prevent solidarity. Every profession has its own little kingdom: nurses, occupational therapists, physio therapists , dieticians, doctors, health care assistants, porters, pharmacists etc. We’re all
treated as separate classes, and collaboration gets actively discouraged.
There’s this unspoken rule of “they can do it” or “that’s their job” that kills teamwork. Instead of working together, we get rigid hierarchies where work gets dumped downward and nobody takes collective responsibility. it is professional elitism rooted in bourgeois individualism, everyone protecting their status instead of building solidarity.
The result? Constant low-level conflict. No shared meetings except the occasional board round. Very little communal spaces. No sense of being on the same team. Even the lunch breaks mirror the class divisions built into the system. Workers end up blaming each other, dumping work on each other, talking behind each other’s backs instead of recognising who the real enemy is.
* The lack of care
This is where it gets really personal for me. I came into healthcare because I believe in caring for people, in dignity, in making a difference. The system has turned that against me and every other worker who gives a damn. Let me be specific about what alienation looks like in practice: I go to work knowing I can’t provide the care I was trained to give. We want to sit with a dying patient, but management demands we clear five beds by noon. We want to properly assess someone’s needs, but there’s a queue of 10 people waiting. I see patients who need time and attention, but I’m measured on throughput. I believe in thorough care, but this is unreal and it is not getting better.
The worst part is how the system turns our compassion against us—we care about patients, so we work unpaid overtime; we believe in our profession, so we accept impossible conditions. Our values become weapons used to exploit us further. This contradiction is eating me alive, and I’m not alone. It is what Karl Marx meant when he talked about wage labour being psychologically worse than slavery. At least slaves knew they were owned. We’re told we’re “free” while being crushed by necessity, and then blamed when we can’t keep up with impossible demands (around 30% of workers in the NHS take time off due to mental health reasons).
I watch colleagues breaking down from stress while managers talk about “resilience training.” I’ve seen brilliant, caring people become cynical and hard because the system ground them down. I’ve watched new staff arrive full of hope and leave broken within months. The technical terms for what we’re experiencing are moral injury and compassion fatigue. Moral injury happens when you’re forced to act against your professional ethics because of policies or the capitalist system to be precise, it causes depression, PTSD-like symptoms, and burnout. Compassion fatigue is what happens when you constantly give but never feel effective; you become cynical, detached, emotionally numb.
Then you understand why some workers end up saying things like ‘this is not a hotel’ or ‘patients sure have a lot of needs all of a sudden’ they are frustrated with the situation, but they’re blaming patients instead of the exploitative system that’s actually causing the problem. Many studies show NHS staff feeling “voiceless,” “undervalued,” and “powerless.” These aren’t just work complaints, they’re symptoms of systematic exploitation under capitalism, and the human cost of this manufactured crisis is enormous, but it serves the ruling class perfectly.
I need to tell you how bad things have gotten, because people don’t understand the reality. We’re running departments on dangerously low staffing, especially nursing. Many wards rely on agency staff just to function, and now even that’s being cut.
Here’s an image that stays with me: blood on the medical notes. Actual blood. That’s how overstretched we are, nurses and doctors are so overworked when they draw blood and it likely gets on them and the medical notes.
Basic supplies have become precious commodities. Pillows are like “gold dust” ,we actually have to hunt around the hospital looking for pillows because wards don’t have enough. Three nurses covering twenty patients has become normal, not exceptional.
And the guilt-tripping has reached new levels. Patients in A&E get handed papers explaining how overwhelmed we are, essentially pressuring them to discharge themselves before they’re ready. I hear patients constantly saying they feel like they’re being kicked out or they want to leave quickly to not be a burden.
When hospitals get really busy, patients end up on chairs or beds in corridors. Exposed, vulnerable, unsafe. This is what “efficiency” looks like in practice.
* The racism
The NHS is systemically racist, and I mean that in the most literal sense. Racism runs through every level, from how staff treat each other to how patients get care. And it serves a purpose, keeping workers and people divided. An effective tool of imperialist capitalism.
This system thrives on these divisions. Migrant workers get alienated from British workers, different ethnic groups get pitted against each other, and everyone’s too busy fighting to recognize they’re all being exploited by the same system and same people.
This particular trust loves to talk about “zero tolerance” for racism and “speaking up” policies, but it is pure performance. They’ll have meetings about diversity while patients from minority backgrounds get worse care and migrant staff face discrimination.
I still hear colleagues spouting racist myths like: Black people have higher pain thresholds, thicker skin, all that fascist eugenic ideologies. Patients make racist comments with zero consequences. The system allows these attitudes because they serve the ruling class perfectly.
Real change would mean better conditions for everyone workers and patients alike. That threatens the people who profit from division, so nothing changes.
Let me expose the “neutrality” lie first. This trust employs ex military as executives hardly neutral is it! The NHS claims to stay out of politics—what a joke. The moment the aggressive NATO war ignited further against Russia in 2022, this trust was organising bake sales, wearing Ukrainian flag pins, even flying the Ukrainian flag. Suddenly politics was fine when it aligned with Western imperialism. Compare that to Palestine: no bake sales, no pins, just vague statements about “mental health” and “global conflict.” Colleagues who tried organising solidarity for Palestinians got disciplined or fired for “antisemitism” because of social media posts. They banned political leafleting after Starmer’s Enoch Powell speech, all in the name of “neutrality.” And then there’s Palantir—a spy-tech company that leaked data to ICE and uses AI to kill Palestinians—now integrated into our systems through some dodgy COVID deal. Where’s the neutrality there? There is no neutrality, just the illusion of it, used to suppress dissent when it doesn’t serve ruling class interests.
* The privatisation
What’s happening to the NHS isn’t accidental decline—it’s deliberate sabotage designed to justify privatisation. The scale of NHS outsourcing is staggering, and the failures are predictable. Capita was awarded a £330 million contract to run primary care support services, cutting staff from 1,314 to 314—a 69% cost reduction that led to chaos and system failures. Capita lost £125 million in the first two years alone, but guess who pays for these failures? Us. Virgin Care won a £480 million contract to coordinate over 200 health and social care services in Bath and Somerset, the first time statutory care services were outsourced to a for-profit company. Think about that: Richard Branson’s empire profiting from your grandmother’s healthcare.
The COVID windfall was even more obscene. DHL, Unipart and Movianto got contracts for PPE logistics; Deloitte managed testing centres; Serco ran contact tracing—all while NHS staff worked without proper protection. These companies made fortunes from public health emergencies while frontline workers risked their lives. HCRG Care, owned by private equity, recently won a contract worth up to £1.3 billion over nine years for community services. Private equity—the same vultures that strip assets from companies and leave workers unemployed—now control community healthcare for millions of people.
The latest scandal is this trust’s renting out the theatres on weekends to private companies like “KPI health”, instead of using their own staff. The staff have the capacity to work the weekends but instead those shifts go to the private company.
Here’s what really exposes the hypocrisy of NHS “efficiency”: the government’s recent 5-year deal with pharmaceutical companies will see “the level of annual growth in sales of branded drugs will double from 2% in 2024” while they claim it will “save the NHS £14 billion.” This is pure doublespeak. While we’re told there’s no money for nurses or proper staffing, pharmaceutical companies are guaranteed massive profit increases. The same people cutting healthcare budgets are handing billions to Big Pharma through backdoor deals that prioritise corporate profits over patient care.
The pattern is always the same: promise savings, deliver chaos, extract profits, blame the public sector when things go wrong. Research shows that NHS privatisation through outsourcing “corresponded with significantly increased rates of treatable mortality”—people are literally dying so shareholders can profit. The pharmaceutical industry has become a parasite on the NHS, extracting wealth while contributing to the very problems they claim to solve. Expensive branded drugs replace cheaper generics, creating artificial scarcity and dependence. Meanwhile, research and development costs get socialised through public funding while profits remain privatised. This isn’t incompetence—it’s class warfare disguised as healthcare reform.
* The problems of community and social care
The destruction of social care shows the privatisation strategy perfectly. What used to be public service got stripped of funding and handed to private companies focused on profit, not care. Qualified carers now work for private agencies that pay peanuts and deliver substandard service. The community health social work is now done by privatised community health providers to deliver NHS services, these providers are always run at below safe levels and staff retention is horrible. New reports are showing non-urgent community referrals can take up to a year before a patient is seen. This collapse directly impacts us in the hospital in many ways. The inconsistency with what they triage as “non-urgent” leaves patients waiting at home for months to a year. I’ve seen people deteriorate while waiting for support that never comes, only to end up back with us as emergencies. The “urgent” referrals still take 1-3 weeks to be seen, which means patients will be waiting for community support in hospital. What makes it worse is that triage decisions are made by staff who’ve never met the patient, basing everything on a single hospital referral we have written. This leads to inadequate care plans that fail our patients and send them straight back to us.
It is very clear that social care has collapsed on purpose, it is completely profit-driven. They create chaos in the public system, force people into private alternatives, and extract wealth from human suffering at every stage. This isn’t just incompetence I’m witnessing, it is the calculated destruction of collective care to serve capitalist accumulation.
But here’s where it gets truly vicious. This system reflects capitalism’s core values, instead of supporting elderly people in communities, we warehouse them in care homes so younger people can “live their lives” without collective responsibility, or we create “young carers.” Here’s the cruel irony: young carers are simultaneously being forced to become carers for their parents, giving up even more of their already limited lives to this exploitative system of slave wage labour. They’re caught in a vice, either abandon family members to inadequate private care or sacrifice their own already massively exploited time to fill the gaps left by destroyed public services. We are told at the hospital whenever we discuss discharging patients to ask them if their families can support them before sending any referrals. Wild isn’t it!
The erosion of clinical autonomy reveals privatisation’s true agenda. Therapists are now forced to beg permission from non-clinical discharge teams before referring patients to community care – a Kafkaesque hurdle where referrals get vetoed by staff who’ve never laid eyes on the patient. This isn’t about efficiency; it’s a discharge-factory scheme designed to manufacture good numbers while clinically vulnerable patients get funnelled back into the system through readmissions. They’ve turned healthcare into a call centre operation – qualified professionals reduced to pleading with gatekeepers whose key performance indicator is bed clearance, not patient outcomes. The paperwork looks pristine while human beings deteriorate in the gaps. This is how you dismantle public healthcare: first strip professionals of their judgment, then replace care pathways with profit-optimised choke points, and finally blame the resulting human damage on “individual cases” rather than the system engineered to fail them.
This is capitalism’s masterpiece of social control. It doesn’t just exploit labour, it isolates and makes people sick, physically and mentally, while forcing families to tear themselves apart trying to survive its contradictions. The ruling class profits from every angle: from the privatised care, from the young workers they exploit, and from the social breakdown that keeps us too exhausted to organise against them.
* The unions
The failure of unions to fight privatisation shows how they’ve been co-opted by the system. Union leaders get cosy with management, becoming mediators instead of fighters. When did we last organise against privatisation? When did we last actually fight for anything?
The process is predictable. Union bureaucrats become alienated from members, developing their own interests in maintaining relationships with bosses and politicians. The state tolerates these bureaucratic unions because they contain militancy instead of channelling it.
In this trust many campaigns have been block by Union officials! They make decisions with the HR that impact staff without consulting with them. Some union chairs are also managers in their roles outside the union which is a massive conflict of interest. This has been seen first hand in how they handle cases and particularly blocking campaigns to buddy up with management.
When we healthcare workers think about organising, two things happen: union leaders make striking harder through endless bureaucracy, and management guilt-trips us about impacting patients. This leaves us demoralised and guilty. No healthcare worker wants to harm patients, but this system is already doing that. We get burnt out, work less effectively, take sick days, and patients suffer anyway because the system is unsustainable.
* What can be done
What the NHS is currently doing is trying to fight off cancer by fighting the symptoms only, but leaving out the cancerous cells (capitalism) untreated and hoping for the best. All the buzzwords about “reform” and “modernisation” are just lipstick on a pig. The drive toward privatisation is inevitable under capitalism because healthcare as a human right conflicts with healthcare as a commodity.
The solution isn’t reforming the system, it is completely reversing privatisation and recognising healthcare as a social right. But that requires challenging the imperialist ruling class with every resource we have.
The choice facing healthcare, and society generally, is clear: genuine public services serving human needs, or privatised systems serving profit. The blood on the medical notes, patients in corridors, guilt-tripped staff and patients, and manufactured crises all serve one purpose. Proving that public healthcare can’t work while ensuring that becomes a self-fulfilling prophecy.
As a heath worker working inside this system, I see how the ruling class uses division, surveillance, and manufactured crisis to destroy collective services. But I also see the potential for solidarity among workers who share the same fundamental interests, regardless of our professional labels or backgrounds.
The key is recognising that our individual struggles, overwork, understaffing, impossible targets, are connected to the broader struggle against capitalism. The same forces destroying healthcare are destroying education, housing, and every other public service. Our fight isn’t just about the NHS, it is about what kind of society we want to live in.
Real change requires building the solidarity that management works so hard to prevent. It means recognising that healthcare workers, patients, and communities have common interests against those profiting from human suffering. And it means understanding that defending public healthcare is part of the broader fight for a socialism to this destructive system.
The NHS could be something beautiful, a genuine expression of socialist care and class solidarity. But that requires overthrowing the system that’s currently destroying it from within. Until then, those of us working inside the machine have a responsibility to expose its contradictions and build the movements that can transform it. This can be done by taking back the power of the unions and working outside the bureaucratic system that does not allow us to strike. Yes this means wildcat strikes and organising from within as the legal frameworks set for us work against us.
That’s why I’m writing this. Not to complain, but to reveal the truth about what’s happening to our healthcare system and why. Because once you see the patterns, you can’t unsee them. And once enough of us see clearly, we can start building the alternative this country desperately needs.
