Opinion surveys have consistently shown that the British public does not support National Health Service (NHS) privatisation, but we know less about why this is. Studies in this area have been limited, despite the importance of the topic for healthcare, its associated workforces, public health, inequalities, (de)politicisation and democracy.
We analyse the first open-ended representative survey of UK citizens’ motivations for opposing privatisation. Public opinion is contrasted with previous academic assumptions – supported by quasi-market theory – that opposition to privatisation is overwhelmingly concerned with services being free at the point of delivery. Instead, we find the largest single reason for dissent is the extraction of profits.
Drawing on political governance perspectives, which advocate a wider scope of actors be included in such analyses, we consider public sphere institutions that have been neglected in recent studies. Thus, we examine our evidence in relation to patient representatives, health think-tank policies and the operation of discursive politicisation. Furthermore, we assess trade unions’ political communications strategies and their ‘public service approach’, in the light of our results.
Our findings raise significant challenges for actors, such as non-executive commissioners. There are important implications for public sphere policy here in acknowledging the full extent of the public’s concerns about privatisation.