In Defence of Public Services: Campaign Processes and Outcomes in British Healthcare and Social Security

Over the past decades British governments have imposed market competition in diverse public services. A purchaser-provider split was introduced to create competition in the National Health Service (NHS), leading to gradual increases in private-sector provision (Bach and Givan 2010). In social security, active labour market schemes funded by the Department for Work and Pensions (DWP) were contracted out as part a broader push for privatization and work-first social policy (Davies 2008).

In both areas, campaigning against public-service restructuring has intensified since 2010, but NHS campaigners have been more effective and more united than their counterparts in social security. In the NHS we identify a string of campaigns that effectively disrupted large-scale privatization and restructuring initiatives.  In social security campaigns, successes have been much smaller: forcing the government to release information, change contractors, or modify procedures. Moreover, the coalition dynamics are very different: while NHS campaigners share a sense of protecting a treasured institution, social security campaigners have to contend with conflict between workers and service users. Why do NHS campaigners have greater success than campaigners around social security?

We compare two cases, which we construct from 80 qualitative interviews, online materials generated by campaigners, and statistics on spending and public opinion. The empirical contribution of this paper is to provide an update on campaigns in the UK to defend public services. Its theoretical contribution is to provide an explanation of relative campaign effectiveness that incorporates insights from the literature on welfare-state retrenchment (Korpi & Palme 1998; Soss & Schram 2007).