Imagining the NHS: Politics and protest in the moral economy of NHS activism

Student thesis: Phd


This thesis takes the imagination of the NHS (National Health Service) as its central theme. I argue that the NHS is a moral example that draws its strength not just from its role as a symbol, but also from the fact of its ongoing presence as an actually existing state structure. Activists, managers and politicians remember and imagine the NHS in particular ways with particular effects on the creation or cleavage of ties between social groups. The NHS is England’s public healthcare system. Since 2010, a Conservative national government has severely restricted its funding, as well as making significant changes in policy and structure. Several groups have campaigned against these changes. For my doctoral research, I spent 13 months doing participant-observation with political activists campaigning to “save the NHS”. I use E.P. Thompson’s formulation of the moral economy as a theoretical framework to develop my argument that NHS activists apprehended changes to the structure of the NHS using moral frameworks built on their memories of how the state used to be structured. Activists understood the NHS as an example of how the state can and should play a role in contributing to the realisation of a good society, in which people took responsibility for one another. They contested changes on the basis that reforms may lead to cuts or privatisation, which would be wrong insofar as they would cause the state to forego its obligation to provide welfare services for all people in the country. As such, activists saw themselves as in alliance with the whole population, and considered the managers and politicians advocating reforms as their opponents – the moral antagonist – even if such opponents did not explicitly support cuts or privatisation. While such a political battle line does hold the potential for the emergence of a putative class consciousness, I witnessed the fracturing of possible alliances and the undermining of solidarities as suspicions of betrayal and individualised evaluations of persons became entangled with broader strategising to overcome the moral antagonist.
Date of Award1 Aug 2021
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorKaren Sykes (Supervisor) & Adam Brisley (Supervisor)


  • class
  • state
  • solidarity
  • socialism
  • NHS
  • political
  • ethics
  • morality

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