Paper short abstract:

I draw on ethnographic research with UK healthcare activists and managers to explore the differences between the imagined values exhibited in their visions for what the NHS should be.

Paper long abstract:

In the UK, state-funded healthcare is undergoing reforms closely tied to a government austerity program affecting all public services. In this paper, I draw on ethnographic research with activists campaigning against these reforms, and the senior managers and local politicians pushing the reforms through.

The managers and politicians describe their own values, and the values of the NHS, in similar terms to those of the activists. However, the actions of the managers are in direct contradiction to those of the activists. In this paper, I reflect on the tension between these diverging actions and mirroring discourses of ostensibly similar moral projects.

While managers and politicians claim to share the same values of universality and comprehensiveness of a free service, they must also consider costs. Insofar as healthcare is a service provided by healthcare workers for a wage, it is a commodity that must be purchased. Managers and politicians argue that the "reality" is that they must stay within their budgets, pre-set by central authorities.

Parry and Bloch (1989) argue that that the problem of such imagined realities is not a result of the commodity fetish's ability to corrupt social relations, but in its ability to mask them. Marx's insight that the reality of the commodity's exchange value conceals a suite of social relations is recognised by activists, who seek to focus on exposing these social relations by making moral arguments regarding their right to healthcare. They counter the managers' economic argument emphasising necessity and constraint, with an ethical argument emphasising political choices and possibility.