Solidarity was important in the creation and maintenance of the English NHS, which was the product of class compromise. Its founding principles were that it was to be free (at the point of access), universal, comprehensive and primarily funded from general taxation. In recent decades, successive governments have renewed the neo-liberal project. This has involved new governance mechanisms (quasi-markets and targets) being emplaced in the NHS and private healthcare companies (which have influenced government policy) being afforded increasing opportunities to deliver NHS services. Such privatisation is antagonistic to patient needs. I undertake an ideology critique of the NHS reforms of the New Labour governments and of governments since 2010. I examine the influences on, justifications for, resistance to, and potential reifying effects of, such reforms. Misrepresentations and mystification may legitimate and obscure legal changes. I identify the ideological modes and strategies that governments have employed to justify their reforms. I also analyse several modes of reification (identity thinking, instrumental rationality, depoliticisation and the legitimation effect of law) to assess whether the reforms produced estrangement, which is the opposite of solidarity.
Many of the justifications for successive reforms were contested. Although such reforms have rendered healthcare more opaque, solidarity endures. Neo-liberal norms compete with residual norms (including the NHS’ founding principles) and emergent norms (which developed due to the problems of welfare states, such as their failure to empower recipients and the persistence of health inequalities). As validity has been given to residual and emergent norms, which have been superficially articulated within government discourse, but which are undermined by neo-liberal policies, a legitimation crisis may arise as public experience increasingly diverges from them. I advocate amending legislation which has undermined residual norms, democratising the NHS to empower patients and the public and increased intervention in capitalism to address health inequalities.