Contract, social relations and the outsourcing of publicly funded healthcare

A prominent and consistent element of Chris Newdick’s work can be understood as a focus on the nature of relations in healthcare and healthcare law. Specifically, he has emphasised and defended the importance of social solidarity and community as core values against the dominant focus on and championing of an individual sense of autonomy in those areas. This article takes up the theme of relations in a different context, exploring the nature of the social relations underpinning the increasing role played by the private sector in delivering publicly funded healthcare. It does so by considering two instances of outsourcing – the private finance initiative and the United Kingdom (UK) Government’s awarding of contracts as part of its response to the Covid-19 pandemic. It is argued that those examples disclose relations between the state, citizens, and what the sociologist Wolfgang Streeck calls the marktvolk (the people of the market) that cannot be comprehended via the notions of solidarity and community traditionally associated with a publicly funded healthcare system like the UK’s National Health Service. Indeed, the social relations involving the marktvolk – including, for instance, the importance of one’s status and duties of loyalty based on acquaintance – tend to have the effect of, in Newdick’s phrase, ‘corroding [the traditional form of] social solidarity’. Thus, while important, it is not only the stress on individual autonomy and rights that has this corrosive effect; other forms of social relations – including those involving elites and revolving around capital – have this impact too and demand exploration.