How I fell out of love with the NHS: An ethnography of hip replacements and healthcare assemblages in the UK

This thesis is both a story of how I fell out of love with the NHS and a proposition for how to do politics in and on the NHS differently. Having begun my journey as a campaigner trying to save the NHS of the 1950s, I suggest it is time to come at the rife and dichotomised arguments about the UK’s healthcare service with a different tack. I do this by drawing on anthropological and STS scholarship to look not at what the NHS is, but how it is done in everyday practices. Through an ethnography of hip replacements, I see the NHS as a fluid assemblage. I collapse traditional macro-meso-micro policy hierarchies to look at how power gets pieced together through everyday practices. In doing so I argue that, far from being a beacon of equality, the NHS reproduces the inequalities it was supposed to rectify. The classed and gendered hierarchies that get practiced through the relations between staff directly affect what kind of hip replacement is given to whom. Long held practices such as maintaining detached concern, valuing surgical labour over other forms of care, and chasing the spot at the top of data tables lead to patients without the necessary social, cultural and economic capital being left to struggle without care. Through incorporating historical data, I suggest that the problem here is not neoliberalism, but a much more historically entrenched problem of trying to remedy the outcomes of capitalism through a welfare state. Rather than resurrect the NHS of the 1950s, I propose ways in which people can become activists as part of the fluid relations of the NHS. Through reorienting the value of our everyday actions, I propose a different way of practicing healthcare activism.