Anarchy and the NHS: how can radical politics bring a new perspective to health and care?

Recently, I’ve been thinking and writing about addressing power imbalances between voluntary and statutory organisations. Reflecting on the importance of understanding power got me thinking about other ways people have tried to think differently about power in health and care.

One concept we don’t really talk about very much in a health and care context is anarchism – perhaps that’s not surprising, given anarchy has a lot of negative connotations in mainstream culture. Sometimes described as a world without rulers, rather than without rules, this actively non-hierarchical viewpoint sits directly at odds with the way most of society – and especially the public sector – is currently organised. But many core tenets of anarchism are surprisingly applicable to a lot of the aspirations around how to deliver the best health and care.

There are of course many different strands and complexities of anarchist thought. From a pragmatic viewpoint, it is the more social aspects that are relevant here, including rejection of hierarchies, opposition to oppression, and collective direct action. Direct action in this sense is the productive, everyday actions that make a meaningful difference to people’s lives. One aspect that I’ve been struck by when meeting health care workers and others who practise in this way is the care they show each other in simple but meaningful ways, such as sharing nourishing food, childcare and creating safe spaces for mutual emotional support.

Anarchist influences on health and care have a long history. One famous example is the Peckham experiment. This was a 1930s initiative to run a local health centre that supported families by promoting healthy activity. Although the founder rejected the label of ‘anarchist’, others have pointed out that the centre worked along several anarchist principles, including contribution (a small weekly subscription) and autonomy (doctors did not direct but instead supported people to make informed choices about their own health, and activities at the centre were self-organised and run by the members). In part because of these principles, the centre was unable to integrate into the emerging national health service and thus closed in 1951. More recently, the mutual aid groups that emerged early in the pandemic again drew on anarchist ideas of non-hierarchical organising. Within the NHS, mutual aid between different organisations, for example co-operating to share resources and support each other, is now an established concept.

In health and care more widely, as well as mutual aid, other forms of co-operation such as social care co-ops have the potential to rebalance power relationships. These can facilitate a context in which people can have greater choice and control over the care and support they receive. Self-organising, such as through facilitating asset-based community development, involves people understanding and utilising their own power to change their local community. The examples in Hillary Cottam’s radical help embody many of these values. For those working in the NHS, challenging hierarchies is essential to delivering effective care and can help to shift the balance of power.

All these ideas challenge the paternalism often associated with health and care services. But it’s also important to ensure that more autonomy doesn’t mean withdrawing support. As someone living with endometriosis plus other long-term conditions, health practitioners have sometimes made me feel like I’m left to manage alone. But what has been most helpful is when I’ve been supported with information and advice to understand my treatment options, and directed towards a support group to share with and learn from others also managing the same condition – a group which is hosted in the hospital clinic after hours.

Autonomy is also vital for health and care professionals, both to enhance their own wellbeing and to support their practice. But again, this works best in a context where people are also working collectively – such as the Buurtzorg model which aims to enable nurses to work in non-hierarchical, self-managed teams to better support their local population.

As we see more of the limitations – and sometimes failures – of the hierarchical institutions that currently dominate health and care, it’s useful to have alternative perspectives to remind us that things could be different. More immediately, it’s positive actions that make an impact, ensuring people can recognise and use the power they have. In a wider context, where many of us often feel like things happen outside of our control, perhaps anarchist ideas could help us to understand and maximise the power we do have to act, not as individual heroes, but together.