This post examines how the NHS can be constructed as a totalitarianist institution - etymologically speaking.

Now, be sure to understand that my aim is not to label the NHS as some kind of evil conspiracy - I'm speaking purely etymologically. "Totalitarian" by definition. The notion of the "total institution" of the hospital extended to the NHS as a whole.

Before anyone can label the UK a totalitarian state, the term “totalitarian” must be dissected. Of course, it is associated with Nazism, or Communism - the personality cults of the 40s and, in the case of North Korea, the ongoing years. The notion that some faceless Party has supreme power, that you are being watched by malevolent evil eyes from around every corner, your ever move, word, even thought, being dissected for any sign of “immorality” or dissent from the overarching ideology of the state.
Indeed, much of the present-day notions of totalitarianism is grounded in Orwell’s 1984, the quintessential book on the dangers of totalitarianism.
But was is totalitarianism? Well, the notion of a “total” state can be directly linked to the idea of a “total” institution - most obviously, a prison, but also, a hospital, where, in each case, the subject’s entire existence is both monitored and controlled. If, then, we are to extend the notion of a total institution to the state in general, if instead of using prison - especially Bentham’s Panopticon - as a model, we use a hospital, then what do you get - arguably, the NHS.
The post-war years saw the emergence of an idealistic vision which became a reality - and this vision has guided the institution ever since. It’s premise was simple - free and equal healthcare for anyone who needed it. Regardless of colour, creed, gender, race, religion - even ethnicity and nationality - you are entitled to free and equal healthcare from the best in the field. Ideally, the NHS would have immediate access to all possible resources - every piece of technology, every specialist field covered wherever you are, every need seen to. So, if a hospital is seen as a total institution, can this realistically be extended to the whole of the NHS - and crucially, to influence the whole of the United Kingdom and the whole population - after all, the NHS may be free for all, but that does not necessarily give it a monopoly on healthcare in the country, and little or no power.
This would have been true with the depersonalised, managerialism of the 1980s and 1990s - the internal market and the re-arrangement of power and fund management associated with the consumerist ideal being extended into the NHS for the purpose of raising standards and guaranteeing a better service. Consumerism is by its very nature anti-authoritarian. It allows individual choice to dominate, emphasises freedom and the notion that anything can be gained simply by paying for it - from fridges and games consoles, to sex, power and fame. However, in the late 1990s and 2000s, there have been renewed calls to begin blurring the lines between private and public healthcare - the same has been seen with the school system.
The proposals would see a more blurred line between public and private, with most healthcare needs being met primarily in the grey area between the two. In this way, free healthcare becomes a part of paid healthcare - for a price, you can have more, not, as it was before, a case of paying for better than what was available on the “national health.” The creation of “trusts” was evidence of this blurring of the lines, and, much more recently, plans to ditch small surgeries to make way for “super surgeries” and “poly clinics” directly show a master plan of depersonalising the service, condensing it, and thus reshaping the landscape entirely - marginalizing the entirely private sectors of healthcare probably to extinction.
On this important point, another aspect must be considered. A total institution by definition manages all aspects of the subjects’ existence in one way or another. While so far I have argued that the streamlining of the country’s health service, as well as the deliberate blurring of public and private, have forged a conglomerate service which is impersonal, but which provides expertise from all areas of healthcare, I have not yet met the crucial aspect of totalitarianism which is most evident - the end of privacy, the attacking of fundamental rights, the denial of freedom. How can such dystopic themes every emerge in the field of healthcare - definitively an altruistic exercise? Simple - because healthcare is grounded in the idea of total privacy, confidentiality, and holistic treatment. Deny these rights in favour of depersonalisation and mass categorization, effectively turning people into quantitative problems instead of individuals, and you have effectively destroyed the fundamentals of privacy and holistics.
And this, too, has occurred - but not quite yet. The modern NHS, with it’s merged public and private functions, it’s depersonalized, target-driven service, has taken another step towards totally abandoning holistics in favour of quantitive problem-solving - the multi-billion-pound NHS Database, a nationwide network accessible by any hospital or surgery in the whole country, will contain the full medical details and history of everyone on record - entirely computerized, and accessible at the click of a mouse. People are reduced to statistics, factors, details printed on a screen or on paper, basically, reduced to almost mathematical problems in need of solving. What is not needed, is simply not needed, negating the need for socializing or even asking questions.
Thus, the NHS has become a target-driven, streamlined, trimmed-down, monopoly of both public and private healthcare - an inescapable monolith towering so high over all aspects of health, mental, physical, immediate, and elective. Not only that, it has depersonalised the person, reducing the individual into computerized “cases,” little more than quantitative problems in need of solving. Finally, it has achieved both of these by various measures - all of which will be compounded by the database, where the need for efficiency contradicts and indeed counteracts the right to privacy.
While no-one is under the impression that faceless, evil “others” are using the details taken from us and put on this huge database for “evil deeds,” or to spy on us, blackmail us, or monitor us, the very fact that our privacy is being literally pulled from under us to consolidate the health service as the definitive monopoly on health in our country, and to further, ironically, the altruistic ideal of free and equal healthcare for anyone and everyone, is worrying. The definition of a “total institution” when applied to the hospital requires several things; inescapable surroundings, your needs utterly met and understood, and your actions monitored.
Then, is not the modern NHS by definition, totalitarian? No-one can escape the database, everything is recorded onto it. Also, no matter where you go, the NHS looms large over everything - in all honesty, no matter where you go - even abroad - your needs will be met by the NHS or an NHS-linked healthcare trust. Thus, you cannot escape the NHS, and it will always know who you are, every detail about you, how best to treat you, how not to treat you, and better, every single special need you may have. On top of that, every doctor and nurse in the NHS will have had training and experience in dealing with people first-hand as well as in textbooks and training exercises. You cannot escape, you’re needs will always be met, or at least, every effort will be made for them to be met, and because everything is recorded forever on a database accessible anywhere, you are indeed monitored.
Yes, I would say the NHS is, or will be in the next few years, completely totalitarian. It is committed, by it’s very nature, to “totality” in every aspect of it’s service. Monopoly, total knowledge and seemingly unlimited resources. Admittedly, that last point is in severe doubt - but the influx of cheap labour from abroad as well as advances in technology will no doubt help fix that seemingly perpetual problem.
In this way, an aspect of our daily life we would never have labelled “totalitarian” now appears depressingly inescapable and depersonalized. Like a huge iron hammer hanging over us when we’re ill." 

"If you have nothing to hide, you've got nothing to fear."

This phrase is worse than Orwell's "IGNORANCE IS STRENGTH," in that it actually prounounced why ignorance is strength.

It is simple in it's unarguable logic - because, at heart, it is true. Only those committing crimes should be worried about surveillance, the loss of privacy, and the limiting of speech and freedom of agency, because those things are aimed at rooting out those who are breaking the black letter of the law. True - but this rhetoric requires a few key assumptions to work. 

One, is that there are intrinsic "rights" and "wrongs" in society. Some actions are bad, criminal, wrong. Therefore, because individuals are responsible for their own actions, there are intrinsically bad individuals out there committing deliberately bad acts. 

Another, is that those who stay totally within the letter of the law - "the majority" - do not need privacy, and freedom of speech, and the restrictions on what they can say and do. This is because - it appears - those at the other end of ID cards which track you and CCTV cameras which film you, will not focus on you, the law-abiding citizen, because you are not a criminal. They have zero interest in the law-abiding majority, and since the law-abiding majority do not need privacy and freedom of speech (because privacy is equated with furtive and suspicious action, and because "freedom of speech" intrinsically breeds abuse), they willingly give both up because it will expose the criminals as the ones who oppose the plans. Simple - those who question or oppose the measures, obviously have something to hide. Worse, as I found out first hand, is that if you dare call these measures "Orwellian" or it's derivitives, you are not just suspicious - you are delusional.

Two threads are apparent here - that "criminals" fall into neat categories distinct from law-abiding people, and of course, the implication that the "criminals" are a minority.
The other thread is that there is a deliberate "divide and conquer" tactic here - the supporters will always be in the majority, because the popular consensus is based on the media - reductionist, right-wing punitivism. The opponents will probably have a better, broader, more intellectual grasp on sociology, law and criminology, but will be talked down by right-wing rhetoric, in this case, the fact that opponents must either be mad, or must be criminal. Here, we see a form of social exclusion actually being practiced by lay society, both at group and individual level - the reductionist notion that only the neat category of "criminal" need fear over the removal, through invisible means, of privacy and freedom of speech (etc.) is self-policing, literally as if there are hoards of eager fanatics out there ready to report you to the Thought Police as a delusional criminal if you dare raise the question of civil liberties. Thankfully, the UK does not (yet) have a Though Police, and opinions are still legal - although expressing them in certain ways is frowned upon.

The notion that criminals fall into a neat little category is a long-dead fallacy. I do not need to back this up, but I will, as I find the article interesting, and I think you'd do well to read it. Howard Becker (1963, "Outsiders," excerpt from Outsiders: Studies in the Sociology of Deviance, pp1-18 [New York Free Press], quoted in McLaughlin, E., Muncie, J. and Hughes, G. (2006) Criminological Perspectives: Essential Readings Second Edition, Sage, The Open University, pp239-247) argues that "deviance" is completely relative and related more to power-relations in society than any intrinsic notion of corruption. A damn good read, and part of an entire galaxy of literature which demolishes the myth of the "categorical" criminal.

Of course, you may argue, you are a criminal if you break the law. But, in reality, whether we realise it or not, we all break some law or another every day.

Hulsman, (1986, Contemporary Crisis, pp63 - 80) argues that black-letter law approaches deal so specifically with the process of law and order, and the literal letter of the law, that processes of law and order ignore all context and focus on "last judgement" rhetoric which cancels out all other possible options in a social structure, when dealing with "deviance." Thus, "justice", law and order are blinkered to reality.

Hulsman's study is not exactly exhaustive - but it's a decent start. Putting Becker's and Hulsman's studies together paints a picture of the justice system, and all related ideas of "the criminal," and "the law-abiding citizen" as interchangeable actors in a power-play deliberately blind to the dynamics of reality. Thus, while the distinction can be made, it's legitimacy is called into question - introduce actuarian social and environmental crime-control/prevention/reduction measures such as surveillance, restriction on freedom of speech/agency, and you realise a horrifying truth - that everyone has the potential to suffer under these punitive preventative/reductive methods. Extend the argument to include ASBOs, where the fuzzy notion of "anti-social behaviour" refuses to be defined within any limits, and you understand that for different reasons, and in different situations, anyone can fall into the (fluid) category of "criminal" depending upon forces beyond their control. 

Because of this, we must consider the final aspect of this argument - the distinction between public and private. Public life is social life - that which can be seen, which all of us experience and all of us are directly or indirectly affected by. Private, on the other hand, is just that - it is immediately important to individuals or families, close friends, but mostly individuals. It is our beliefs, our personal identity expressed in our belongings, our opinions, an entire mountain of definition which is beyond most people's remit. 

While public life is, and should be, regulated according to the law, because, all said and done, the law generally keeps us safe and keeps society running, despite it's ideological shortcomings and contradictions, private life should be simply directed by legally instituted social requirements based on absolute no-nos. We should not commit fraud, embezzle, visit illegal websites, collect racist or deeply offensive or defamatory materials, terrorist materials - I'm okay with restricting that kind of stuff. The problem arises when, again as Orwell wrote, the core of all crime is narrowed to the human mind and thus everything outside of it is made fair game - because of the contemporary fascination with "extemists," or "perverts," or "undiagnosed personality disorders," the primary site of crime is seen to be the human mind - everything external to this is simply "the devil's playground." With this logic, people become criminals if anything in their private lives, never mind their public lives, is seen to be reflective of the "inner criminal," or the "potential risk to society." Thus, the private becomes something open to examination, to see if the individual is a potential criminal mind. 

If you have nothing to hide, you have nothing to fear.

In other words, anyone, and their entire lives, public and private, should be opened up completely for scrutiny by crime control/prevention/reduction agencies - specialists - in case you harbour "deviant," or "criminal," or "anti-social" beliefs, opinions, thoughts. Because your private life will evidence this. The idea of the mind as the source of crime - and everything outside of it fair game to search for evidence of this criminality - means those with "nothing to hide" must have the purest minds in the whole world. And those who do have something to hide must, in essence, be "thought criminals."
So, then, only those without pure minds have something to fear from not merely some vague idea of a conspiratorial, malevolant "them" watching from some dark control room in some seedy government surveillance office (which would be simply silly, and yes, paranoid), but moreso from society - at an individual and group level. 

In summary, then, how is the phrase at the head of the post related to "IGNORANCE IS STRENGTH," amid a discussion on the reductionist notion of the "thought criminal" implicit in lay notions of criminality, law, order and security? Because people choose not to think about these implications - they repeat the mantra without even considering that they may indeed have something to hide. They do not question society, they simply accept it, self-categorize themselves as "law-abiding" and declare that they have nothing to fear from society. Here, they ignore the fact that they accept the "fearful" concequences of the measures, and also, they do not even consider the true implications of the idea of "what people have to hide." Are they hiding the thoughts in their heads? Because surveillance will take care of the evidence, won't it?
Moreover, the reason such ignorance is strenght, is that to simply fall placidly into the mantra is satisfying - you have nothing to fear, because you're law-abiding. Thus, you're not just safe, you're part of a noble majority helping to root out evil. From your armchair, without doing anything. 

Re-read this post, and see other examples, rooted in the text, of how ignorance can be strength.