Article published In: Multimodality, Politics and Ideology
Edited by David Machin and Theo van Leeuwen
[Journal of Language and Politics 15:3] 2016
► pp. 288–303
Opening up the NHS to market
Using multimodal critical discourse analysis to examine the ongoing commercialisation of health care
Published online: 4 August 2016
https://doi.org/10.1075/jlp.15.3.04bro
https://doi.org/10.1075/jlp.15.3.04bro
Abstract
Since its implementation, the British Government’s controversial 2013 Health and Social Care Act has had far-reaching effects on health care provision in England, not least the creation of 212 regional practitioner-led clinical commissioning groups (CCGs) which are now responsible for much of the service provision across the country. Taking as an example the website of one of these new commissioning groups, this study shows that multimodal critical discourse analysis (MCDA) can reveal how health and social care matters are being increasingly framed within a corporate and neoliberal set of ideas, values, identities and social relations. Despite government assurances that the Act preserves the (non-commercial) founding values of the NHS, our MCDA provides textual evidence of the influence of neoliberal and commercial discourses operating across this particular website, which appear to be just as much about promoting an appealing corporate identity as responding to the practical, day-to-day concerns of patients.
Article outline
- 1.Introduction
- 2.The 2012 Health and Social Care Act and the (on-going) privatisation of public health provision
- 3.Data and Method
- 4.Analysis
- 4.1The NNE commercial brand
- 4.2Representing social actors: the patient-practitioner partnership
- 4.3Representing processes: the idealised and abstracted health care encounter
- 5.Conclusion
- Acknowledgements
- Notes
References
References (44)
Billig, Michael. 2008. “The language of critical discourse analysis: the case of nominalization.” Discourse and Society 19 (6), 783–800.
Brookes, Gavin & Harvey, Kevin. 2015. “Peddling a semiotics of fear: a critical examination of scare tactics and commercial strategies in public health promotion.” Social Semiotics 25 (1), 57–80.
Brown, Brian J. & Baker, Sally. 2012. Responsible Citizens: Individuals, Health, and Policy Under Neoliberalism. London: Anthem Press.
Cannock Chase Clinical Commissioning Group. 2012. Communications and Engagement Strategy. [URL] (Accessed 8/8/2015).
Davies, Anne C. L. 2013. “This time, it’s for real: the Health and Social Care Act 2012.” The Modern Law Review, 76 (3), 564–588.
Department of Health. 2012. Health and Social Care Act 2012: Chapter 7, Explanatory Notes. London: The Stationery Office.
Fairclough, Norman. 1993. “Critical Discourse Analysis and the Marketization of Public Discourse: The Universities.” Discourse and Society 41: 133–168.
Fougner, Tore. 2006. “The state, international competitiveness and neoliberal globalisation: is there a future beyond ‘the competition state’?” Review of International Studies 321, 165–185.
Guseva, Alya. 2014. Health Care, Commercialism in. 2014 William Cockerham, Robert Dingwall and Stella E. Quah ed.. The Wiley Blackwell Encyclopaedia of Health, Illness, Behavior and Society Oxford: Wiley Blackwell772–775.
Hansen, Anders & Machin, David. 2008. “Visually branding the environment: climate change as a marketing opportunity.” Discourse Studies 10 (6), 777–794.
Holder, Holly, Robertson, Ruth, Ross, Shilpa, Bennett, Laura, Gosling, Jeni & Curry, Natasha. 2015. Risk or reward? The changing role of CCGs in general practice. London: Nuffied Trust.
Kress, Gunther & van Leeuwen, Theo J. 2002. “Colour as a semiotic mode: notes for a grammar of colour.” Visual Communication 1 (3), 343–369.
Le Grand, Julian. 2013. “Will 1 April mark the beginning of the end of England’s NHS? No.” BMJ, 3461.
Ledin, Per & Machin, David. 2015. “How lists, bullet points and tables recontextualize social practice.” Critical Discourse Studies 12 (4), 463–481.
. 2016. “A discourse-design approach to multimodality: the visual communication of neoliberal management discourse.” Social Semiotics, 26 (1), 1–18.
van Leeuwen, Theo J. 2008. Discourse and practice: New tools for critical discourse analysis. Oxford: Oxford University Press.
Lister, John. 2013. “Breaking the public trust.” In NHS SOS: How the NHS Was Betrayed – And How We Can Save It, ed. by Jacky Davis, and Raymond Tallis, 17–37. London: One World.
Machin, David. 2004. “Building the world’s visual language: the increasing global importance of image banks in corporate media.” Visual Communication, 3 (3), 316–336.
Machin, David & Mayr, Andrea. 2012. How to Do Critical Discourse Analysis: A Multimodal Introduction. London: Sage.
Machin, David & Thornborrow, Joanna. 2003. “Branding and discourse: the case of Cosmopolitan.” Discourse and Society 14 (4), 453–471.
Martinec, Radan & van Leeuwen, Theo. 2009. The Language of New Media Design: Theory and Practice. London: Routledge.
Mautner, Gerlinde. 2010. Language and the Market Society: Critical Reflections on Discourse and Dominance. London and New York: Routledge.
McKee, Martin. 2015. “Introduction.” In NHS For Sale, ed. by Jacky Davis, John Lister, and David Wrigley, xvii–xxvii. London: Merlin Press.
Mooney, Helen. 2014. “Funding crisis to lead to 34 million fewer appointments per year.” Pulse, 24th February.
Morrish, Liz & Sauntson, Helen. 2013. “Business-facing motors for economic development: an appraisal analysis of visions and values in the marketised UK university.” Critical Discourse Studies 10 (1), 61–80.
NHS Confederation. 2014. Reconfigure It Out: Good Practice principles for Communicating Service Change in the NHS. London: NHS Confederation.
NHS Support Federation. 2014. Private firms win 70% of NHS contracts. URL: [URL] (Accessed 10/08/2015).
Player, Stewart. 2013. “From cradle to grave.” In NHS SOS: How the NHS Was Betrayed – And How We Can Save It, ed. by Jacky Davis, and Raymond Tallis, 38–61. London: One World.
Pollock, Allyson & Price, David. 2013. “From cradle to grave.” In NHS SOS: How the NHS Was Betrayed – And How We Can Save It, ed. by Jacky Davis, and Raymond Tallis, 174–203. London: One World.
Pollock, Allyson & Roderick, Peter. 2015. “Why the Queen’s Speech on 19 May should include a bill to reinstate the NHS in England”. BMJ, 350, h2257.
Pollock, Allyson, Shaoul, Jean & Vickers Neil. 2002. “Private finance and ‘value for money’ in NHS hospitals: a policy in search of a rationale?” BMJ 3241: 1205–1209.
Sauntson, Helen & Morrish, Liz. 2011. “Vision, values and international excellence: the ‘products’ that university mission statements sell to students”. In The marketisation of higher education and the student as consumer, ed. by Mike Molesworth, Richard Scullion, and Elizabeth Nixon, 73–85. London and New York: Routledge.
Swales, John & Rogers, Priscilla. 1995. “Discourse and the Projection of Corporate Culture: The Mission Statement.” Discourse & Society 2(6), 223–242.
Cited by (13)
Cited by 13 other publications
Aroles, Jeremy & Kevin Morrell
Tereszkiewicz, Anna & Magdalena Szczyrbak
Vocásek, Tibor
Procter, Simon
Tse, Vincent Wai Sum, Jasper Zhao Zhen Wu & Andre Joseph Theng
Zhao, Wenting & Gwen Bouvier
Brookes, Gavin, Tony McEnery, Mark McGlashan, Gillian Smith & Mark Wilkinson
Brookes, Gavin
Brookes, Gavin & Daniel Hunt
Brookes, Gavin, Emma Putland & Kevin Harvey
Chałupnik, Małgorzata & Gavin Brookes
Rasmussen, Joel
This list is based on CrossRef data as of 13 november 2025. Please note that it may not be complete. Sources presented here have been supplied by the respective publishers. Any errors therein should be reported to them.
