This paper examines the introduction of the Market into the National Health Service, viewing it within the perspective of the destruction of the Welfare consensus. It is suggested that the ideology of the Market and the attack on welfare-ism derives considerable support from their appeal to primitive parts of the personality that view dependency or vulnerability as weakness, the process originally described by Rosenfeld who termed it ‘destructive narcissism’. The paper develops this theme and uses a clinical example to illustrate the phenomenon. It is also suggested the NHS reforms create fragmentation and alienation. This has led to primitive survivalism which, although a natural outcome of the process described, will prove very costly in terms of its effects on morale — an essential component of adequate health-care delivery.