Comment: Market dogma will damage the NHS
Pro-market dogma is clearly hurting the PM’s brain. There’s no other explanation for this counter-productive reform of the NHS.
By Ian Dunt
We are governed by a pro-market government. We have been for a very long time. That’s a shame, because market dogma tends to rot people’s brains.
Margaret Thatcher, John Major, Tony Blair, Gordon Brown and David Cameron are all pro-market ideologues. While Blair and Brown were prepared to let the state interfere in people’s lives, they never wanted it involved in providing services, which, the consensus said, markets did far better.
Cameron’s lesson from Blair was that he had proceeded too slowly in that first term, those early years when he could have probably gotten away with anything. It’s a lesson which is actually starting to damage the coalition, as it proceeds, crack-addict-like, with a mad variety of initiatives at breakneck speed.
Tomorrow, the health and social care bill will be published. It is a thorough, gutsy variation on Blair’s reforms, which had the same intentions, but were only nervously promoted. Under health secretary Andrew Lansley, GPs consortia will deliver an artificial market, effectively commissioning services from hospitals. Blair and Cameron are united in their beliefs: the state cannot deliver satisfactorily. Only competition provides decent services. Where markets exist they should be expanded and deregulated. Where they do not, they must be created.
But the Conservatives do not have a marvellous track record when it comes to creating artificial markets. Think of the railways, where the separation of rail and train operators, to name just one aspect, has proved hugely problematic. The forced atomisation of the industry was equivalent, as playwright David Hare pointed out, to employing cooks, waiters and washer-uppers from different companies to run a restaurant.
The important aspect of consumer choice is that unwanted products can fail. The restaurant with bad food or poor service loses money. The T-shirt company with eye-catching designs succeeds.
But you can’t replicate that in services where no choice is desired. No-one wants to choose a kind of kidney operation. They just want it done right. The fact that Blair thought the mantra of ‘patient choice’ was a winner shows just how demented his mind had become by the influence of market dogma.
Because there is no diversity required of the service itself, the government is forced to create artificial markets which then invariably fail. They lack the fundamental quality of markets: namely, of being a natural by-product of human desire on one hand and labour on the other.
Natural markets communicate information instantly. They do this better than any other system on earth, because they do it effortlessly. Price communicates supply and demand.
This is the benefit of markets, and it is particularly suited to services where people want different things. When our political leaders want to create a market despite these conditions they turn to the role of competition, an argument so pathetically overestimated its proponents sound like mad infants banging their heads again a wall.
Creating suitable incentives constitutes the meat and potatoes of economists’ diets, who enjoy playing around with how people are encouraged, or otherwise, given certain conditions. One of the problems in the Soviet Union, for instance, was that workers were discouraged in their efforts. Local workers’ groups which accomplished their tasks quickly and competently were heaped with more work. There was no incentive. The man painting a fence had nothing to gain by doing it faster.
Humans excel when we find an appropriate way to motivate them. That can be material but it is often through elevated social status, flexibility or simply collegiate recognition. Competition between organisations can provide an incentive, but its role has been absurdly overrated against other factors. It certainly does not merits what the coalition is planning to do to the NHS.
Because of a baseless ideological obsession, the prime minister is pressing ahead with health service reform. From someone who comes across as reasonable, it is startling how bonkers it is.
The government is handing four-fifths of the NHS’ £100 billion budget to GPs and dismantling the health services’ management structure. This is despite claims from Francis Maude that last year’s quango cull was designed to increase Whitehall responsibility. It now appears Whitehall is being stripped of responsibility so that when cuts hit the government can evade blame, in much the way that it is currently doing with local councils.
It is spending money on reorganisation when the NHS is having to belt tighten anyway.
It is reorganising, pointlessly, when clinical outcomes and patient satisfaction are significantly improving.
It is suddenly reforming Britain’s best-loved institution with no democratic mandate at all: no pre election pledge, no coalition agreement. Either Lansley and Cameron formulated these plans years ago, in which case they are responsible for evasion on a grotesque and unforgivable scale, or they really did come up with them in June, in which case they are unspeakably irresponsible and petulant.
It’s crazy of Cameron to do this, but that’s market dogma for you. It makes people do weird, terrible things.
There is no logic to it. There is no sense to it. It’s a form of religious fervour. It will damage the NHS and, if there’s any justice, the government as well.
The views expressed in politics.co.uk’s Speakers’ Corner section are those of the writer and do not reflect the opinions of the website or its owners.
