Talking Politics

Market dogma will damage the NHS

Tue Jan 18 03:07PM

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.

Comments1 - 10 of 162

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2 simple questions:
Which is more important: eating or health care?
Does anybody seriously believe government would make a better job of food distribution than messrs Tesco, Asda, Sainsbury etc?.
So why do people believe it will make a better job of healthcare?
(and yes - food distribution IS as complicated as health care - just different)

From paulyoung55 on Tue Jan 18 03:17PM
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2 simple questions:
Which is more important: eating or health care?
Does anybody seriously believe government would make a better job of food distribution than messrs Tesco, Asda, Sainsbury etc?.
So why do people believe it will make a better job of healthcare?
(and yes - food distribution IS as complicated as health care - just different)

From cedarway on Tue Jan 18 03:20PM
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Mr Dunt - the past particple of the verb "to get" is GOT, not GOTTEN. Your Americanisms are very unwelcome. I have told you this before - PLEASE TAKE NOTICE!

From hal12158 on Tue Jan 18 03:33PM
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Mr Dunt cannot accept that Communism has failed in every country that has tried it. Look at North Korea where totalitarianism means the people cannot even feed themselves. Even China has now introduced Capitalism to make it's markets and industry competitive.
The current NHS is an enormous bureacracy that is devouring cash at an increasing rate because it is run by an army of administrators that pay themselves vast amounts of taxpayers money but achieve very little. The radical re-organisation is long overdue.

From wm1csc on Tue Jan 18 03:52PM
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A thought provoking article, how I remember those big posters saying that the Tories would cut the deficit, NOT the budget for the NHS. This seems to be a good way of doing it through the back door.
My worry is that the effects could be drastic and lead to us falling even further behind the other European Nations.
Is this current political system encouraging such extremes. Would proportional representation give rise to more consistent approach so that government could provide a guiding hand rather than such differences in approach.

From johnandalmaz on Tue Jan 18 03:53PM
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Good article Mr Dunt.So what your trying to say in plain English is that this coalition government is about to f**k up the NHS.Nothing new there then,after all this is what the Tories are good at

From raymondtho on Tue Jan 18 03:58PM
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The market is not a "dogma". It is simply the most efficient mechanism for allocating scare resources. It is a measure of how deep a grip socialism has got in this country that the nonsense in the above article even sees the light of day. If Cameron had any spine he would introduce private sector insurance based choice for all and end the 1960's holiday camp that is the NHS.

From jor200 on Tue Jan 18 03:59PM
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If your doctor fails to register within this new system, do you then obtain the hospital care that you might need or require or are you then refered to the surgeries that have obtained this funding. The PCT's are also a waste of space as they are a form of quango for the @#$% (and @#$%) of the nodding brigade.
The largest waste within the NHS is the management lineup, a line manager has to have a senior manager who has to have a director who has to have others to answer to and so the upward spiral continues to a board of directors who then passes the buck back down the line to the lowest worker to take the blame.
I've often heard the phrase "bring back the matron" under the present system that's an impossable dream, as you would still have all the other levels of management in force, should the matrons return as they have in some areas, all we got was a promotion for one of the lackies and nothing changes other than having another tier of management by another name, you cannot turn back the clock as it would not work due to all the tiers in place thus adding another pay scale to the payroll and again another job for the blue eyes not ability.
Likewise any new government will seek to change thing for the better, but normally it cost us more in the long run and the "Told you so" is not recognised as the idea was the brain child of some idiot with a little power who for what ever reason cannot see the nose on his/her face. Its the old story over and over again "I'm in charge and I know best" except for when they are voted out and then the blame game starts, its like watching a couple of kids fighting over a bag of marbles .
Desite the promise of we "are listening to you" they fail to inform us of the following words which are hidden in long do@#$%ents "as you are un edumacated and not in power" we cannot listen to you under any cir@#$%stanses or at least until we want your vote at the next election then will move the earth for you, until then mind you P's and Q's. Already the cost of living has gone up, but my pay remain the same and I like many other are expected to survive, the question now is "How long will it be before the NHS is privatised".

From jaythomp100 on Tue Jan 18 04:20PM
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hal12158, comment no. 3: "Gotten" is the old English past participle of the verb "to get." It was in use in Britain for a couple of centuries (at least) while people were emigrating from here to our American colonies. Like many other "Americanisms" it survived over there while falling out of use over here. Actually, "gotten" was still in use by a few old folk when I was a lad. Those same old folk were very dismissive of things American, which they derided as "Yankee nonsense".
Did you know that "yeah" for "yes" was used, many years ago, in only a very small area of England? From there it was exported to North America and spread like wildfire. We've re-imported that one too.

From std2e on Tue Jan 18 04:48PM
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Cameron says I should have choice as a patient. Ok, I'm exercising that choice- I don't want any privateer to profit from my ill-health.
Blair was Thatcher in drag.
Frighteningly, Cameron seems to be an offspring of both, a clone who has inherited their worst characteristics, especially the arrogance & obsessive behaviour.
And why does he keep insulting my intelligence by saying the NHS is free "at the point of delivery"? Of course it is- we've already paid in advance for it via our taxes & N.I contributions. I seem to recall that the latter went up 1% not that long ago, specifically to put more funds into the NHS.....
O7

From ophelia_seven on Tue Jan 18 04:51PM
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