During the NHS debate the Conservative element of the Coalition failed to convincingly argue for competition in the public services. Unfortunately Cameron, Lansley et al did not seem to have the confidence to promote competition with pride. They lost because they didn’t expose the myth that competition, while good for cars, is bad for GPs. When discussing the role of markets in health my left leaning friends would often say: “It is wrong for corporations to profit from illness and death.” My response to this is: “I’m happy for those who keep people healthy and alive to make money.”
The basic argument is that it should always be the outcome – not the process – that matters; and in order to get the best outcomes there needs to be a diverse range of options available to those in need.
On Sunday it was announced the Government will enable patients and the elderly to choose how money is spent on the care they receive by giving them responsibility for their budget. This is great because it will bring accountability to the place where it matters most; the direct relationship between patient and provider.
But this system will only work well if people have the ability to freely choose what they consider to be the best option. No meaningless barriers should be erected, such as banning those who have the audacity to make a profit. Number 10 knows this but in all the publicity this fact seems to have been hidden. If this is being done to try and avoid an ‘NHS’ type of backlash then Team Cameron is in for a big disappointment.
Attack is the best form of defence. The monolithic providers (civil service) and staff that benefit from the status quo (unions) will fight hard, poisonously characterising the slightest change as a capitalist take-over of people’s entitlements. It is worth remembering that when Cameron said that he would give power away to the people he was actually talking about their power. The Government must promote the benefits of competition to Joe Bloggs by standing tall and being proud of what these reforms will lead to. Anything less is likely to end in retreat.
The artificialness of the “public good/private bad” argument can easily be exposed by showing how across the world there are few uniform answers to the question: what services are ‘inherently government’? For example, in Denmark the company Falck provides around 60% of the country’s fire service and 80% of its ambulances. The French privatised their water industry in the late 19th Century. Germany and the Netherlands have well function private postal markets.
Competition is good for patients, good for tax payers, good for providers, good for staff, good for the economy and good for society. Lets be positive and loudly say so. If the Conservatives are not brave enough to fight for one of our fundamental principles then people will be right to question whether we believe in the benefits of what we stand for.
Related posts:
New blogpost: Repeat after me: "Competition is good" http://bit.ly/ja4iqh #fb
Repeat after me: "competition is good" http://t.co/V8wockI New blog: Conservatives need to be proud of what we believe in
"@betapolitics:Repeat after me:"competition is good" http://t.co/V8wockI Blog:Conservatives need to be proud of what we believe in">>Quite!
Nick Denys on @PlatformTen: Repeat after me: “Competition is good” http://t.co/XqIKmju
Never a truer word spoken.
I think its only fair to say that although it’s wrong to suggest ‘public good/private bad’ it is equally wrong to suggest competition will always result in improvements in public services.
Personally I support greater private sector involvement and competition in the health sector. But it has to be done in the right way. For instance, it should not have been Monitor’s job simply to promote competition. Competition is just a means to an end. It is the quality of patient care that should be promoted and safeguarded.
As you rightly point out, the government did not make a case for competition at all. Unfortunately, as Alan Milburn said last week, this has been a huge failure of government and a disaster waiting to happen for the NHS. As far as the public are concerned that debate is over, and it will now be almost impossible for any answer to the health service apart from hugely increased spending on everything.
In my view the reasons the public are concerned about competition in healthcare are twofold. First, I think people know intuitively that the NHS is not a transparent organisation, and they don’t feel they have got a good deal from extra competition in slightly opaque markets like energy in the past. Second, people are prepared to take a chance on telecoms or the railways, but not with the health of themselves or their family. I think most people feel the NHS is working pretty well these days, maybe not perfect, but certainly not worth making sweeping changes.
It took one of the foremost politicians of the 20th century, Nye Bevan, to be the last person to significantly change health provision in this country, and take on the vested in interests. Perhaps Lansley and Cameron shouldn’t feel so bad they couldn’t make their case as effectively in that light.
Hello Dave. Thanks for your comments. You raise really good points. I agree that one assumption is as blinkered as the other. When I say ‘competition’ I don’t necessarily mean the state withdrawing from the arena. It is important that certain standards are met – such as decent universal health care – but meting a universal standard should not be confused to mean having a single provider. (ps, I know that you weren’t advocating having single suppliers.)
aristeides – Thanks
I am not sure David does raise good points. He says that people don’t “feel” they have got a good deal from extra competition in the energy markets, but in fact the average domestic energy bill was lower in real terms (taking into account VAT) in 2010 than it was when privatisation took place in 1990, despite crude oil being much more expensive (at least 60% in real terms), and in almost every year since privatisation.
Similarly, he thinks “most people feel the NHS is working pretty well these days”. The reason why I praised your statement that it is outcomes that matter is that health outcomes can be measured. See the Lancet’s Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995—2007 and recent comments by Cancer Research. From the report’s findings: “Survival was persistently higher in Australia, Canada, and Sweden, intermediate in Norway, and lower in Denmark, England, Northern Ireland, and Wales, particularly in the first year after diagnosis and for patients aged 65 years and older.”
That is why your are correct and David is, in fact, wrong. We should base policies on outcomes, not on process and what people “feel”.
Blog on #BigSociety Bill & lessons Cameron & Co should learn from NHS u-turn. Competition is good! http://t.co/V8wockI #platform10
I have a company that provides residential care for people with learning disabilities. I have lost count of the number of times I’ve been asked if I think it’s wrong to try to make a profit out of it – notwithstanding the empiricial evidence that (a) private sector providers are on average about 35% cheaper than state provision while having on the whole higher quality and (b) the not-for-profit sector is no cheaper or better – indeed often the reverse.
There’s a complete mental block with some people over this and it’s tragic that the argument simply isn’t being made that monopoly provision by the state isn’t the only answer.
The Social Market Foundation have a lunchtime talk (free) on whether competition in the NHS can save lives.
It’s on 7 July and you can register here.
Hey Nick,
Do you mean that the French PRIVATISED water in the 19th century?
Cheers Tom. ‘Nationalised’ has now been changed to privatised
aristeides - Improving the NHS is not high up on voters agendas because a) most of them don’t come into contact with it much and b) for those who have fleeting visits (most of the rest) walking into some of the new shiny buildings makes us feel good. The Conservatives needed to educate us as to why change was needed, which they failed to do.
I agree with you that most people wouldn’t want to re-nationalise the utilities (especially as we hear no more about ‘fat cat’ salaries), though price is of course the number one concern.
It IS the outcome not the process that matters. I REALLY couldn’t care less who provides my treatment as long as it’s good and works. So I think one question we need to ask first is, what problem do we need to solve, and then is competition the answer?
I don’t think rampant, unbridled, unregulated, no holds barred competition is good for any of us in anything (see banks, passim…) – there do need to be proper boundaries, oversight etc, as David Ward suggests.
Having made 3 visits to my (newly registered with) doctor to try and have some vaccinations for my trip to Rwanda, there is plenty that could and should be better organised, and a touch more commercial-flavoured reality might well mean that I only make one trip – which would save them and me time and effort. I went to the dentist last week – booked for when it suited me, all done in one (very quick) trip. It wasn’t cheap though – and I think perhaps we might need to remember that having many options can (but doesn’t always have to) be more expensive.
And while I don’t have any figures to hand, NHS polling figures are most odd. Most people think their own local hospital is great but given the weight of horror stories in the papers etc, they think the NHS nationally is creaking at the seams.
Some time ago, I was sent a very long, very detailed email about the NHS changes. The person who sent it would rather not be named, but is happy for me to post a summary of some of it:
I am not sure I agree. The theory is that opening up the NHS to innovation will result in better outcomes – and whether that innovation is competition, mutuals, more personalised services as we’ve seen today with long-term care budgets… isn’t really the point. The point is the outcome, as Nick says.
My wife and I, retired, live in Germany and are looked after by the German health system – not a perfect system but I leave you to judge. Last year on a routine visit to my GP she said that I needed to consult a vein specialist as I had a problem. I telephoned the specialist of my choice for an appointment and was seen within 5 days on a Wednesday. After a thorough examination he told me that I needed to have two varicose veins stripped and asked if I could come into hospital on the following Monday for a two night stay for the operation. I was seen and operated on quicker than I could have got a consultation in UK with a consultant.
My wife developed cataracts. Same procedure, the opthalmologist of her choice, a quick referral to the Eye Hospital and, but for developing a cold in between operations on each eye, would have been dealt with from start to finish in 3 weeks.
Neither procedure could be considered an emergency or to be life threatening. In my very unprofessional view I know where I would rather live for my health care. Does the NHS need surgery?
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