The NHS is being pushed further and further down the competition route. The theory is, quite possibly, convincing. Organisations work better when they are competing with each other because competition improves efficiency and makes things cheaper. Which is actually the point. This sort of free-market capitalism seems to me to be dreamt up by a certain type of man. And a few women. But mostly men, I reckon. People who live in a world where everyone wants to win; being cheaper and more efficient is the most important thing; and actual people are sidelined in favour of theoretical economics.
Theoretical economics doesn’t take account for the presence of humans, who are not always fair, who do not all like a level playing field; we might even so far as to say people will often cheat and lie and put themselves, rather than than the greater good, first. Where having winners makes other people losers. And so the weakest suffer, the strongest prosper, and I suddenly feel like I’m writing a Psalm from 1,500 years ago. Has nothing changed?
Having said that, I am a fan of people. And I am a fan of remembering that there is no such thing as an ‘economy’, just humans in communities who make transactions. In the NHS, as with other state services, I am a fan of putting people first. Sometimes that makes things more efficient; sometimes less efficient. Ok, often less efficient. Like taking away train carriages to reduce costs may make things more efficient, but doesn’t help the people crammed in the remaining ones like sardines. Taking away doctors from doctoring so that they can manage bidding competitions means that they are not doctoring, or are managing and doctoring, which is surely less efficient as doctors need to be awake when treating patients. And have trained for x years (at our expense) to be doctors, not managers.
I don’t want hospitals to be in competition with each other any more than I want train stations to be. When my son had an accident I didn’t check the league tables to see which hospital was the best; I went to my nearest (St Helier). I want my nearest hospital to be as good as it can be, because the staff are motivated and the hospital is resourced. I don’t want to be treated by the company that put in the cheapest bid and employs the cheapest staff. Of course there is nothing wrong with competition in itself – it can be motivating and inspiring and encourage good behaviours. But in the NHS context I cannot see how it will improve things, with private companies circling to cherry-pick the easiest patients and the NHS left to do the long-term difficult care.
If humans could be trusted, the free-market could work. But humans need boundaries, because unless we are all filled with the love of God and allow that to direct and influence our every move we have a tendency to be selfish, to look out for ourselves, to turn a blind eye to those beneath us in the pile. Or not to notice there is a pile at all. Just look at the banking crisis, where people are rewarded for failing simply because they are allowed to, and let the poor suffer the consequences. Free market is great when you are the one that writes the rules.
There is an alternative to competition, there is an alternative to turning every public service into a free-market. Because although we are all equal, it is always the rich who are more equal than others.
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