Patients suffer. Standards fall. So why is competition still such a dirty word in the NHS?
Published in the Daily Mail (May 26th, 2011)
Living in a high-tech age of instant communication, it is easy to forget how painful the process of obtaining a phone used to be.
It was not unusual to have to wait several months for the privilege of having a landline installed in your house by the state-owned provider. This was why the privatisation of British Telecom in 1984 came to epitomise the Thatcher era.
Scores of inefficient public services were forced to confront commercial and consumer reality, like fledgling birds pushed out of the safety of the state nest.
Imagine if you went into a shop today and asked for an iPhone, only to be told to come back in September. You would laugh out loud, before taking your business elsewhere.
We have learned that selling phones is no different from selling baked beans or cars.
Firms that want our business must respond to our needs. They must innovate, improve their products and battle it out on price. The result is a dynamic market and better services.
We have seen this again and again, even in public services. A study by Gordon Brown’s government concluded that private firms in the public sector created savings of up to 30 per cent ‘with no adverse effect on, and sometimes an improvement in, service quality’.
So what’s so different when it comes to health? This country is frozen in fear at the idea of competition within our sacred NHS.
The easiest way for a politician under pressure to win cheap applause is to condemn ‘privatisation’ in the NHS.
This is the key reason why the Government is in such a pickle over its health reforms, poisoned by a toxic combination of political opportunism and sanctimonious hypocrisy.
You can point the finger at self-serving doctors and short-sighted politicians. Ultimately, however, we all suffer the consequences.
The promotion of these reforms has been botched from the start. One senior minister told me this week he still failed to understand them.
Essentially, they have two core strands: to hand consortiums of GPs the power to commission services in place of primary care trusts, giving them more power to shop around for care for their patients; and to use the health watchdog monitor to increase competition.
Despite the national devotion for the dear old NHS, there’s a crushing need for these reforms.
For a start, the cost of healthcare is soaring far faster than inflation, with a £20billion funding gap looming by the end of this Government’s term. This funding crisis will grow worse as Britain’s population grows bigger and older.
As former NHS chief executive Nigel Crisp has pointed out, we have a system designed for the last century, when it battled infectious diseases, infant deaths and industrial injuries.
So the NHS is built around huge hospitals, with expensive technology and platoons of medical professionals led by all-powerful consultants.
But needs are changing. Our society is growing older and richer, leading to more long-term conditions such as cancer, dementia and diabetes.
This means more people coping with multiple conditions and living with disabilities, which require personalised services based as much in the home and community as in the hospital.
On top of this, the brutal truth is that the NHS fails too many of those most in need: the elderly and vulnerable, whose numbers are set to grow.
There have been a succession of scandals involving the mistreatment of such patients, most notably in Staffordshire, where hundreds died in hospitals in the most squalid and obscene circumstances.
The Patients Association has heroically drawn attention to scores more cases of neglect across the country. And yesterday a shocking report from the Care Quality Commission revealed the extent of the neglect of elderly patients in NHS hospitals.
The watchdog found three of 12 NHS trusts visited in the past three months were failing to meet the most basic standards laid down by law, so lax is the care they offer.
As the parent of a child with profound and multiple disabilities, I have seen the NHS at its best — but also, sadly, all too often at its worst.
I used to share the national reverence for the NHS, but this has been wrecked by reality. Over the years I have seen too much bungling bureaucracy, gross inefficiency, poor treatment and witnessed terrible — even life-threatening — incidents.
The NHS is simply outdated. It has to become more efficient, more effective and more responsive to the changing needs of its users. And the best way to drive this, as with any other industry, is through the unleashing of competition.
Perversely, this is considered a controversial statement, as too many of our pusillanimous politicians are aware.
Just listen to the Labour Party, publicly condemning ‘privatisation’ despite allowing more private sector incursion in the NHS than Mrs Thatcher.
Or listen to Nick Clegg, who in opposition called for the health service to be broken apart because it was unresponsive to users, but now, in a political panic, declares ‘there will be no privatisation of the NHS’.
Go abroad, however, and it is a different story.
For Britain is unusual among the wealthier nations in having so little private sector involvement in its health service — which may explain why you often receive better service in nicer surroundings if taken ill abroad.
In Sweden, that socialist nirvana, market-led reforms transformed the health service.
In Germany, beloved by so many on the Left, there are more privately run hospitals than publicly run ones.
In Spain, profit-making firms run more than a fifth of health-care services in certain regions.
Even in the once Communist state of Slovakia, nearly half of the hospital provision comes from the private sector.
What makes our myopia all the more mystifying is that study after study has shown choice and properly regulated competition benefits patients.
A Bristol University investigation showed that quality is higher in more competitive markets, while another study published by the London School of Economics found hospitals in areas with more choice had lower death rates.
Politicians are not the only people playing to the gallery over the health service.
The British Medical Association, so vociferous in complaining about ‘privatisation’, has ramped up public fears. Scarcely a mention, of course, of the fact that nearly all GPs are private contractors on six-figure salaries. Nor that productivity has fallen despite the doubling of NHS budgets in recent years.
And if there is one reform that this Government, like its predecessors, has ducked, it is perhaps the most needed one of all if we are to protect the NHS: tackling the closed shop of consultants in hospitals.
These are the people who must see you when you’re referred for outpatient treatment — and, in many cases, the ones who make so much money in private practice.
By restricting who can join their elite club, they have ensured we have one of the lowest proportion of consultants per head of population of any developed country. ‘This creates a small, unnecessary bottleneck, driving up waiting lists,’ said David Joselin, a former GP and author.
Mind you — and this is the ultimate heresy — if we really want to modernise our sacred NHS we should be closing hospitals and diverting the money towards low-level chronic facilities in communities and home-care professionals, such as palliative nurses and physiotherapists.
The Public Management Foundation says six hospitals in London alone could be closed to fund more vital services.
Instead, even a courageous politician such as Iain Duncan Smith — who is bold enough to take on welfare reform — is fighting to protect his local maternity unit in Ilford, Essex, when it is threatened with closure.
It is, of course, so much easier to appease public sentimentality than to confront a looming crisis.
When politicians are scared of real reform, the public worships an antiquated system and doctors are so protective of their cartels, what hope is there for a modernised and affordable health service?