Having denied that the Health and Social Care Act 2012 created a risk of privatisation of the NHS; having denied that the contracting of private providers to replace public provision is privatisation; the latest argument of the privatisation supporters runs something like this:
“Over 4% of the NHS was delivered by private business when Labour left government in 2010. Only a bit more than 6% is being delivered now. The risk of privatisation was exaggerated.”
In response to the instigators and lazy propagators of this disingenuousness, a few points:
Make your minds up. Is that extra 50% privatisation, or not?
You do Andrew Lansley a great disservice. He was absolutely clear when addressing the NHS Confederation five years before taking up office that in his view previous Conservative privatisations had partly or wholly failed, and that he would have to build a new regulatory structure to create competition between multiple providers and to transfer private provision to multiple private providers. He even had the temerity to tell you this in plain English
I believe that the Conservative Party became confused itself about what the experience of privatisation told us. We interpreted the lessons of privatisation as, literally, that: the transfer of public sector activity into the private sector. With private sector ownership would come enterprise, innovation and, temptingly, private capital off the Treasury’s balance sheet.
Andrew Lansley – “The Future of Public Health and Regulation”, 2005
Not only did Lansley never doubt that
the transfer of public sector activity into the private sector
is privatisation – something, repeat, you persist in denying – but he wanted to give you a better privatisation, one not just with added ‘competition’; but competition of a new and magical sort where instead of failing, competing private providers would never fail, but would all drive quality up. He even made up a new saying to prove it, and referred to evidence (though didn’t provide any).
How can competition work, whether on prices or quality, if it does not lead to variation and divergent outcomes? Some will gain. But do others lose? No, the evidence is that in effective competition the response of other producers of good and services is to raise their game, so that even those who are less fortunate or successful purchasers will gain by this. As the saying goes, “competition is a tide which lifts every boat”.
The sheer volume of the Bill would only have shocked you if you hadn’t thought about it as deeply as Lansley: if you had been convinced that all you needed to do was what you had always done: get Goldman Sachs or whoever to create a share issue for the NHS and sell of the lot at one go.
Except, of course, Lansley actually cares for the NHS, perhaps almost almost as strongly as his vision of private competition. He is not like rest of you , who just think it another 60 year mistake, another bit of public property to grab and scarper offshore with, another pile of excuses to help people avoid work. He may not think, as so many of you do that old age is a mistake, and that people with no economic usefulness should be discarded, like old mobile phones.
No, Lansley actually believes in what he did.
That is why the Act was so intimidating even in its first published forms. It simply had to contain all the reorganisation to create his new regulator (Monitor) and all the foundations of the regulation to create in the real world his vision of competition.
More firmly than you, Lansley had a grasp of what he had to create to push the NHS not into a new state, but in a single and irreversible direction: towards his utopia of proliferating providers, omniscient customers, and private capital. In brief:
- To force the NHS to be moved piece by piece from public to private ownership and provision, but never to move in the other direction.
- To create, regulate and maintain in perpetuity his vision of competition.
- To fortify his machine against attack or disassembly.
Lansley, however, is not so much risk-averse as averse to the very thought of risks (whether to his plan, or caused by his plan), which he sees as mere distractions. Inevitably, he underestimated or ignored some possibilities which became reality: beginning with the risk that not everyone, not even his fellow Conservatives and fellow travellers, would be captured by the brilliance and perfection of his solution.
Political expedience would delay the bill, implementation would eat up two more years of the Coalition, and the practical problems of the privatisations would take up even more time.
- The Coalition government could never admit what he was actually doing.
- Senior members of the Coalition wouldn’t, or couldn’t understand his Bill, or even bring themselves to read it.
- The number of Liberal Democrats in Coalition who would jump at the chance to grandstand and to posture.
- The sheer length of time it would take to get the bill through Parliament, with Labour opposition and (3) and Cameron and Clegg’s panic and the delay of the “listening exercise”.
- The length of time it would take for the reorganisation to be completed after royal assent, even though begun in advance.
- Persistent opposition from NHS campaigners, who at least managed to delay individual tenders.
- The length of time, the resource requirements, and the effort necessary to complete a commercial tendering process from start to finish, particularly for high-value tenders.
- The cuts in funding for the NHS, which would make tenders less profitable.
- The poor performance of existing – or new – private providers, including the fiddling of performance data.
- The collapse in morale within General Practice, where funding cuts, unsubstantiated criticisms from the CQC, and constant attacks from government were completely contrary to Lansley’s vision of crusading commissioners.
- NHS staff would be busy trying to provide the services it actually provides, with Lansley’s rebuilding going on around them and the CQC waiting to punish.
- Lansley’s massive regulatory machine was built with square wheels, with no-one knowing who was in charge and fights for the steering wheel between Monitor, NHS England, the SoS and the CQC.
- As Clive Peedell of the National Health Action Party and many others pointed out, the private providers would only ever want the cherries off the top of the cake; the profitable bits.
- Monitor and the regulatory regime would never be strong enough to overcome the private bidders, who would want to protect themselves from competition by demanding ever-longer contracts which they designed.
- Commissioners, without support units in the first years, would not have the expertise or resources to commission at a high pace.
- By the time the reorganisation was complete and the commissioners ready, the next election would be approaching and the Coalition uncertain of victory; frightening the private providers.
Yet the Health and Social Care Act 2012 and the enabling legislation are on the books, Monitor exists, and the CCGs are commissioning by competitive tender: the NHS is privatising itself, as Lansley envisaged.
To argue that this was never privatisation, or that the amount of privatisation completed via the Health and Social Care Act 2012 is so low as to prove it was never about privatisation, is drivel. The Act was intended to privatise as much of the NHS as possible; to salami slice it into pieces which could never be reassembled.
Either you truly don’t understand what Lansley has achieved and you think he failed (Letwin promised you the NHS would be gone within one Conservative government; the NHS was to be shown “no mercy”, remember?) or you know full well what the Act does and that privatisation must follow and you’re being economical with the truth (or fooling yourself).
Whichever, do us all a favour, and stop insulting us with this nonsense.