In the aftermath of Thursday’s elections, it’s no surprise that there is plenty of speculation on how the results may affect the re-thinking going on over Andrew Lansley’s NHS plans. But there’s another significant public services dispute bubbling along, mostly unnoticed.
It’s over the forthcoming Public Services White Paper, an early draft of which caused consternation in Liberal Democrat ranks (with one senior Liberal Democrat calling it shocking) due to its enthusiastic backing for introducing widespread private provision of public services. In the latest draft, as the BBC reported during the week, the emphasis is much more on bringing in mutuals, not for profits and charities to provide services rather than private firms.
Liberal Democrat influence has been heavily responsible for those changes – so much so that Ben Brogan in the Telegraph has said of these changes that, “Nick Clegg is winning the big battle” and that “it is being systematically filleted by Danny Alexander, the Chief Secretary to the Treasury, who is proving adept at using his internal leverage to shift Coalition policy in favour of the Lib Dems”.
Some of the debate over ‘privatisation’ gets very silly very quickly – just think of some of those who regularly shout ‘no to privatisation’ in response to all sorts of health policies from all sorts of parties but never once object to GPs being private workers; ‘nationalise all GPs now!’ is not a banner often seen at anti-privatisation protests.
But those fringes should not obscure the proper debate there is to be had over who should supply what services. It’s unexceptional that the pencils and notepads used by the police are sourced from private suppliers. Provision of cars and radios is much more sensitive, whilst when it comes to police officers themselves the sort of private employee arrangements used by GPs would cause outrage if introduced.
As I wrote of this issue last December:
The party has often had a rather unusual relationship to the question of who should provide public services. The party’s general support of diversity, love of cooperatives or mutuals, belief in local provision and local accountability and suspicions of state power could naturally lead to many forms of local provision of services through means other than staff on a public sector payroll. And yet, it never really quite has on a significant scale …
But the party is likely to be put on the spot again and again over the : who does the party think should provide services? Is it all about provision by local public bodies answerable to the council, or is it about more than just public bodies and more than just councils?
With the White Paper, here comes the spot.
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6 Comments
Doctors don’t need nationalising – they already have a stranglehold on taxpayers thanks to the monopolistic privileges that government gifts to the BMA.
Dispute? What dispute? The Lansley proposals are CUPs (Complete Utter Pants) worked out on the back of an envelope.
@mark
Some rather irrelevant red herrings about note pads and stationary there . Privitisation (of core services) even to charities is a throwing away of the ability to be able to manage and be accoutable day to day for vital public services . Running essential public services is a day to day thing it can not be written into a 5 year contract however long and complicated and however much it makes the lawyers millionaires.
John: I’d have thought GPs are, on your definitions, a “core service” and an “essential public service” – so do you think they should all be nationalised (i.e. their private / self-employed status ended and them brought onto the public sector payroll as direct employees of the NHS)?
Mr. Pack,
The objections to the privatisation of the NHS are complex and varied. To claim that those arguments are rendered ‘silly’ by the employment status of GPs is, dare I say it, silly. The White paper put forward by Andrew Lansley will, if implemented lead to the privatisation of health care. I mean privatisation in the widely understood sense that the full range of health care will be distributed on the basis of ability to pay and universal provision free at the point of delivery will end. This is a necessary consequence of marketising the provision of health care through private companies that are subject to competition legislation and will be allowed to fail regardless of the health needs they exist to service, whilst at the same time as lifting the cap on the amount of private work that hospitals take.
The purpose of the reorganisation is to bring an end to universal provision of health care. This is made obvious by the regularly made assertion that the escalating costs of health care and an ageing population necessitate the changes. What could these assertions mean when coupled with reforms that experience and observation of all similar systems show to be more expensive, other than that there will be a reduction in the scope of provision?
Rather than diving straight to the bottom of the barrel with the ridiculous argument that ‘GPs are self employed so why shouldn’t the local hospital be private?’ why not debate the merits of the White paper? This white paper proposes that individuals fund their own social care. It also, through lifting the cap on the private work that hospitals can do whilst removing the funding levelling that PCT’s used to do and introducing competition law into the mix, incentivises providers to undertake private work ahead of NHS work. This incentive structure is the same as we see in the provision of dental care where some NHS dentists only do NHS work in the antisocial appointment slots that they can’t fill with private clients. It is also the same incentive structure that the Americans enjoy. Would you be happy with an NHS hospital that only deals with private patients for parts of the day, week or year?
If you think I am wrong about this please let me know why. If you think I am right on this then please let me know why you think it is the right way to provide health care. Anything other than the usual sophistry would be welcome.
The really important tests about the provision of public services are:
Is the service being provided efficiently and at reasonable cost?
Is the provider working to the service’s goals and not skewing things too much to the provider’s goals?
Is the provider working within the legal framework in respect of how they treat their employees and consumers.
All sorts of providers – in-house, private contractors, mutuals, charities – (both large and small) can meet those goals, but they all have different pressures pushing away from achieving them. Keeping in-house staff on course is matter of management, but using outside contractors is a question of getting the contract right, monitoring performance, and having a Plan B for when you have to get tough with the contractor or terminate the contract.
Very large company private contractors, especially those run from outside the UK and the EU carry the risk that they may be much more powerful than the public body that is their customer.
One thing that experience of recent years should teach is to avoid, is applying centralised “reforms” in a blanket fashion to places that don’t need them. Fine to reform the service in X-town, which is in a mess, but it’s just wasteful and disruptive to apply them to Y-town, which was getting along fine.