The law of unintended consequences
Never attribute to malice what can be explained by mere incompetence.
For the health service is on the cusp of being subjected to European competition law and, should that happen, hospital bail-outs might cease to be legal. The liberalised health service would then resemble Pandora’s box - something which, once opened up, could not again be closed.
Member states have enjoyed autonomy over health, and the European court continues to accept that countries have a right to organise healthcare on non-market lines. However, the court has recently been stressing that if countries decide to run their healthcare as a market then they must play by market rules. And, as new research from the Centre for Health Economics concludes, a host of government reforms in the English NHS - from business-style bankruptcy rules to official classification of hospitals as commercial bodies - effectively invite the court to deem the service a market.
The implications could be profound. Ken Anderson, who recently left the top commercial liaison job in the Department of Health, has said the NHS could soon lose its right to decide which services to deliver itself. If that is correct, neither politicians nor NHS managers could punt work towards public hospitals that need it to remain viable. For if a private company wanted to make a bid for that work, it would have a legal right to be properly considered. Attempts to foster “third-sector” provision, for example nursing co-operatives, would also falter, for such providers could not lawfully be privileged against commercial players.
There are hard-headed economic reasons for not treating healthcare as just another market. Gordon Brown has argued that untrammelled choice can work against rather than for efficiency, given the risk of providers cherry-picking the easier cases, the need for cross-fertilisation between specialisms and the impracticality of patients making decisions about where to receive emergency treatment. Whether his case is accepted or not, it is surely better that it falls to elected politicians - rather than to judges or bureaucrats - to determine where the balance of public and private provision lies.
The main complaint against the current set of changes is that they are not fully thought through & what better illustration of the danger they pose can there be than this, scaremongering though it may seem?
Most of the dangers being warned about are already imminent, the relationship between cause & effect not being strictly proportional.
Speaking of the Commercial Directorate, having a department full of people with minimal experience or knowledge of the health service & very little strategic awareness or consideration towards the wider situation interpret & implement ministerial wishes is not a very good way to reform the NHS, rather an easy way to damage it. It is about choosing process over product & quite a lot of the blame for the current brouhaha about the market based reforms can be laid at the door of expedient decisions.
I wonder what Chris Ham or other advocates of market based reforms have to say about this?