There has been a detailed review, pros and cons have been analysed, and Nick Clegg has concluded being seen to reform the NHS is bad for his poll ratings.
The party now consistently believes that regulated competition is a good thing in almost all fields of human activity, but not the provision of health services which are ‘special’. The Parliamentary Party would like the proposed new regulator Monitor to support ‘collaboration’ not ‘competition’ for the benefit of patients.
This looks like cowardly sophistry.
Outside the UK, Finland and Cuba competition for the provision of health services is perfectly normal. International League tables on health outcomes, where the UK often languishes in mid-table mediocrity would suggest this has not harmed patients. Quite the reverse.
There is a good article today in the Guardian of all places on why competition benefits patients:
“The media debate has ignored the most obvious evidence: the fact that almost everywhere where they have been tried, market approaches work better than centrally planned government ways of running the same activity. Not all markets work well, but even the bad ones seem to do better than central planning.”
Meanwhile what a duty to protect ‘collaboration’ might mean, and why this needs to be different to competition, is unclear.
Good collaboration happens in competitive markets all the time. Entities come to together to offer packaged services. They network, they work with clients to tailor services to their needs. You do not need to work for the same company as your clients to deliver excellence for their customers or patients. The profit motive means the constant pursuit for the quality and value your clients demand not a race to the bottom.
Bad collaboration, or cartel behaviour also happens in competitive markets, but is illegal. Stopping professional interests within the NHS colluding to cheat the taxpayer and patients by offering poor quality services at high cost is the point of giving the proposed regulator Monitor powers to enforce competition policy.
It is not yet clear whether Liberal Democrat obfuscation on this matter will yield changes in the Health and Social Bill. Parliamentary arithmetic on any Liberal Democrat revolt is tight.
It is further not clear that if implemented the outcome would quite what the left-activists lobbying against affordable healthcare will have hoped. A shrewd regulator could interpret ‘collaboration’ and the ‘for the benefit of patients’ as a licence to demand NHS purchasers collaborate with better value private and third sector providers rather than costly in-house alternatives.
This could actually be a contest of political language, not substance.
In that respect Nick Clegg could be playing quite a devious long game. But we will have to wait for the detail; and I’m entirely sure the anti-reformists will be lobbying for all sorts of caveats in the Bill precisely to stop that happening.
And, as we warned last week, what this looks like on the surface is opportunism rather than political courage. It is inconsistent with Nick Clegg’s recently stated desire to be a radical centre-ground party of Enterprise and Fairness. Enterprise requires competition.
It is preparation for permenant Opposition, not the act of a party in Government. That in the long-term will harm the Liberal Democrats, entrenching the sense of two parties within a shell of convenience, not bringing us together around a consistent narrative.