Competition will make us sick

An entire generation of public service managers who learned their craft under Thatcher, Major and Blair have had it drummed into them that competition in the delivery of public services is good. It's been part of teaching public servants to despise our deviant desire to devote working lives to doing good rather than to the more honourable pursuit of shareholder value.

For many of these managers - and of course for those politicians for whom managerialism is a faith - the very word "competition" has now almost achieved the status of "flexible" or "modern" as a self-evident good requiring neither explanation or justification.

That's why the Tory Coalition have been able to get the knife of the Health and Social Care Bill so close to the throat of the National Health Service - and why it is so important that the chairman of the British Medical Association's Consultants' Committee has spoken out (http://www.guardian.co.uk/society/2011/mar/06/nhs-reforms-health-bill-compete). He exposes why market competition won't improve health care.

That it takes a medical doctor to try to educate politicians about economics says a lot about the laziness of the advocates of capitalism in the twenty years since they declared the end of history (and the weakness and marginalisation of those of us who think otherwise).

To the extent that there is an economic argument for competition it is that "economically rational" and informed consumers able to make decisions about the purchase of commodities will, by seeking the best value for their money, continually drive producers to improve quality and/or cut costs.

Health care is not a commodity in respect of which many of us can be informed consumers. Judging in advance the likely quality of a hernia operation or a course of chemotherapy isn't like weighing up how ripe the bananas are in Brixton market!

So whilst it is a good thing that the Government is backing off on the suggestion that competition on price will be part of the post-NHS system (http://www.unison.org.uk/asppresspack/pressrelease_view.asp?id=2201) the problem remains competition on any grounds. It won't improve the quality of the service because the conditions which can enable "the invisible hand" of the market to do that cannot exist in relation to health care.

The real purpose of the Health and Social Care Bill has, of course, nothing to do with improving either health or social care, but with opening up ever more areas of service provision to the opportunity for the making of private profit.

Follow UNISON's campaign online at http://www.unison.org.uk/ournhs/takingAction.asp. Another excellent campaigning resource is at http://www.healthemergency.org.uk/.

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