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Guest editorial Monday 4 July 2011: Not bothered by the advent of Market Stalinism

Irwin Brown of the Socialist Health Association welcomes the advent of Market Stalinism to the NHS.

I was worried and even more confused when I read the latest amendments to the revised, revised Bill.

No longer – I have seen the light.  


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At least there is no longer any doubt that the Bill is based on introducing competition and making our NHS into a regulated market - as with gas, electricity and water.  It’s in the Government Response to the Future Forum, paragraph 5.27.

The Bill assumes that we will get to this Nirvana soon. In maybe two-and-a-bit years' time, will see a system ready to act like a market.

There will be a comprehensive set of prices (broader and more granular than anything ever seen before, anywhere); there will be all the necessary rules and regulations to enable the market to function; and for most services there will be a number of willing providers able to meet the set price.

A farewell to the NHS pension?
The Bill assumes hundreds of thousands of NHS staff will cease to be NHS staff and adopt a new role in new forms of providers, no longer within a national system of terms and conditions. It also assumes that many more patients will have real choices as they will have personal budgets.

It assumes over 500 new forms of organisation will come into being and get up to a level of competence not seen so far in similar bodies.  Amongst them will be several hundred commissioning groups (of some sort) acting on our collective behalf, able to plan and secure the delivery of all the services we need.

This is all without any noticeable transition plan – and with many of the experienced planners being made redundant.

The easy bit
But that is the easy bit.

What it actually assumes is that we want the sort of choice that this market will offer; we want to shop for healthcare; we want to be consumers as well as patients.  

Well we don’t.  And it will be at least one generation before we do – those who use the NHS most are the least likely to want choice of provider.

So I worried about what would happen over the 15 years this would actually take to happen, given the NHS is facing major problems now – and this market stuff won’t help anytime soon.

Let us now praise Stalinism
Then I realised that in the interim we have Stalinism, and I was relieved.

You can already see the huge centralisation that is taking place. We will have a Board for NHS England which is appointed by the Secretary of State - but not accountable in any obvious way.

It will have regional and local outposts as management layers, but without any of the nasty Boards with nasty independent minded (well, sometimes) non-executives like the old SHAs and PCTs.

It will be the biggest quango in the world, and the least accountable, and the least devolved – and all power will come through the top.

There may be some fledgling Regulator, and the mad dog may be allowed a feeble occasional whimper; but competition has been branded as nasty. Local councillors will soon find (as they have found in the past) that nothing they do or say makes much difference to the NHS, and drift into other areas.

The Board with the Commissar for England at its head will commission most of the services either directly or indirectly, through regulations it imposes on the commissioning groups which it will performance-manage. It will control the advice that is given to the commissioners, which they have to follow. It will control the providers by controlling the commissioning.

And best of all, it will control the timetable over which changes are supposed to happen.

We will have Market Stalinism, with the emphasis now on the last bit.

So I’m not bothered. Bring it on.

Irwin Brown, Socialist Health Association