Image: Flickr/Roger Wollstadt
The Labour Party is, we are told this month, considering a long-journeyed return: back to the nationalisation of rail services. Some claim this will offer better long-term value, efficiency and safety.
Many would welcome this, but there is a puzzling anomaly. Why do we not instead start with renationalising the NHS? Surely the contentious market principles of competitive commissioning are even less suited to human healthcare than to human transport. This is an important distinction, and our failure to recognise the difference between the mechanical and the human has led to a new tranche of serious NHS problems.
For twenty-five years we have had successive governments push through legislation to extend the operation of the NHS as a ‘market’. Yet almost all senior practitioners with long prior experience agree about the human and economic cost that follows our depersonalised fragmentation of the NHS. The Royal Colleges have consistently taken this view.
Yet governments have persisted in engineering an NHS ‘market’, through such commercialising devices as competitive commissioning and autarkic NHS Trusts. Cumulatively these measures have been highly destructive to the quality of continuity of care, the morale and the trust of staff. From my own long-serving GP practice I have hundreds of documented cases to illustrate these organisational follies.
Personal knowledge and continuity of care may matter little in the carriage of passengers. It matters a great deal in the care of the complex human interweavings of the ailing body, mind and spirit. The NHS Market is like Communism: a failed ideological experiment. Such ideologies may start with some aspirational ideas of merit. But they are only partial and conditional truths. Our failure to heed the difference between guidance and dominance has led to our failed massive social experiments.
Yes, a reconstituted national British Rail could possibly offer us greater economy, choice and comfort. What an intelligently refederalised NHS would offer us would be much more. Here is another anomaly: why do we still hear no substantial challenge to the existence of the NHS 'market' from our usually glad-to-be-contentious opposition politicians?