Why selling healthcare isn't like selling underwear

The last thing the NHS needs is another supermarket-man selling 'market' solutions.

Kailash Chand
29 July 2015

Former Marks & Spencer Sir Stuart Rose, hired by Cameron to advise the NHS, has reported back.

The health service could learn from the management practices of the big high-street chains, he told us.

NHS boss Simon Stevens responded grouchily that “the complexity of managing the NHS was greater than that of selling underwear”. 

More ‘market’ ideology, more ‘free market’, is the last thing the NHS needs.

Healthcare cannot be marketed and run like M&S.

Nobody disagrees that the NHS has got to be cost-effective. But purchasing care services from private providers with shareholders demanding profits can only lead to increased costs or reduced quality of care – or both.

If there is one lesson we can take from the last ten years it is that the NHS does not need another dose of advice from commercial companies, especially when it tells us our health service needs to be run like a “supermarket”. 

Healthcare is not like buying underwear.

You don’t know when or whether you'll need healthcare – but if you do, the care can be prohibitively costly. Only a small minority of people can afford to pay major medical costs out of their own pocket.

And healthcare is that it is complicated, and you cannot rely on experience or comparison shopping. That is why doctors follow an ethical code, and why we expect more from them than from bakers or M&S.

But private companies like Virgin and Care UK aren’t in business to promote your health – they are there to make a profit. There’s far more money in safe, elective procedures, like hip, knee, heart or cataract surgery than in unpredictable emergency treatment or labour intensive care for the chronically ill (unless you cut corners on the numbers and skill of your staff, of course).

So healthcare cannot be sold like a commodity in supermarket. It must be largely paid for by some kind of central taxation like the NHS, or an insurance scheme like in the US. In either situation, someone other than the patient ends up making decisions about what is affordable. Choice and competition is nonsense when it comes to healthcare.

For the last two decades, the leaders of all major political parties have been wedded to the idea that healthcare should be run as a ‘market’. Do they really believe that chosen private healthcare firms will treat all patients fairly, and not just select those based on the criteria of how much profit will be made? The ‘commissioning’ system makes it easy for private providers to cherry-pick tasks to maximise profit and minimise costs. From the perspective of patients and taxpayers this bias is highly undesirable – a recipe for overcharging, over-treatment and corner-cutting on safety.

There are no evidence-based examples of successful healthcare systems relying on the principles of the free market.

People like Sir Stuart Rose who say that the market is the answer to achieving better outcomes for health are flying in the face of both theory and overwhelming evidence.

The NHS faces huge challenges. A continuous evolution is needed, with greater responsiveness and accountability.

But a high-quality and efficient NHS will never be achieved using the market forces of creative destruction.

It is time to reject the market ideology that has plagued the NHS for more than 30 years and wasted billions of pounds, and move forward with a depoliticised NHS, a publicly funded, provided, comprehensive and accountable healthcare system based on co-operation, collaboration and the social contract between doctors and patients.

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