Matthew Maxwell Scott is Conservative PPC for Carshalton & Wallington. He is a former chairman of the Conservative Group on Wandsworth Council and a professional speechwriter.
Words change meaning. It is one of the weapons the young have in irritating the old. They may not own property or have final-salary pensions, but they know ‘sick’ means good, ‘book’ can be used in place of ‘cool’ – thank predictive text for that one – and an ugly person might be described as ‘butters’.
ConHome readers are probably mostly old in mind if not yet in body, and would be advised just to accept these semantic shifts or pen a strongly worded harrumph to the Daily Telegraph letters page. But there are moments when something more is needed.
Once upon a time, ‘privatisation’ meant the transfer of public assets into private hands. In the UK, it was a practice which helped define an age. Although the first sale was that of Lunn Poly, the travel agents, as far back as 1971, privatisations peaked in the 1980s and 1990s. You may recall the iconic “If you see Sid, tell him” advertising campaign for British Gas shares.
But after more than 40 years of generally understanding privatisation to be one thing, a much broader definition is now in use. According to no less an authority than the House of Commons Library, the P-word means something quite different.
In a paper published in November, the library suggested that ‘privatisation’ includes all outsourcing to the private or voluntary sectors. The NAO estimates this to be around half of all Government spending on goods and services.
So even when ownership of an asset remain firmly in public hands, it can be said to have been ‘privatised.’ If your bins are emptied by Biffa. If you are doing time in a Serco prison. If you are receiving palliative care from MacMillan Nurses.
There is an element of pedantry to this. But there is something more important too. ‘Privatisation’ is now being used as a lazy pejorative to describe any injection of much-needed competition into our public services. For those who believe the ideal model of service delivery is one which would have suited 1960s East Germany, diversity of supply is as welcome as a subscription to the Spectator. But by badging attempts to achieve reform as sell-offs, the impact on public consciousness is understandably negative.
It is in our health service where the battle rages most fiercely. The idea that large parts of the NHS are being transferred into private hands is now common currency. Take the infamous tweet from Guardian food writer Jack Monroe in which she criticised David Cameron for using “misty-eyed rhetoric” about his late son Ivan. The Prime Minister was using his loss not, as any decent person would surely acknowledge, to demonstrate his belief in a health service which has been so important to his family. Good Lord no. It was “to legitimise selling our NHS to his friends.”
Like other parliamentary candidates, I received many emails ahead of a recent Commons vote on Labour’s National Health Service (Amended Duties and Powers) Bill. This draft legislation, I was told, seeks to prevent the “privatisation” of the NHS. As I politely suggested in my replies, no serious political party is planning actually to privatise the NHS. All of them are committed to providing care free at the point of use.
It is not surprising my suggestion was met with suspicion when even some fellow Conservatives have taken to using the P-word as profanity. Apparently, Andy Burnham ‘privatised’ the failing Hinchingbrooke Hospital when he was Labour’s Health Secretary. In fact, it was merely outsourced, and I have yet to see anyone claim Circle’s regrettable withdrawal from its management contract necessitates ‘renationalisation’.
If privatisation is taken to be a bad thing, and if its new definition becomes so wide – and so widely accepted – then the future for public-service reform could be bleak. Private and voluntary sector providers will be put off bidding. Perfectly rationally, they will choose to take their reputations, their capital, their expertise and their potential to transform services elsewhere. This will mean we fail to build on the good track record of competition and outsourcing.
DeAnne Julius’s independent review of the public services industry for the last Labour Government showed “cost savings from competitive tendering to be between 10 per cent and 30 per cent (including when the in-house team won the bid) with no adverse effect, and sometimes an improvement, in service quality.”
Anyone who really cares about outcomes ought to believe that public services should be delivered by whichever organisation can do it best. Providers from the public, private and voluntary sectors should be competing on a level playing field (a place which, alas, you are still about as likely to stumble upon as Narnia) to deliver more for less.
The much-maligned profit motive brings with it innovation, risk analysis and a focus on results over processes. It sharpens minds and helps ensure resources are allocated more efficiently. But be warned: suggesting profit should play any part in public services will send many on the left into a boiling rage.
Yet other countries with a much-more left-wing tradition than the UK are far more pragmatic. France and Italy both have mixed provision in healthcare. They also have two of the best healthcare systems in the world. In Denmark, most emergency services are outsourced and have been for almost a century.
Clearly, we don’t want a healthcare model like America’s. It contains egregious inequalities, swallows up a far greater proportion of GDP than our system and delivers only slightly better health outcomes. But to rule out using American providers from delivering NHS services is a pyrrhic triumph of ideology over common sense.
The irony is that the vast majority of us access health services through the private sector. Around 95 per cent of the UK’s family doctors are contractors to the NHS, and there are no better-trusted professionals in the country.
So perhaps there is hope. Perhaps we can reclaim the P-word. Correct those who rely on the House of Commons Library’s dubious definitions. Ignore scaremongers who say diversity of supply is an existential threat to our public services. And if they claim the NHS is being sold off, ask whether they have told Sid.