Charlotte Leslie is a member of the Health Select Committee and MP for Bristol North West.
For the sports junkie pining for 2012, help has been at hand. The Commonwealth Games blasted onto our screens in an extravaganza as bursting with flavour as the juiciest clootie dumpling. Two years ago, I wrote for Conservative Home about what competition, seen in its purest form in the London Olympics, can teach us about responsibility, individually and as a nation.
Now, as the opposition bray that evil Tories are privatising the NHS, Labour say they’d renationalise rail, and councils propose a ‘supermarket tax’, what does sporting competition say about how we interpret that concept into our public and private sectors?
I happen to have a faith and go to church. But that’s where I keep ‘faith’ – a consciously chosen answer to the question none of us, not the staunchest of atheists or the cleverest of scientists, can ever possibly know: what’s the meaning of ‘all this’, and what happens when we die?
In the absence of any possibility of correctly justified, accurate knowledge, that’s where faith belongs. Not with politics – where issues are usually empirical and nuanced. But this belligerent ‘tribal faith’ (which replicates the very worst manifestation of religious faith) is surprisingly common in politics. Soon after I was selected as a Parliamentary candidate in Bristol North West, controversy erupted over the privatisation of the local council’s Home Care service.
It was taken for granted that, being Conservative, I would support privatisation. However, from all that I had seen from my own experience of caring, and all that I saw of the dynamics of too many private providers, I concluded that the council would provide better home care. So I found myself sharing a platform with Jack Dromey, for my first big political outing.
Why does the political Right can so easily confuse ‘privatisation’ with the actual dynamics
of competition? This mistake is best illustrated in the move to outsource hospital cleaning
to external companies. A medic (who, incidentally, votes Conservative) explained the situation
in his hospital:
Before privatisation of cleaning, he said, ward sisters and a small group of cleaners, dedicated to the ward, were responsible for the cleanliness of their ward. If it was unclean, they, personally, were responsible; both structurally within the organisation, and personally. There was significant peer pressure and competition to have the cleanest ward in the hospital. Responsibility , risk, autonomy to act, incentive to act; regardless of the fact these individuals happened to be employed by the state, the genuine dynamics of real competition were at work.
As ‘privatisation’ delivered better services after breaking down the stagnant state monopolies of the 1970s, it began to be rolled out rather indiscriminately. When private cleaning companies took over, the medic said, that dynamic of competition that existed amongst NHS staff was destroyed.
Some suits in senior management ‘picked a winner’ from cleaning companies blagging the best deal on paper. If the blag won the contract, that cleaning company cleaned all the wards. There was no daily competition, no risk, no integral sense of personal responsibility, and no equivalent inbuilt incentive for the company to strive to keep each ward as clean as possible each day. Floors underneath beds were not cleaned to save time; MRSA began to hit the headlines.
That is one hospital example. It is not to say ‘state is always best’, any more than ‘private is always best’. It is simply to illustrate how the genuine dynamics of competition can be flushed away by the lazy assumption that ‘privatisation’ is the same thing.
The problems over Rail Franchising illustrate the same problem. Unless we build multiple rail lines
on which providers can literally compete, like a racetrack, it is hard to see how genuine
competition can exist. A state provider doesn’t solve the problem; it is simply choosing a
But unless we are honest about what we actually mean by ‘competition’ vs. civil servants picking winners, and negotiating contracts with highly paid private sector lawyers who run rings around the public sector contracts (the writers of which often have no private sector experience) we won’t solve the problem.
Labour screech about a so-called ‘privatisation of the NHS’, but it is one which they energetically began. Few would disagree that excellent, efficient, alternative providers should be able to offer NHS Care. But Labour illustrated the imbalance between private and our public sector lawyers impeccably with their Private Company ISTCs – Independent Sector Treatment Sectors, in 2001. These cherry picked easy patients away from NHS Hospitals, got paid more per case, did not fulfill their contracts for how many they treated, didn’t train junior doctors, and deposited their surgical complications back on the poor old NHS.
And Labour’s disastrous PFI, for which we are going to pay big companies many unnecessary millions for years to come, is almost too painful to think about. The lesson for our Government is clear: variety of providers can be good, but watch it – or we will be serving the big private companies, not them us.
It is not much simpler in the private sector. Derby Council has called on a Supermarket Tax for the Big Six, to help even the playing field. In Commonwealth Games terms, supermarket chains would have created a down-hill lane for themselves and their accumulated haul of medals (their self-perpetuating market success.) Conservatives who believe in genuine competition must decide what, if any, role the state should play in keeping that playing field even.
These are difficult questions; often pragmatic issues of fine balance. But if competition really is to create a ‘Common Wealth’, as we see in the best of sport, it needs to be tackled objectively, not bound down in pathetic tribalism and blind dogma, calling it competition when the only competition is for the contract and you get the Gold medal at the start, not the finish.