Since Margaret Thatcher was leader, the modern Conservative party has had a contradiction running through its passions. It yearns for the radicalism of the impact of markets on most aspects of our society and it also yearns to conserve aspects of our society. Whilst this contradiction in opposition can create interesting political discussion, when in government this contradiction can rip their medium-term effectiveness apart.
On the one hand they passionately believe in the power of markets and the capacity of the informed consumer to help markets tear up the past and make the future. They see a whole range of public sector institutions that protect themselves from the rigour of the market through restrictive practices. Their policy is to unleash the markets on to those practices.
In the 1980s and 1990s markets rushed through whole aspects of our society that had been protected from them and life was radically changed for millions of people. Communities were uprooted and had to move to where there were jobs and occupational traditions of generations were destroyed.
The promise of markets is that all that is solid turns into air.
Whether you agree with these policies or not, the impact upon our society was truly radical.
The problem for modern Conservatism is that it is also concerned to Conserve. It feels that certain parts of our society have been changed too much and what is needed is much more continuity and the conserving of aspects of our way of life.
Frequently the economics of radical change and the necessity to conserve came in to conflict. Globalisation demands movement of money and people. Protecting traditional communities demands restrictions on the movement of people into this country. Markets demand the radical change in school curriculum to keep labour up to date with those markets. Conservatism demands a traditional curriculum that was taught to our parents and grandparents.
Under Margaret Thatcher, given the primacy of economics, the radical markets side of this struggle won and institutions that they wanted to conserve – such as the traditional family, the old fashioned school curriculum, the army, hundreds of traditional communities were turned inside out. This caused much puzzlement to the people in her party- including her- since they mourned the loss of some of the things they destroyed.
David Cameron’s conservatism is no different, and given the primacy of the markets in the economic model it is certain that markets will be encouraged to rip through what is left of tradition.
In the first two weeks of Conservative policy towards the NHS we are seeing that policy unfold. In their manifesto, the bulk of the Conservative policy on the NHS was a set of pledges to unleash much more market power into the NHS. More private providers would be encouraged, GPs would be given the budget to buy healthcare and there will be incentives to drive much better bargains than existing Primary Care Trusts. Patients and the public will be empowered by much more information and choice. With gathering pace these drivers will get the sclerotic NHS on the move changing it with greater and greater rapidity.
And as with other markets there will be winners and losers. Some parts of the NHS will succeed. They will attract business from GPs and the patients who chose to have their care there. Other parts will wither as patients move away from them.
So much is an unremarkable aspect of markets.
Within a week of getting into government we can see these aspects of their policy unfolding and the NHS bracing itself for a much bigger and faster set of market driven changes.
But on the other hand there are aspects of the health services within our communities that modern Conservatism wants to conserve. With its heart still in the 1950s it wants to keep the small GP practice where the same doctor treated you that treated your grandmother. Here the doctor-patient relationship runs like a seam through the generations.
They want to keep the cottage hospital and the larger District General Hospital as the buildings provide continuity and meaning to small and large towns alike. People love their local hospitals because they represent a strong relationship between past, present and future. With everything changing around them they demonstrate continuity.
So in the first week Andrew Lansley has taken personal control of the whole process of changes in hospital services. In the election campaign his boss David Cameron called for a moratorium on changes in maternity and accident and emergency services. There was just too much change being engineered within the health service and it must be stopped.
The problem is that the market in health that will be accelerated by Conservative policy will develop change deeper and faster in the NHS and of course this will have an impact on hospital services. Nor will many small single-handed GP practices survive.
When the 25,000 GPs are given the £100 billion to buy the healthcare in the NHS then they will not continue to do that in small one or two doctor GP practices. As in other industries, GP services will size up into medium and large scale organisations. The mom and pop stores of the last 50 years will disappear and a number of large chains will emerge in the same way that supermarkets have developed. These will have much better and bigger buying power on behalf of their patients. This sizing up – a feature of all markets – will mean that the conservation of small GP practices will be a thing of the past.
And puzzled Conservatives will look at the new market created by GPs and wish for the past that their party has destroyed.
The developing market in healthcare will have an even bigger impact on hospitals. The informed consumer will work with the GP as commissioner to buy healthcare from a range of organisations that are outside of the local hospitals. Many of these institutions will be hollowed out and there will not be new money sloshing about the system to prop them up. As business leaves some will become inefficient institutions and staff will leave, making them not only financially insolvent but unsafe.
For a while, as they have been in the first week, both policies can be followed at once. But in a short while – 18 months – the market will rush through inefficient organisations and as the money runs out, they will close.
Conservatives will want to keep them open as an important part of their local community, but there will not be the business to do that, because Conservatives have unleashed a market on what were inefficient organisations.
As with the impact of all markets, all that is solid in the NHS will turn into air – including some hospitals and, I suspect, this secretary of state.
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