Quality, not privatisation
Should there be a Progress column on public service reform? Not according to Polly Toynbee, who argues today that the coalition have abandoned the centre-ground and opened the NHS up to privatisation. In her view, Labour in government will have to repair the damage, not pursue further reform.
This seems wrong to me, on two counts.
First, there is a danger in characterising the debate about public services in 2015 as being about privatisation rather than quality.
There is no doubt that the NHS reforms have opened the government to this charge but it is not what is happening on the ground. Just as significantly, focusing on privatisation frames the debate with Labour as the champion of public services workers, rather than the champion of patients.
Yes, some tenders are being put out to contract but we have long had a mixed economy of providers. Today, for example, it has been announced that Virgin Care have won a contract to deliver children’s services against competing bids from NHS trusts and charities like Barnardo’s. As a former employee of Barnardo’s, I know how good their services are and want to see them do well. But charities want a level playing field with other providers, not an advantage handed to either public or private sector. So long as services are integrated, being able to put them out to tender can result in faster improvement and better outcomes and avoid the dangers of cherry-picking. Those working in local government and mental health are relaxed about this mixed economy and not without reason. It is managed competition – what Labour called contestability – and not a free market. Reading this week’s headlines, what will worry patients the most is not the award of a contract to Virgin Care but the death of a man from dehydration in an NHS hospital.
Labour in government won the argument that the NHS should be free at the point of use. As a result, what matters to patients is the quality of care provided and the outcomes achieved, not the name of the provider. This, for me, has always been at the heart of Progress’ public reform agenda.
Which brings me to my second point, which is that there is a genuine centre-ground offering real choices about the future of public services. In a nutshell, we either deliver transformative change and productivity gains which allow the NHS to continue to offer a wide range of quality services or years of financial attrition will result in a return of the familiar spectres of queues, rationing and more co-payments. Progress has been right to explore transformative changes whether they are delivered by the public, voluntary or private sectors, because it is the best way to guarantee the future of a future universal, quality service.
If every local reform or attempt to improve quality and productivity is met with the cry of privatisation, Labour will indeed inherit a crisis when it returns to government.
Polarising the NHS debate about privatisation will generate headlines but it won’t tell voters the truth about the real choices facing us and it won’t help deliver the changes on the ground the NHS needs.
Neil Churchill is the chief executive of Asthma UK. This article is written in a personal capacity
Labour, NHS, Polly Toynbee, privatisation, public service reform