Do you remember when Dr Grumble introduced you to the words 'contestability' and 'plurality'? He puzzled over these strange words and what they might mean. He came to the conclusion that they were veiled references to privatisation of large chunks of the NHS.
The trouble with privatising the NHS or with putting it on a private footing is that you lose two of the greatest strengths of the NHS. The first great strength was that it needed few administrators to run it. Of course that is no longer true. The number of managers is shooting up. The reason is that if you are working like a private organisation you need to look after the processes like billing and, yes, even advertising like a private organisation. The NHS never used to need to send out bills and advertise. How does this affect us at the coalface? To give just one example, Dr Grumble's hospital now has a very large press office and, from time to time, a large car is sent to whisk him to the heart of London to talk on the telly, or God forbid, even on LBC. All this is new. It all takes time. It all costs money. And none of it makes sense unless you have competition and choice - more favourite government words. And to have choice you need Choose and Book - which is also expensive. And to have competition you need to duplicate services. Which also costs more because you have at least two of everything. And you need to know what you are buying so it is claimed you need the execrable iwantgreatcare.org. And the end result is that you have a gleaming new polyclinic with lots of investment and advertising versus traditional GPs with good quality family doctoring. Which will win out do you think? Dr Grumble knows. If you can persuade people to pay for water they do not need the answer is clear. But people will not be getting what they really need for genuine quality care. They will be getting what they have been persuaded they need but really just want. Because of the power of advertising. Which will be another very expensive part of the process.
Those that didn't believe Dr Grumble (and there were many) when he said the health service was essentially being privatised should surely believe him now. A few short years and all has become clear. Of course for this to work you need multiple providers. You need world class commissioning. You need supermarket-type competition. And all this means that you lose the other great strength of the NHS - cooperation and collaboration. So, to deal with this you, have the Orwellian Cooperation and Competition Panel which doubtless will also waste yet more of your money. Nobody knows how this will work. Nobody knows if any of this will work. Nobody knows if all these things will cost more than they save. But you could have a good guess.
Here is some newspeak for you:
"a community in which power, wealth and opportunity are in the hands of the many not the few, where the rights we enjoy reflect the duties we owe...in which the enterprise of the market and the rigour of competition are joined with the forces of partnership and co-operation."
Where do you think that comes from? Yes. It's Nulabour-speak. Their new Clause 4. Would you believe it?
With thanks to Richard Taylor who was the inspiration for this post.