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The Remaining Anachronism • Tom Kilcourse In 1945 a mild mannered ex-army officer named Clement Atlee came to power in Britain to head the most radical reforming government in recent history.

Under his leadership the Labour administration nationalised broad swathes of the British economy, embracing energy, including coal mining, transport, health care and some manufacturing, including steel production. Though such an extensive programme would be unthinkable in today’s profit driven environment, it had many benefits at the time, bringing improvements particularly in transport and mining. British pits became the safest in the world. There were notable gains too in health care, with the formation of the National Health Service.

During the following decades that programme was dismantled. In the sixties the steel industry was denationalised, ironically by another Labour government led by Harold Wilson. The eighties saw the gas industry privatised under Margaret Thatcher, and her successor, John Major, privatised the railways in the nineties. More recently Royal Mail came under the hammer, flogged off at a knock-down price.
From personal experience I know that the sell-at-any-price mentality we witnessed in the Royal Mail fiasco was not a unique occurrence. I joined British Rail some three years before its privatisation, specifically to prepare the organisation’s management training centre at Watford for the move into private ownership. From my vantage point as the Director of that centre I observed an unseemly scramble to fragment the railways and to unload the bits to any taker at almost any price. This was no carefully planned, considered development, but the disgraceful vandalism of a national transport system.

The rationale offered by governments for this rush to privatise is that competition is beneficial, giving consumers more choice and driving prices down. For many people receiving their energy bills the latter point seems like a cruel joke, as it does to users of the privatised railway. Having lived in France for fifteen years, until 2013, I can assure the reader that both energy and transport is cheaper there than in the UK. Another argument advanced in favour of privatisation is that it allows government to cut costs to the public purse. However, in the aftermath of rail privatisation, government subsidies to the system actually rose.

The competition case must be questioned when we see that state monopolies, for which government could be held directly accountable, have been replaced by privately owned oligopolies operating with inadequate public oversight. Opportunities for collusion, passive or active, clearly exist, as do conditions in which corruption can take root. Is it too cynical to suggest that we have perhaps moved from a system in which governments owned and ran industries to a system in which the private owners of those industries now run governments? That last remark is not made in jest. We often hear the complaint that trade union funding of the Labour Party gives the unions undue influence over Labour policy. If that is the case, should we not be equally concerned about what influence corporate funding of the Conservative Party buys?

However, such partiality is not the only anomaly we face when considering the question of private versus public ownership. Let us accept for argument’s sake that nationalisation is anachronistic. Let us also accept that competition is an all-round benefit, giving more choice, driving down costs and raising standards of service. No, don’t laugh, I did say ‘for the sake of argument’. Why, then, is the largest anachronism of them all left in existence? Why is health care seen as an exception to the rule, so preserving the largest employer and the biggest bureaucracy in Europe to look after the health of most of us?

I say ‘most of us’ because the National Health Service is not the totality of the British health care system.

During much of my managerial career I was afforded health-care insurance as a perk, and a very welcome one. I was far from alone. Health care insurance is a very common perk that enables many thousands of managers and executives to pay for attention and treatment in the private sector of the medical industry. Such beneficiaries deny themselves the pleasures of sleeping in multiple bed wards, long waiting times for appointments, treatment by doctors to whom they are just a number, and attending appointments handed down rather than made by mutual agreement. These experiences are reserved for the oiks and their dependents.

Odd as it may seem, there is no clear dividing line between the private sector of medicine and the monolithic NHS. Consultation with a specialist still requires a referral by an NHS general practitioner, even when the patient is paying. In truth, that rule is not always adhered to, but it is a small example of the control that the NHS attempts to exercise.

A more important link between the public and private sectors is found in the personnel employed. Since returning to this country from France we have occasionally ‘gone private’, only to find that the specialist we consult is moonlighting from his day job in the NHS. It is common practice for specialists employed ‘full time’ in the NHS to supplement their salary by working privately in some clinic or other. This situation has a direct impact on the service that the patient receives. It provides an incentive to doctors to encourage patients to consult them privately. Given that not all doctors are self-sacrificing saints, this leads to the situation where patients are commonly told that the operation found necessary for their wellbeing involves a wait of months within the NHS, but ‘if you go private, sir, I can fit you in next week. *Waiting times in A&E can be up to 24 hours now since Covid.

The vested interest of medical staff provides one reason why change over the years has been limited to tinkering, rather than initiating fundamental change, but it is not the sole reason. Another brake on progress has been the determination of politicians to avoid what they call ‘post-code medicine’, a desire to ensure absolute equality of treatment for everyone irrespective of their location in Britain. This unrealistic, pie-in-the-sky ambition led only to spreading the misery, subjecting every part of the NHS to the iron grip of bureaucracy.

Bureaucracy is not simply another word for hierarchy, it implies a state of mind. Hierarchy is necessary in any organisation, private or public, as an instrument of co-ordination and dissemination of information, but the way that instrument is used makes a real difference. In a dynamic business environment decision making occurs as close as possible to the affected area, with lower level management making decisions within policy guidelines. Such a concept is alien to the bureaucratic mind, in which the instinct is to control in detail from above.

A recent example is seen in plans to monitor performance of general practitioners and put underperforming practices into ‘special measures’. This move typifies the bureaucratic approach to problem solving. It is an inadequate solution, and an unnecessary one, showing benevolent bureaucracy protecting the patient from inefficient doctors. A more effective alternative exists, and one found in the supposed rational for privatisation: competition and market choice for the consumer. Let patients be free of registering with a particular practice and they will sort the bad ones out.

Why is it believed that people who are sensible enough to choose their provider everywhere else are incapable of making choices when it comes to their medical treatment? Political interference, vested interests and the bureaucratic mentality provide the answers. Ridding us of the last of these is the best argument I know for privatisation in any field.
© Tom Kilcourse
kilcoursetom at yahoo.co.uk

The British & the Unions
Tom Kilcourse
...for all the rhetoric and angst, the British attitude to trade unions remains confused.

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