The NHS has been entrusted to Jeremy Hunt, the man with an expressed desire to get stuck in to ‘denationalising the provision of health care in Britain’. The many ardent defenders of comprehensive at-point-of-need healthcare are suspicious (to put it gently) of the ability of the profit-pursuit to make ethical judgement calls, provide real value for money (rather than promises of the moon made in winning tenders), or to be as genuinely accessible to those without the means to pay.
The dismissal of Andrew Lansley may have been a chance for public acknowledgement of the public mood, and the removal of a figurehead who has drawn some of the fire. But there’s no chance of heart. The way forward is, by and large, corporate provision of healthcare: taxpayer-funded, shareholder-profiting, likely to be further boosted by a growth in private heathcare brought on by decreasing NHS performance.
I was talking the other day to someone involved in big public construction projects, who was bemoaning, since Thatcher, the contracting structure that, among other misplaced incentives and practices, places responsibility for design with the people who care about it the least, and who are effectively disincentivised from spending more than absolutely necessary. Large housing developments – of that kind we are going to see roll out, to ‘get out economy going’, are, predictably, going to be low-quality, uninspiring, and unfit for flourishing lives.
Adam Smith was one of the first to warn of the dangers of placing control of something in the hands of people who don’t really care about it (by separating out the functions of ownership and management), or care about the wrong things. Yes, mostly we work along broadly self-interested lines, we are in part economic creatures. But there are many ways self-interest expresses itself in the world. Some guide our collective work to make it productive, beneficial, beautiful, beneficial. Some suck out life, quality, equity, and turn it into short-term shareholder return.
Perhaps at the root of a lot of the instinctive mistrust, thought-through fears, and evidenced detrimental impacts of something like the privatisation of the NHS, is the perception, and reality, that we are handing precious things to people who don’t quite care enough about those things themselves, and give those things to those people in shaky contractual structures with misaligned structural incentives.
Where do we fight? For some, it’s defence of what we had, defiance and clear statement of the non-negotiable. Hands off our NHS. Renationalise the railways. Leave it in the ground. In short, stop letting corporations abuse that which we care about just because it’s in their interest and we’ve no choice but to buy what they’re selling.
But there are other fronts. And one vitally important one is to be with those people who don’t care enough about the things themselves, and find out what in our edifices of self-interest can be shifted, deflected, challenged or reformed. If we can find a way to bring those things themselves into clear relief within our understanding of what it means to be involved in business or any form of corporate activity, that allows us all to re-integrate appropriate care of the things themselves and the pursuit of true value into everything that is done profitably-
– then perhaps we will start to demonstrate that, after all, we can entrust the world to ourselves?
The next, (I hope regular), blog posts here will be relections from the masters course I am doing with Forum for the Future. Next up will be a drier overview of some initial starting points of exploration…