Who is this scumbag idiot Marxist?

Choice is an illusion created by people to sell you something. The egalitarian utopian market in which social businesses and the mightiest US private healthcare companies compete and provide health services in a mixed economy is a fallacy. Competition creates mega, monopoly suppliers.


War is Peace? Competition means monopoly?

What? Who is this moron?

Dr John Middleton is director of Public Health Sandwell

Jesus, no wonder the NHS is fucked. He\’s cribbing his economics from the Ladybird guide to Marx. That special one for those not up to \”See, Spot the Dog\” type complex dialogue.

Stories of the incompetence and impersonality of telephone, water and energy companies are legion. All beneficiaries of choice and competition: an ideology successive governments have planned to bring to the NHS.

Well, yes, there\’s a good reason for that too. We\’ve been able to see that competition improves results without increasing costs.

We saw it with water for example: at \”privatisation\” there were four different systems put in place for the structure. In England, regulated private, for profit, monopolies. In Wales, a mutually owned monopoly. In Scotland, a State owned monopoly. In Northern Ireland, direct local council provision.

OfWat, the regulator, had a look at the results a decade or so later. Which system lowered costs, improved the quality of water and reduced environmental damage the most (in theory all should, for technology does advance)?

England first, then Wales, then Scotland, lastly NI. For profit ownership, even in the absence of true competition, worked.

And is there anyone at all who thinks that telecoms have got worse since the abandonment of British Telecoms\’ monopoly? (Heck, since the GPO?)

Trains were something of a fuck up, true.

And we\’ve even had experiments in the damn NHS that we can look at. NHS England embraced limited competition while NHS Wales and NHS Scotland did not. NHS England has improved in productivity more than NHS Wales or NHS Scotland. Shit, we\’ve even got detailed studies of the effects of non-price competition on patient outcomes and costs. Patient outcomes improved at no increase in cost.

So we\’ve a senior manager in the NHS quoting from the \”Teenage Trots\’ Guide to the Evils of Imperialism\” or whatever and entirely ignoring all of the empirical evidence. It\’s as if he was basing medical treatment on his misunderstandings of Galen\’s humours instead of all the hard scientific work that\’s been done over the centuries.

This is the spouting of idiot prejudices, not a reflection of anything in the real world.

That we\’re spending £110 billion a year through morons like this just shows exactly why we really do need to reform the NHS.


31 thoughts on “Who is this scumbag idiot Marxist?”

  1. Trains were something of a fuck up, true…….

    In the sense that they were bankrupted by the government for ideological reasons.

    Trains have hardly been a great success, but in the years after privatisation passenger numbers soared, and the subsidies needed fell. They were almost certainly better off, even with the rushed sale and poor structure.

  2. The bloke is talking out of his arse.

    Lets not forget tho’ that water/energy/banks etc
    as they exist in this country are not “free markets”. They are friends and buddies of the state and corporate socialism is the name of the game. If you get shoddy service from one you can go to another but they all operate on the same lines ie under the thumb of govt scum. Witness the energy companies and the green taxes bullshit. You can say that is forced on them by law but they are all helping the state to keep quiet about what is going on because they all piss in the same pot.

  3. You can’t tell much from trains because things like track and signalling are still monopolies, and always will be, and that has a huge effect on the service that’s delivered.

    It’s air travel that’s the biggy. Look at European fares pre- and post-Open Skies.

  4. I’m afriad you are correct Public Health does attract the Trot types who believe they have a right to tell others how to live.

    Of course telling others how to live whilst pocketing a large salary, well over £100,000 for this chappie is fine. It must be so easy to be a Marxist when you are suckling on the state tit.

    He would not be paid as much if opened up to competition, very few Doctors would.

  5. He’s got lots of people to agree, though.

    Commenter ‘teaandchocolate’, for one:

    “Phone companies are a bleeding nightmare. Very confusing and the packages all amount to the same, so the competition driving prices down is a load of hogwash.”


    “Having more Sky channels has worsened the quality of TV programmes and, if anything, the BBC should be given more money, not less, especially for science and nature programmes.”

    Double what?

  6. Unless Dr John Middleton has obtained his title though a doctorate in economics rather than through medicine then what right does he have to make such sweeping and generalising comments on what is an economic issue?

    This article is offensive to anyone who has studied economics at pretty much any level. I wouldn’t dream of lecturing him on illnesses and their preventions and causes.

    Why is it that economics seems to be one of the few areas where those that have not trained in it seem to have as much weight attributed to their arguments as those who have dedicated their lives to it?

  7. “Competition creates mega, monopoly suppliers.”
    Er – you create monopoly if you reject competition or eliminate it.
    Does he know the meaning of “mono”?

  8. Reforming the NHS is a lost cause. We might just as well accept the fact that for the vast majority of British, it’s a religion (as postulated by Nigel Lawson) and not open for rational debate.

    Ignorance and faith bind together to frustrate all efforts at any change.

    I’m fed up with the whole chatter around Lansley’s reforms. No matter how worthwhile, how effective they may be or how necessary, there’s a section of society, too large to confront, that simply won’t allow them to happen.

  9. Serf. Subsidies to the rail industry didn’t really fall, it depends how you measure a subsidy exactly, the whole thing is excessively complicated but put simply the rail industry now costs the taxpayer at least twice what it did in the last years of British Rail. It’s arguable that this figure is distorted by the low subsidy that BR received in the run up to privatisation but even so there’s no doubt that trains and maintenance are far more costly than they were. There are a number of reasons for this not all of which have anything to do with privatisation as such but the system as it stands lends itself to the incurring of unnecessary cost, “something of a fuck up”, pretty well covers it.
    Hugo. I could go on for hours about how privatisation should have been done, don’t worry I won’t, however a fundamental error was made in separating infrastructure from train operation. Tim Almond says that track and signalling are monopolies, yes but seeing them as separate entities is where a large part of the problem lies. Railways operate as an integrated whole and only people who knew nothing about how railways work would imagine otherwise. the proposals for re-integration won’t work either as it will still be within a fragmented industry what is needed is a drastic slimming down of the number of TOCs ( six should be enough ) which would be fully private companies responsible for their own track maintenance and train procurement. Add to that proper open access arrangements for anyone who thinks they see a gap in the market ( this could be regulated by something like a modern version of the old Railway Clearing House ) and you would be part way towards a viable and affordable rail network.

  10. Railways operate as an integrated whole and only people who knew nothing about how railways work would imagine otherwise.

    Conjecture: only people who know nothing about a) logical debate; or b) the topic being discussed use the ‘know nothing about’ construction.

    Once you have freight, long-distance and open-access services, track and train operation are *inherently* separated.

    Either you have an arm’s length regulatory system in place that ensures the ‘home’ railway company’s trains aren’t unfairly privileged (which would be operationally the same as if the ‘home’ train and track companies were separate), or you don’t, in which case the ‘home’ operator screws over everyone else.

    The UK rail network reversed its passenger decline starting in the 1980s when BR moved from a regional to a sectorised business model – in other words, instead of basing services on “where do the tracks run because that’s where they were built”, they started being based on “who is this train aimed at and where and when do they want to go”.

    This means running trains that don’t follow regional track splits, with multiple different routes on the same track – or, the opposite of a traditional Big Four model.

    I’d say anyone who favours re-integration on that basis doesn’t understand how passenger demand works. Which – in any industry – is the most important factor, far more important than the tedious mechanics of how you deliver the service.

  11. John B. My reference to not understanding how railways work was aimed at the people who privatised the railway not anyone conducting a debate, who are they ? It’s fairly obvious that the DfT don’t have much understanding of the subject either. I know about sectorisation, I’ve worked on the railway for 35 years , it was a success and we had an integrated railway so what was your point there ? I also know all about the tendency of ‘home’ companies to favour their own services, I see it regularly in my job ( signaller ) it’s abetted by Network Rail so that rather undermines your argument. Network rail don’t like open access operators either ( neither does the government ) so again your argument is weakened. Do you think cross country passenger and freight operations are a recent thing ? How did they manage them in the heyday of the private companies and where do I suggest that services be constrained by regional track splits ?

  12. War is Peace? Competition means monopoly?

    His point is that smaller groups formed up by healthcare professionals (as so feted in CMD Big Society bullshit) ain’t going to be competing with the kind of megacorp now waiting for the green light. In truth, it’s already happening. And the likes of Assura are not being shy about legal recourse where they feel they are being denied a slice of the NHS pie. WTF any of this has got to do with patient choice is beyond me.

    Wibble on about competition (and flawed evidence a la Cooper) as much as you like – in real terms, it’s not how the nascent consortia will be operating. The ConDem reforms will see more & more provision handed over to Crapita* Healthcare Inc – with increasingly dire overstretch in frontline/acute care (even for those who can afford reasonable levels of private cover). Whatever your daydreams about market utopia, that will be the reality. It’s the prospect of screwing things up even more that concerns most of my colleagues, not some religious fetish – I know full well where/how the NHS is good, bad and indifferent.

    (*a generic term – in honour of shitty-but-no-doubt-profitable outsourced services everywhere).

  13. “Whatever your daydreams about market utopia, that will be the reality. It’s the prospect of screwing things up even more that concerns most of my colleagues, not some religious fetish – I know full well where/how the NHS is good, bad and indifferent.”

    Please propose a route of action that will improve the NHS then. (Not for the nurses and the doctors but for the patients and the taxpayers)

  14. Emil, just quickly: for starters, bin what is fast-becoming a stupidly expensive re-org. Senior DoH types are pretty much white-faced with fear about how it’s all going to work, on top of an extensive management cull (the NHS needs good/i> managers, not a blanket clearout) and the required savings. No wonder AL wants to wash his hands of accountability…

    There needs to be a proper, robust debate about the limits/remit of public healthcare. It might be to Tim’s distaste, but that involves taking on board the fact that alcohol (for one thing) is causing utter carnage. Cost-savings in heathcare are often a matter of prevention. Concentrate acute care in fewer-but-larger centres and run it on military lines. It’s what (IMO) taxes should be for. I don’t care if that forms part of a European style (better invested, highly regulated – natch) social insurance system – but don’t fcuk about with it.

    An end to screwing around with procurement – before it was farmed out, NHS Logistics used to run a tight ship, across multiple lines. Utilising buying power on a massive scale has somehow given way to all manner of nonsense (home oxygen supplies being a classic…).

    Bin PFI. I don’t care if it takes an emergency act – servicing such contracts whilst we are cutting frontline services takes the piss. Full stop. Both DoH and MOD are riddled with revolving-door gravy-trainers. The cronyism is costing us dear.

    Devolve all IT, comms etc to those on the ground. There was no excuse for Blair’s topdown holy vision of NHS IT. We didn’t ask for it & our tech guys sure as hell didn’t.


  15. (cont… although I am in a crazy hurry).

    Pensions & salaries: no more ham-fisted Gov negotiation (e.g. losing OOH cover whilst paying GPs more – although that was partly because Gov didn’t believe how much work was being undertaken by decent GPs. To their – and our -cost).

    Pensions are going to be an obvious topic of disagreement here – except to say that IMO it forms part of the deal in certain lines of work. I’d say the public gets a pretty good deal out of my boss (senior sister, emergency surgical admissions – band 7 salary). Decent morale retains staff, saves money and keeps things running tight – it’s no coincidence that the wards at Mid Staffs etc were often running on bank/agency etc, with all the breakdown of comms/continuity that can bring. But that’s a whole ‘nother debate.

    Acknowledge and accept the fact that elderly care is going to be a big challenge. Although that is probably going to require a sea-changc in social attitudes…

    There’s lots more, of course.

  16. Ps, and bluntly, a “better” French/German healthcare system requires more cash. Until NuLav (who managed to spend badly, but even so) the NHS provided a reasonable service for less-than-continental levels of investment. It’s no accident that costs (& bureaucracy) rose with successive Gov attempts at pseudo-market reform. It would be pretty stupid to throw away that which is good and cost-effective about the NHS- imo, all too often taken for granted, whether in terms of critical care capacity or workforce training. And if the ConDem reforms merely result in handing over infrastructure and services to the megacorps without a commensurate improvement in choice, outcomes (whatever the soothing rhetoric) etc … well, don’t say you weren’t warned.

  17. lost _nurse:

    so your suggestions basically boil down to:

    1) pay nurses more
    2) do not touch nurse’s pensions
    3) no re-organisation
    4) micro-manage people’s lifes
    5) centralise one of the world’s most centralised systems even more (except for IT)

  18. Fine, Emil, if that’s how you want to take it. Perhaps you could explain how insurance-based (the underlying reality in any health ‘market’) systems reduce costs (a clue: they don’t)? And if you think producer-interest is bad now, just wait until we get going with the over-investigating…

  19. lost_nurse

    There are two sides to the story:

    1) through whom is the service financed: I for one am by no means certain that insurance based financing of all healthcare (most certainly not emergy/acute care) is better than state-channeld financing of healthcare

    2) who performs the service: here it is quite apparent from international benchmarks that the best systems have some sort of private market based system for at least parts of the healthcare provisioning.

    The two are not the same and when you claim that they are you are either being ignorant or dishonest. (Given that this is nth time that I am pointing this out to you it shouldn’t be ignorance)

  20. 2) who performs the service… The two are not the same

    Erm, nowhere do I deny the strengths of (better funded) Continental mixed-economy systems (though they have problems, too). But, in all honesty, do you think this is what the ConDem reforms will achieve? FFS, if I thought it meant everybody on my ward flying club class and not Crapita cargo, I’d be singing from the rooftops/helipad.

    Point blank: the NHS at its best does not excuse it at is worst – but that is no reason to fragment decent services, least of all for ideological reasons (simply put, it must be smashed). Especially when rhetoric about choice and competition is being used to disguise reforms that will result in (IMO) anything but!

  21. lost nurse;

    “FFS, if I thought it meant everybody on my ward flying club class and not Crapita cargo, I’d be singing from the rooftops/helipad.”

    Yes, that’s the very point of us not listning very much to you ’cause the rest of us have little interest in paying for you flying “club class”. Health care should exist for the consumers of said healthcare and not for the producers.

    ” the NHS at its best does not excuse it at is worst – but that is no reason to fragment decent services”

    but to move from a centralised system to a mixed-economy one you necessarily have to fragment services

    “least of all for ideological reasons”

    1) It is not ideological reasons when there appear to be very strong evidence for that other type of system working much better

    2) socialisation is built on ideological reasons or assumptions that were proven false.

  22. And, straight off the bat, you mis-read my comment about club class. I meant the patients, for gawd’s sake. I graduated with a decent Oxford degree and (prior to RN training) spent ten years as an auxiliary nurse, wading thru blood, shit and vomit for about £6 an hour. It’s hardly up there with being bailed out for betting the farm with absurdly-arcane financial instruments, as is the case with some of my uni contemporaries. A godawful sanctimonious point, I know – but, ffs, don’t lecture me about producer interest, unless you’ve cleaned up shit for less.

    Fragmenting services is a bloody stupid idea if hiving off (profitable) bread n’ butter surgery leaves your local infirmary unable to provide emergency cover – as is happening.

    I suspect we will have to agree to disagree.

  23. Of course it’s the profitable bread n’ butter surgeries that you want to hive off. That’s the whole point: it’s where you can make savings through automatisation and innovation. There is just no point in having the government monopolising something that others can and will do.

    It’s precisely the non-profitable surgeries that you don’t want to hive off as that’s where you are very likely to have market failures if you do.

  24. you want to hive off

    No, you don’t get my point… bread and butter/routine surgery isn’t necessarily a whole separate thing from emergency surgery (and even simple procedures can go south very fast). They are better viewed as a continuum – in personnel, skill-sets, kit, everything. It’s why fragmenting surgical services can have serious implications for workforce training and emergency cover. Hive off, say, routine vascular surgery – and you might well find yourself struggling to deal with incoming Triple As (for which read: bleeding out very fast). For sure, some stuff is amenable to a production-line approach – but that’s generally simple stuff in the otherwise fit n’ well.

  25. regarding the railway privatisation, i just recall how hard it was to get from North to South london [pre-privatisation – there was one route via Neasden over olds good track, but the trains would only run at about 5 mph plus a couple of halts while I imagine the driver took a tea-break, so it was mostly better to go to Euston, take the tube to Victoria and then catch another train – although there was masses of track around London, with interesting foliage growing through the sleepers. Now, it is at least acknowledged by the franchises that people might legitimately want to get from one side of London to the other.

  26. Pingback: Do You Fear Choice? | Orphans of Liberty

  27. Pingback: Privatisation works! | oliverblogs

Leave a Reply

Your email address will not be published. Required fields are marked *