A socialist talks to us about competition in the NHS

Colin Leys that is. Used to be editor of Socialist Register. One of Ralph Milipede\’s more attractive offspring.

In the pages of The Guardian Colin tells us the following:

But Monitor is tasked with creating a market in healthcare and faces the problem that making money out of acute (hospital-based) healthcare is very difficult unless the state stacks the cards in favour of profits. The main reason for this is that in most markets, making profits depends on innovative labour-saving technology, whereas providing good healthcare is unavoidably labour-intensive.

Yup, the old static technology fallacy. That acute care is today labour intensive means that it has been, is and always will be, labour intensive. This is the attitude of the mattock maker regarding the turnip weeding machine. The blast furnace operator looking at electric arc furnaces. The buggy whip maker considering car steering wheels.

For technology does change. Humanity advances by mechanising labour in fact. What was formerly labour intensive becomes capital such and off we go in a new round of getting ever wealthier.

And we also know that market based systems produce more of this innovation, this substitution of capital and machinery for labour, than planned economic systems. Precisely because market based systems are not constrained by idiots who think that technology is static. And this leads us to the actual reason why we are introducing markets in health care.

good healthcare is unavoidably labour-intensive.


good healthcare is currently labour-intensive.

And we\’d prefer it not to be which is why we want that market as the best way to explore how it might be made less so.

Think about it. Two hundred years ago the treatment for a headache was a cool cloth wiped over the forehead by a comely maiden. Then some capitalist bastard invented aspirin and we\’d mechanised the treatment of that particular problem. We\’d made it less labour intensive and Hurrah!

How much of acute care we can mechanise is entirely unknown. Which is why we want the market, the experimentation, the incentives and the copying of what works that goes with market based systems.


Elderly socialist professor wrong. Now that\’s a surprise, isn\’t it?

18 thoughts on “A socialist talks to us about competition in the NHS”

  1. Just had a new hip put in, privately, using new technology and procedures that radically minimised the impact on me. I’m walking and pain free after 13 days (tho it will take a few more weeks for the joint to bed in fully). In the NHS, they slash through muscle to get at the joint because it is cheaper, at the point of delivery, so to do. But the cost in unproductive recovery time, physiotherapy and care means it is actually, in the round, MUCH more expensive. In the NHS everything is calculated in boxes/silos because the people who run it can only see, and therefore understand, things that lie just beyond the end of their nose.

  2. “The main reason for this is that in most markets, making profits depends on innovative labour-saving technology, whereas providing good healthcare is unavoidably labour-intensive.”

    So close to getting it – but still missing that it hurts to watch

  3. and then at then at the end of pretty dry article about accounting comes this

    “we must be prepared to see more and more of our healthcare, including hospital care, provided by for-profit corporations, with the rise in cost and loss of quality that invariably follows.”

    What, Where did that come from!

  4. as improved by an NHS surgeon in Wrexham?

    Ignoring the fact that nearly every surgeon in the UK is an NHS (or Defence Medical Services) surgeon …

    Isn’t that just an utterly appalling condemnation of the NHS? Employee has really bright idea for improving service delivery. Which is pretty much ignored by employer and anyone who wants it (except from that particular employee) has to get it from the “competition”.

  5. So the NHS owns the surgeon do they?. Whatever the proceedure is it came out of the mans experience and effort, not from the wonder of socialism.
    And don’t bother with any crap about the NHS trained him–other doctors trained him–and if the NHS paid for his training that is probably because they soak up most of the money for medicine in this country–if the NHS didn’t exist medicine still would and would be vastly cheaper and better.

  6. It was mainly his brother in engineering, working from some expert knowledge provided by the surgeon:
    “With this in mind Mr Wootton set his engineer brother Malcolm a challenge 12 months ago to design a device which helps to fit the new hip at a fraction of the cost of current products.”

  7. Mr Ecks,

    The UK is about halfway in the OECD table for expenditure on healthcare, and that’s only because health spending here as a % of GDP has risen quite sharply in recent years.
    So leaving aside arguments about quality of care I don’t see any reason to believe the existence of the NHS is causing the cost of medicine to be vastly higher than it would otherwise be.

  8. I had a conversation with a man Tuesday who was lamenting all the jobs lost by John Deere’s using robotics to make implements.

    I pointed out that all of those implements were taking the jobs of men with shovels.


  9. The argument seems to be:

    1) Innovation cannot arise within the NHS
    2) Therefore when innovation does seem to arise within the NHS, it must in fact be exogenous.
    3) Therefore there can be no examples of innovation from within the NHS
    4) Since there are no examples of it, it’s apparent that innovation cannot arise within the NHS.

    I diagnose a chronic case of petitio principii

    Tim adds: No, the academic finding is: invention arises in both systems, planned and market. Innovation (here defined as the actual use of an invention) disperses vastly more rapidly in a market than a planned system.

  10. The argument seems to be:

    1) Innovation cannot arise within the NHS

    No, simply not true. Perfectly happy that the surgeon works, all or the majority of his time, for the NHS.

    And, with that premise demolished, your argument falls. You’re normally better than this?

  11. The invention was the product of the man (and his brother’s) minds. Those minds are not part of the NHS and do not owe their talent or efforts to the NHS. The Doctor may have been employed or part employed by the NHS but as being a doctor is not a casual choice of employment I have no doubt the man would still have been a doctor if the NHS had never existed.

    Andrew Adams–the extra costs of the NHS are in its socialistic and bureaucratic nature. The billions on their computer “Spine”, the excess levels of managers, the paid-for but piss-poor levels of care and standards of hygene(not everywhere but still far too wide spread), the poor treatment of old people ( including my late Father) who have paid in all their lives, the bungled and expensive GPs pay deal,costly PFI hospital deals,the expensive habit of chucking people out of hospital early to meet targets and then having to re-admit them because they were not well enough to go home, the 3-hour waits in A&E (my elderly neighbour up the street took his sick wife up the street to A&E last Monday week and waited 3 hours to see a doctor. This is in a 80,000 town with one large, –too large and mostly empty-NHS built hospital on a Monday night.) £106 billion a year is a lot of money for that level of service.
    Not to mention the purchase of overpriced goods and services from all manner of suppliers who know that the state should be known as the Simple Shopper (thanks to the old “Burning our Money” website for that name) and will pay over the odds for almost everything.

    According to the NHS’s own website the NHS cost 437 million in 1948–they say approx 9 billion in todays money. They say it now costs 106 billion for 2011/12. That is 12 times more. The population has not increased 12 times. I don’t care what the rest of the world spends.We spend a lot and huge chunks of it are misallocated and /or wasted.

  12. Hope they dont innovate or mechanise the Liverppool pathway thing. You cant expect a machine to care what you think. So state murder will become ritualised by the box tickers.
    And what is worse you wont even know because you wont wake up.

  13. So whose argument fails?

    Well, yours, still. Your argument failed logically. Your conclusions might be supported by fresh evidence but your argument is still as dead as last night’s dishwater.

    However, a private company bidding for a 10 hospital trial _is_ the NHS ignoring this invention. I’m part of a minor UoL trial to determine whether a mildly irritating condition I have is merely correlated with an increase in throat cancer risk or possibly causal (there is a putatively reasonable underlying mechanism.)

    That trial involves at least 10 hospitals just in Scotland – and it’s neither my issue nor throat cancer are anything like the expense or problem hip replacements are to the NHS.

  14. If you’re saying that the only proper response by the NHS to this invention would be to kidnap every surgeon in the world experienced in the DAA procedure and force them to take part in a large scale trial, then I disagree, with all due respect. If not, what do you want the NHS to do?

  15. why we are introducing markets in health care

    As with your wilful Daily Mailograph misunderstanding of the LCP , these posts bear very little relation to what is actually happening on the ground (I know, because I’m standing on it). The likes of Serco and Virgin certainly aren’t blazing a trail of innovation – they are simply profiting from NHS acute capacity, infrastructure and workforce training. It’s a fugging joke.

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