Recently the media has told us that the Labour Party is considering a long journeyed return: back to the nationalisation of rail services. Some claim that this will offer better long term value, efficiency, and safety.
Many would welcome this, but there is a puzzling anomaly: why do we not, instead, start with the NHS? For surely, the contentious market principles of competitive commissioning are better suited to human transport than human healthcare. This is an important distinction, and our failure to recognise the difference between the mechanical and the human has led to a new tranche of serious NHS problems.
For 25 years we have had successive governments push through legislation to extend the control, reach, and leverage of the NHS Internal Market. Yet almost all senior practitioners with long prior experience agree about the human and economic cost consequent to our depersonalised fragmentation of the NHS. This has been engineered by such commercialising devices as competitive commissioning and autarkic NHS Trusts. Cumulatively, they have been highly destructive to both the quality of continuity of care, and the morale and trust of staff. The Royal Colleges have consistently taken this view. From my own long serving GP practice, I have hundreds of documented cases to illustrate these organisational follies.
Personal knowledge and continuity of care may matter little in the carriage of passengers. It matters a great deal in the care of the complex human interweavings of the ailing body, mind, and spirit. The NHS Internal Market is like communism: a failed ideological experiment. Such ideologies may start with some aspirational ideas of merit, but these must always be diluted and titrated. For they are only partial and conditional truths, and our failure to heed the difference between guidance and dominance has led to failed social experiments.
Yes, a reconstituted national British Rail could possibly offer us greater economy, choice, and comfort. What an intelligently refederalised NHS would offer us would be much more. Here is another anomaly: why now do we not hear a substantial challenge to the existence of the Internal Market from our usually glad to be contentious opposition politicians?
David Zigmond is a GP in London.