Polly Toynbee Still Doesn’t Understand Competition, Cooperation, In The NHS


Actually, Polly Toynbee doesn’t understand competition and cooperation in anything at all, let alone the National Health Service. Which is a pity as that’s what she’s decided to shout at us all about today. And it is true that if you’re going to soapbox us all about how things should be then you have a certain duty to understand how things are.

Markets are a form of cooperation. I undertake a market exchange – as I’m about to do in the supermarket to get lunch – then I am cooperating with whoever I exchange with. I hand over my cash, they their bread. In what manner is this not cooperation?

Quite – the competition comes in deciding whom I am going to cooperate with. As it happens, right where I am, I’ve three reasonable choices- reasonable here being defined as not needing to use any transport other than Shank’s Pony to gain my lunch – as to who to cooperate with. There’s Aldeia do Pao just on the corner but I don’t like their bread even as they like my cash. There’s in one direction a Pingo Doce and in another an Intermarche. Either have acceptable bread, either have other offerings as well that I may wish to partake of.

Competition is me deciding which of these three I shall get my bread from. Cooperation is the act of gaining the bread from the one who has competed to win my custom.

At which point Polly’s whines cease to make sense:

Some bad ideas are very hard to kill. The NHS in England is finally trying to strangle the notion that competition between hospitals is like competition between supermarkets, an anti-cartel spur to quality and low prices. But, zombie-like, the competition mania keeps being resurrected by those who think nothing works without red-in-tooth-and-claw markets. This ideological fight has battered the NHS for decades.

Note that markets don’t require capitalism. They might work better with them – could be without them too – but they don’t require it. If all three bread suppliers were workers’ cooperatives, or even tax funded outlets, we’d still be getting that competition for my cooperation.

Since Simon Stevens became head of NHS England, he has striven to stitch Lansley’s fragments back together, to create collaborative, joint NHS and social care structures locally, not competing but cooperating.

Competition is just deciding who to cooperate with. Just that word “locally” shows that we’ve got the competition already, we’ve excluded those who are not local.

Polly’s just not got the first clue of the subject under discussion. And yes, this is long before all the evidence we’ve got that it’s exactly the competition that does increase productivity etc. It’s lucky no one in power takes any notice of her prescriptions for how we should do things then, isn’t it. Oh, wait….