How hard can it be to keep hospitals clean? Well, if you’re thinking what we’re thinking, the answer is… it’s fairly difficult if you outsource responsibility for cleaning, erode working conditions and labour standards and provide inadequate cleaning materials – all in the name of market-based efficiency. Unsurprisingly, Conservative health policy is silent on the impact of commodification on the reduction of healthcare standards. But the party’s Manifesto, launched today, does hint at how the system of market ‘choice’ will be extended if the Party gains office.
The Tory pledge to give all hospitals 'the freedom to hire staff, specialise and borrow to invest' can be read as a commitment to continuing the (neo)liberalisation of the NHS. Although it is presented as a rebuff to Labour centralisation and bureaucracy, this measure is little more than an extension of the present government’s Foundation hospitals scheme, which already undermines pay bargaining and allows for increased subcontracting to private firms. Conservative pledges to reduce ‘radically reduce the number of Primary Care Trusts, abolish the Strategic Health Authorities and cut the number of quangos, inspectorates and commissions’ also follow the logic of Foundation hospitals to their logical conclusion, since that measure has already damaged the ability to achieve the efficient, non-market planning of services and undermined these bodies.
What is striking here is that a measure introduced by Labour to protect an NHS ‘free at the point of use’ (a ritual commitment which is also repeated in the Conservative manifesto) is being used as a means to further undermine it. The ideologically shared vision of ‘patient choice’ serves as a metaphor for the opting-out of the system by the middle-classes, undermining the universalist aspiration for equitable treatment on the basis of healthcare needs.