Socialist Worker

Does 'choice' mean better services?

Labour and the Tories both promise that the NHS and schools will get better if we are offered more "choice". JUDY COX looks at the ideology behind the rhetoric and what it will mean for us

Issue No. 1909

‘CHOICE” was the buzzword on the politicians’ lips last week. It is rapidly becoming the ideological linchpin of Blair’s vision of a “radical” third term.

In reality New Labour’s embrace of choice demonstrates that it has accepted wholesale the entire ideology of the capitalist market. The “modernisers” are resting on ideas that were produced by pro-capitalist pioneers some 250 years ago.

Michael Howard wants selection in schools and an increase in private health provision through the front door. Tony Blair wants them through the back door.

In Blair’s mouth the word choice, like the word reform, means the exact opposite of what you might expect it to mean. It means less choice for the vast majority.

It wasn’t ordinary people who demanded “choice” in schools and hospitals. They wanted (and still want) a decent local hospital and a decent local school.

The vast majority of campaigns about the NHS or education are about the closure of a valued local school or hospital.

People don’t march in Newcastle for their grandmother’s right to go to Inverness, Brighton or Marseilles to have her hip operation. They march because they want the procedure available quickly, close to home and relatives and visitors.

Choice assumes that you are faced with a variety of services, some of which are better than others. It assumes that some schools and hospitals are not up to the mark and that therefore you have to be allowed to compete to get into the best.

The market reduces us to individuals scrabbling over each other to do better than our neighbour, not a cohesive society where we all have an interest in proper public provision.

It assumes that we want the NHS or our children’s futures to be subjected to the bewildering deluge of propaganda and half-truth which has resulted from, say, the privatisation of electricity.

Can it be long before agents for various NHS providers are knocking on our doors urging us to choose their particular firm when we next get ill?

There are some basic truths we should not let the politicians’ rhetoric obscure. If health or education is based on the market there will inevitably be success and failure, winners and losers, and boom and bust.

The “top” schools are already ten times oversubscribed. They can’t react to their popularity by instantly building nine new schools to go alongside the present one!

So they select—and the selection, as ever, favours the better off, the people who are confident, the people who know people who matter.

So choice ends up with favours for the rich and disappointment for the majority.

Imagine the same system now with hospitals.

The last thing you want when you are ill is to be given false choices. You need an operation—has your GP or consultant really done their homework and looked for the best choices? Someone at work reckons that they searched the internet and saw a better one 400 miles away—and someone else says if you go to a third place you get first priority for your child’s next operation there.

It will be all the stresses and misinformation of choosing a mobile phone—except it will be about pain and perhaps even your life.

The “dynamism” of the market inevitably means more uncertainty. One example is private pensions.

Now there is huge “choice” but there is more fear than ever that your money will get stolen or disappear in the bankruptcy of a private firm.

The choice agenda will mean we live even more in the age of anxiety. Is your child’s school or hospital about to be downgraded or even closed?

And Blair’s plans mean diverting money from public services to private health companies and privately run schools.

“Choice” is not the way forward. The government should invest in all schools and hospitals so they all reach a decent threshold, rather than letting the market drive some hospitals and schools, along with those who work in them and use them, to the wall.

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Sat 10 Jul 2004, 00:00 BST
Issue No. 1909
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