The mundane malfunctioning of markets – a tale of life and death

We are currently awaiting the fourth visit from a well-known high street electrical retailer to fit a new hob in our kitchen. The first two visits led to a new hob being fitted, only to discover that the new one was faulty. The third visit occurred on the wrong day. No one was at home. When my partner phoned to point this out the company had no record of the booking. They couldn’t revisit on the date we’d agreed (today) because there were now no available spaces. So they are coming next week. Fourth time lucky?

Clearly this is not the end of the world. Rather more salad is being eaten than is normal for this time of year. And there is more oven-based cooking than typically happens. But it isn’t a disaster.

This is the mundane reality of markets. They don’t always work very well. And sometimes the consequences can be considerably more significant.

There are some exemplary private providers, whose consumer care and professionalism is beyond reproach. But there are some absolute incompetents and charlatans out there. Some of them are long-established high street names. Those harsh winds of competition don’t seem to have been sufficient to discipline them into improving their performance over a period of many years.

Anyone who has their eyes open and is paying attention knows this from personal experience.

It is therefore all the more striking that current discussions about provider diversity and the marketisation of public services are being conducted on the basis of caricatures and idealisations (as I discuss further here). There is the caricature of the Stalinist inflexible and inefficient public sector monopoly and the idealisation of the consumer-focused, responsive, innovative and efficient private provider. The dismantling of the NHS and the attempt to privatize most public services, which is apparently imminent, are driven by discourses operating entirely on the basis of ideal types, not the reality and lived experience of markets.

The failure to install a hob first time round is of no real significance, just inconvenience. But this morning I read Hugh O’Shaughnessy’s account in the Guardian of the end of life care provided to his terminally ill wife. An objective of his account was to highlight the contrast between the standard of treatment received from over-stretched public and not-for-profit providers, driven by an ethic of care, and the much poorer standard of service received when private multinational service contractor became involved in the process, apparently driven by an ethic of “don’t care”. The piece was genuinely moving and thought-provoking. It provides an insight into the mundane malfunctioning of markets in a situation where it has much more profound consequences and human costs. Clearly that is the rhetorical and political purpose of the piece. In one sense the message is simple: if you pay peanuts – unless providers are motivated by something other than money – you get monkeys.

If you haven’t read O’Shaughnessy’s piece, please do. It does a great job of humanising policy debate. It makes clear what is at stake. It isn’t just about the dry technicalities of billions of pounds in spending, or saving, or redrawing organisational boundaries and changing contracts and incentives. It is about all those things and more. It is about quality of life. And death. It is about the respect with which we would expect fellow citizens to be treated in the situations of extreme emotional and physical vulnerability. And about how we would wish to be treated ourselves. It tells us much about the very nature of a society.

And if you are not in the slightest bit moved by O’Shaunghnessy’s piece then perhaps it might be a good idea to check your own vital signs.

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  1. Fantastic post – thank you…!

    I found the Guardian piece particularly moving – I lost my Grandfather on Monday and we went through something very similar, experiencing incredibly sensitive and clinically very good care from NHS nurses.

    I had an observation. The nurses assigned to my Grandfather’s care during his 5 day stay were all staff nurses, not agency – they therefore were invested in the ward, knew their patients, and cared – not just about the patient but about the family too, calling him Pappa (our name for him).

    A truly humbling thing seeing underpaid nurses (I’m an academic research scientist and I get paid 40% more that what a nurse does) doing heroic work, in awful conditions – the hospital was crumbling because of the crippling PFI repayments and failure of the (contracted out, private) cleaning and maintenance staff to do their job properly – and yet the NHS guys were just brilliant.

    I hope to see you at Lib Dem conference, where there will be a fierce debate over the government’s plans for the NHS…

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