One of the little difficulties of life is that some folk just have knee jerk reactions. Take this from Polly Toynbee about health and social care:

Here’s how the Northumbrian plan works: Mackey’s trust has bid for social care contracts from local authorities that would usually be awarded to private providers. The NHS foundation will seamlessly integrate domiciliary care within the health service. Mackey plans to build care homes to take over residential contracts too, if he can raise the capital. Here is a smooth transition without bottlenecks between the two sectors, with health and social care funded from the same budget, with every incentive to stop people needing a hospital bed and to get them home quicker when they do.

Polly would expect us to think this is a disaster - see, this is going against the privatisation and contracting that the neoliberals insist upon!

We, those neoliberals insisting upon the privatisation and the contracting, insist that this is the point, the very purpose.

We don’t know - the government doesn't, the health trusts don’t and obviously Polly doesn't - know what the finest method of organising, in detail, this cooperation across health and social care is. Clearly there needs to be cooperation here. But between whom and how?

Which is what markets allow. The competition part of markets is the ability to choose whom to cooperate with. Further, in what manner will that cooperation take place?

So, in order for us to find out what is the best method of cooperation across these related fields we need to have markets so that the necessary experiments can be done to work out who should be cooperating with each other and how? If it turns out to be the health trusts doing it internally then fine, if it turns out not to be then also fine.

The entire point of markets and contracting is to set up the system so that we can find out. We are in a discovery process and that can only work if different people are conducting different experiments and thus illuminating the problem from different angles.

Now we do have our own kneejerk here which is that we think integration under a centralised bureaucracy is unlikely to end up being the efficient or even equitable solution but we are willing to be pleasantly surprised by the outcome. For this is the entire purpose and point of the system. What is it that actually - on the ground, provably, reliably and copyably - works? Great, so let’s then go do more of that then.

It’s the finding out which justifies markets.