BMJ  2006;332:363 (11 February), doi:10.1136/bmj.332.7537.363-b

Letter

Turning round NHS deficits

Deficits are not for turning

The first 150 words of the full text of this article appear below.

EDITOR—Ham is right to be sceptical about the private turnaround teams.¹ Personal experience with "franchising," a similar process, has led me to a similar position.² Faith in their abilities is misplaced for three reasons.

Firstly, the private sector underestimates the wider responsibilities of hospitals. Unlike the private sector, public institutions are not free to simply disinvest in non-profitable areas. Accountabilities run wider than just the organisation itself, into the wider local community. Also the demands of transparency and the burden of governance are more stringent.

Secondly, the private sector does not genuinely comprehend the complexity of medical care. As in chaos theory, one small action in the organisation can have a myriad of unforeseen consequences for the whole system.

Thirdly, NHS finances and organisation have major structural problems. Resources are not distributed equitably at the national and health authority level. Only selfless political leadership will resolve these problems. . . . [Full text of this article]

Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton WV10 0QP david.churchill@rwh-tr.nhs.uk

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