Deficits not for turning
Ham is right to be sceptical about the private turnaround teams1.
Personal experience with “franchising”, a similar process, has led me to a
similar position2. There are 3 main reasons why faith in their abilities
Firstly the private sector under-estimate 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. Like chaos theory, one small action within the
organisation can have a myriad of unforeseen consequences for the whole
Thirdly, there are major structural problems with NHS finances and
organisation. Resources are not distributed with equanimity at the
national and health authority level. Only selfless political leadership
will resolve these problems.
Ham is right to point out that the solution lies with the full engagement
of clinical teams. However the Department will have to rebuild confidence
in clinicians and managers. It may be unpalatable to hear, but after years
of being blamed for the failure of the NHS, managers and clinicians at the
front line have distaste for all things central. It is time to stop trying
to remodel the NHS in the mould of the private sector, take stock of the
successes over the last 60 years and reaffirm its founding principles.
Then the experience of the NHS workforce should be brought to bear on the
problems of the NHS. Local teams must be allowed to take risks and
politicians should have the courage to support them, even in the face of
opposition from the public and vested interest groups.
1. Ham C. Turning round NHS deficits. BMJ 2006; 332: 131-132
2. Churchill D, Zissman B. The facts about franchising at Good Hope
Hospital. (letter) BMJ 2003; 327: 412.
Competing interests: No competing interests