Thursday, 1 March 2012

NHS: Public or Private?

Previous blogs have voiced my frustration at NHS inefficiency, and questioned what we are trying to "save" in the context of the NHS Bill. This doesn't mean I support the Bill; this blog looks at its implications from a performance management perspective.

Current focus may be on the NHS but this is just the latest of many government initiatives (CCT, Best Value, CAA, NHS Modernisation) aimed at bringing some private sector motivation and efficiency into public services. If you believe that the public sector is inept, inefficient and incapable of change, then something radical has to be done to control spiralling costs. Commissioning plus direct private sector (and third sector) involvement  is one way to do this.

The counterargument is that private sector organisations will prioritise profit above care, ethics and anything else that matters to the NHS, hence equality of access and standards of care will fall.

Of course, neither of these stereotypes is true for these sectors as a whole - although it's never hard to find striking examples of each. But it's equally possible to find great examples of innovative improvement in the public sector, and outstanding examples of care from private providers.

From a performance perspective, I don't believe there's anything inherently 'bad' about either the public or private model. It's as much about mind-sets as mechanisms, and a carefully-constructed performance framework could support this by demanding the right balance of clinical, financial and patient-based outcomes. So for examples, private providers would have to demonstrate their ability to deliver equitable services as judged by patients, and that they don't just cream off the most profitable business. And those in the public sector would have to demonstrate an ability to manage within plausible financial limits, and that they don't view the NHS as a bottomless pit of money.

My real reservation with the Bill is one of transparency. As others have commented, it seems to allow the Government to make future budget cuts without being accountable for any consequent reductions in service. Whilst it could be argued that this is a further stimulus for greater efficiency, experience suggests that few organisations have the capability and maturity to respond in this way. It's much easier just to make cuts and blame someone else.

What we need is honesty about money and honesty about the outcomes - community as well as patient-based - that we want to achieve, together with a transparent framework that captures these outcomes. And then have everyone working towards those goals.

Check my web site at for more information and ideas.

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