On Question Time this evening (2015-11-26) the ‘Should we privatise the NHS?’ question came up again. It was stated that the German and French health services are more efficient (whether this is true is open to endless debate) and that the reason was private sector involvement.
Despite the fact that many people in an audience to such discussions must have experience in both the private and public sectors, no one ever challenges this notion of the highly efficient private sector. As Jeremy Hardy once put it, “The private sector is just incompetence combined with greed. At least the public sector is well-meaning incompetence.”
Even if we accept that the private sector is more efficient, is there a route to this holy grail that doesn’t involve the profit toll?
Inefficiencies in the NHS, and elsewhere, are down to inexperience, the modern tick-box culture and greed.
I attended a meeting held by the recently appointed Managing Director of an NHS hospital. He was utterly unapologetic for his 6 million pound salary. A Year later the Trust went into special measures, and he walked off into the sunset. Managers brought in from the private sector see the NHS as a soft touch, which it is: a conglomerate of beleaguered Trusts desperate to solve their problems and hoping against hope that a little private sector magic will make it all better.
Up until 1871, well heeled aristocrats could buy a commission in the British Army, no experience necessary. Fortunately today the officer ordering you into battle is not telling you to do anything that he hasn’t done before, and isn’t willing to do again. Sadly British management has yet to catch up with it’s military counterpart. However good your Business Studies degree, it will never be any substitute for real experience of that which you are managing. Most NHS managers have never done any of the front-line jobs.
“Rules are for the obedience of fools and the guidance of the wise.” However paraphrased, I find it hard to believe that this gem of advice arrived as recently as the Second World War. Unless, of course, the problem it addresses really did manifest in the Twentieth Century. Either way, this Group Captain’s counsel has gone unheeded and we now live in a society with the motto, ‘rules are for the obedience of everyone because wisdom is in short supply’. And wisdom in NHS management is in short supply because it’s all being run by bureaucrats with MBAs. No organization is as bogged down with rules, tick-boxes, and those happy to worship them as is the NHS. If absolute rules solved anything then we could do away with people altogether and run everything by computer.
So who do we get to solve the problems? Some people are driven by money, but others are driven by a desire to get things right and do things properly within the profession they love. Identify these people, and put them in charge. And when things do go wrong, which they still occasionally will, judge the reasoning not the tick-boxes.
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