Privatizing the NHS?

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Yesterday Ben Bradshaw, the health minister, announced plans to allow the private sector to take over failing NHS hospitals. Gordon Brown backs the idea. On the one hand, this is a welcome development: the government is acknowledging that even in healthcare, private sector management can deliver better results at a lower cost. That realization bodes well for the public service reform agenda.

But the details of the plan are rather less appealing. The government will set a range of minimum standards that hospitals will have to meet. If they don't meet the standards, they will be given a deadline to turn things around. And then if they don't improve, management will be transferred to other NHS units or (potentially) to private companies operating under a franchise agreement (with lots more targets to meet).

Essentially then, this is about strengthening central control over the system. And, to adapt Reagan's line, central control is not the solution to the NHS' problems – it is the NHS' problem. Care is not focused around patients because management incentives all point in the opposite direction. Hospitals do not succeed by satisfying patients, but by meeting government targets. The targets are well intentioned, certainly, but they lead to bloated management, endless paperwork, creative accounting and distorted clinical priorities.

The NHS does need to be made more accountable – but to patients, not the government. Hospitals should be given their independence, and patients should be put in charge of their own care. That's the kind of 'privatization' I'd be in favour of.