Don't always brand private providers as 'bad'

Last week, I wrote about the need to challenge our assumptions about 'public' and 'private' healthcare providers.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

Not only does everyone involved in healthcare work for profit, but the more that the profit motive is ignored within an organisation, the greater the risk of that unit developing serious systemic inefficiencies.

So let's turn the whole argument on its head. Rather than worrying about who makes what level of profit, let's look at it from the taxpayers' point of view. The question now becomes: 'How much healthcare do taxpayers get for their money?' If, by being thoroughly efficient, the private sector can deliver more for less cost, why use the NHS as the provider?

The problem is the difficulty of comparing like with like. Do private providers cherry-pick the easy cases while leaving the complicated (and therefore expensive) ones with the NHS? Are standards of cleanliness and of staffing levels within the private sector better or worse than in the NHS? (Former patients of the Mid Staffordshire Hospital may well have an opinion here.)

In other words, we have to ensure, whoever the provider, that the level of remuneration is commensurate with their effort, responsibility and the risks - or to put it another way, that at all times the taxpayer gets value for money. This is yet another reason why having a national tariff is counterproductive: it doesn't allow for subtle price variations to take these important factors into account.

Private providers may well be an efficient way for the NHS to perform routine high-volume procedures, such as herniorrhaphies and knee replacements. (And it is also important to congratulate the private providers when they do indeed perform to high standards at a sensible price.)

This is where the dispassionate monitoring of standards and conditions is vital. Whoever is the supplier, there must be a level playing field. One set of providers cannot be given preferential contracts or be allowed to select the easy cases.

It is time to move away from the simplistic dogma that 'public is good, private is bad'. Instead we need to concentrate on 'good value for money in all circumstances'. It's a much more practical goal, far more logical, and far less emotionally divisive.

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