Chris Lancelot: NHS set to follow economy into meltdown

The global credit crunch should serve as an awful warning to everyone, whatever their field of work: a bad deal is still a bad deal, even when well-disguised. Ultimately the markets will sniff out a duff arrangement.

And, like the sub-prime market, the NHS has been developed on a series of extraordinarily bad decisions dressed up as something clever, innovative and modern.

The private finance initiative - a financial wheeze to stop the government having to put capital expenditure on its balance sheet - will drain billions from the NHS over the next 35 years; the absence of joined-up management stultifies drive and dedication among healthcare workers; and managerial intrusion and excessive data-gathering paralyses healthcare activity and perpetuates inefficiency.

Then, there is the assumption that the incredibly efficient gatekeepers of the NHS (GPs) will always be there to mop up every outstanding problem - despite having the viability of their practices undermined; that commercialisation of the easy bits of healthcare somehow represents a move forwards; that despite its vast time and financial requirements practice-based commissioning in some way saves resources; and that the National Programme for IT is an economical and efficient solution to NHS record-keeping and messaging.

These are fruitless strategies that, like those underpinning the sub-prime market, will eventually surface to wreak their special brand of havoc.

Just as market forces have exerted their corrective effect on the world economy, so they threaten the NHS as debts mount, professional advice is ignored, wisdom is replaced by 'cleverness', and the whole over-complicated machine grinds to a halt.

Like the law of gravity, economic forces are too basic to be overturned. You can bend the market (for a time); you can postpone its effects; you can disguise it with sophisticated management-speak, but ultimately the truth will out. Wherever the NHS is built on shaky foundations or a non-level playing field, economic forces will eventually force a reconfiguration, at considerable cost.

So beware. Last month it was Fanny Mae, Freddie Mac and Lehmann Brothers: how long before it's the NHS?

Dr Lancelot is a GP from Lancashire. Email him at

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