The UK is one of just three countries in the world with a ‘nationalised health service’.
Some of our pride melts away when we learn that Cuba and North Korea are the other two, because we share few other traditions with either of these countries.
Maybe this is why both present and previous governments have increasingly flirted with private-sector ideas, in common with our European partners.
Some undoubtedly feel there is a fundamental ideological issue here, and Nye Bevan must be turning in his grave. But the alternative view is that British Leyland is dead and it behoves the NHS to examine different ways of delivering healthcare through a variety of effective contractual modes.
No one blames retail chains for concentrating on selling products rather than directly employing cleaners and other ancillaries. It is common business practice to contract out these services and concentrate on core business, which, in our case, is healthcare delivery. Why therefore should we feel uneasy about the ‘fragmentation’ of our NHS?
In fact, the business world could teach the NHS a trick or two in primary care.
There is an example in rural Suffolk which is testing the proposition that the NHS should command much better value in new premises.
A general practice in Saxmundham has been trying for nearly four years to build a one-stop shop to house health and social care, an ambulance station, a birthing unit, an NHS nursery and a community cafe, as well as ‘NHS businesses’: a dental practice, an optician and a pharmacy. The commercial clout of drawing patients to the site brings some other tenants distinct advantages so why should they not subsidise the NHS rent?
The PCT pulled out of the project for reasons that would not be tolerated in the commercial world. Through cross-subsidy from some other tenants (and even an SHA grant of £267,000) the PCT could have had this facility for no extra rent cost. However, it refused because it did not want to ‘raise public expectations’ as this could lead to ‘hitherto unmet need’.
So much for the centrally spouted but locally flouted tenet of access. The PCT itself described the project as ‘innovative and progressive’ last year when it formally rejected it after John Hutton had written that he hoped it could be progressed as soon as possible.
I do hope that the ethos of British nationalised industries is not still alive and dribbling in NHS management. If this particular gift horse opens its mouth any wider it will dislocate its jaw.
Dr John Havard,