Someone has to say it…

Losing an illusion makes you wiser than finding a truth (Ludwig Borne) – I keep reading posts from people who “want to protect the NHS”; its time this illusion was busted…

You may feel like you’re about to be told there really isn’t a Santa, but please remember that worked out OK for us all in the end didn’t it. So here goes; there isn’t a National Health Service in the UK, not in the simple functional way that most people think of it. Yes, there is a publicly funded health service that is available to varying degrees across the UK, in different formats depending on where you are and when and where you access it. But its not a Nationally Consistent Service. Its not the same in each area in the way that a franchise or tightly controlled global business might work. There is no effective central leadership or management from a controlling hub or business unit that is entirely focused on ensuring customers get the same standards and experience wherever they touch the service, there are few shared visions and even less agreed versions of what good looks like, there are no common standards for the way to be greeted and treated once you access the service and there is no brand manager overseeing the details of customer touch points to ensure each interaction is consistent.

UNICORNThere are hundreds of very different “NHS Trusts”  sitting under the NHS umbrella. They are paid from the Public Purse to provide health services and most of them do things differently to each other. The people overseeing this “Nationally Variable Service” proudly display their differences under the tiresome and over-worked Public Sector mantra of, “one size doesn’t fit all” … those of us who live in the real world and who just want good services call this inconsistency. Is it worth pointing out at this stage that we have nationally consistent rates of tax?

But if we let the profit mongers of the Private Sector in on the act, then they will cream off all the profits and give them to shareholders. The current swathe of NHS Trusts is sitting on billions in reserves, they are afraid to commit to any expenditure that would incur ongoing costs and have minimal ability to plan their futures strategically and invest in services. These NHS Trusts are simultaneously stifling innovation whilst stockpiling reserves in a way that is less transparent than most global profit seeking corporations.

But privatisation will be the end of the NHS … this is confusing competition with privatisation; they are not the same thing. The system is essentially privatised now, real competition at the level of provider (not consumer) is what’s needed. The current system offers taxpayers and service users the worst of all worlds, fragmentation, minimal transparency, inconsistency and the pretence of quasi-competition … nicely topped-off with the inherent ineffectiveness of the Public Sector. A heady cocktail if ever there was one, but not a recipe for delivering great services!

Advocates of the current system talk about the incredible brand loyalty of the NHS and how private sector companies would give their back teeth and more for such loyalty; they forget that most NHS service-users are not customers but compliers. There is no readily available alternative on offer and the public’s loyalty to the NHS is for what they might desire and think the service to be; which is often not an accurate reflection of what it is.

There are of course those who would have you believe that the private sector barbarians are at the gate waiting to pounce upon the precious national treasure that is the NHS, but they are misled … it is the commercially profligate barbarians and the cultural Luddites that are firmly camped on the inside of this crumbling once great city, the civilized liberators and the skilled re-builders are trying to break in from the outside.

It seems that the people who want to protect the NHS either aren’t really sure what it is they think they want to protect, or they’re being disingenuous and playing politics … but what am I thinking, of course people would never play politics with such an important thing as our health; would they?


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