Headlines: July 7th, 2006

The structure of the National Health Service is described as a ‘worm-infested sham’ in a hard-hitting comment article in today’s issue of ‘The Lancet’. The article says the service is a shadow of what it once was and goes on to call for politicians and mandarins to step aside so that problems can be tackled with clarity of thought and planning that is independent of personal conflicts of interest.Under the heading “Mismanagement as a prelude to privatisation of the UK NHS,” William Jeffcoate, a contributing editor at the magazine, pins the blame for the steady decline of the NHS on the failure of those in control to understand the difference between a business and a service.

Mr. Jeffcoate takes as his starting point the reports last week that the Commercial Directorate of the Department of Health was advertising for expressions of interest in managing the purchase of clinical services from healthcare providers in the UK. The advert was later withdrawn but Mr. Jeffcoate writes, “This apparent gaffe should make it blindingly obvious to all who were not previously aware that the National Health Service is being rapidly, cynically, and deceitfully privatised.”

The NHS, he says, was once a phenomenally successful institution which was close to providing first rate care round the clock for rich and poor at home and in hospital. It was also remarkably cheap, harnessing the underpaid professionalism and dedication of health-care professionals and ancillary workers and was run by a minimalist system of management. “The whole structure of the once great NHS is now a worm-infested sham-a crumbling edifice which consumes increasingly vast sums from the national purse while delivering a service which is progressively shoddy,” the article argues.

In spite of repeated managerial restructuring, he says, the service has declined because of the failure of those in power to appreciate that there is a fundamental difference between a service and a business. A service is based on humanitarianism, while a business is based on self-interest.

Attempts to cut the cost of the NHS have used business methods, leading to failure. To run the service like a business it has been necessary to employ increasing numbers of administrators-in both primary and secondary care. “But the business was always doomed to fail, for the simple reason that there was no real commodity for sale and no real purchaser, and all that was being achieved was the exchange of debt,” he writes.

But he believes the NHS is not irretrievably doomed and that a first-rate, centrally funded service could be viable. It would be viable if run by private industries but he argues that would lead to greater costs because of the need for profit and would result in care being rationed and not always available to the disadvantaged. He concludes, “This is the crying tragedy that underpins the whole process: the NHS could be saved, but only if there is a real desire to do so, and only if the task were tackled with clarity of thought, planning that is independent of any personal conflict of interest, and ruthlessness of implementation. Apart from the ruthless aspect, this is probably an impossible task for the politicians and mandarins who are currently charged with the job