News from nowhere

In a recent meeting that was not open to the public, but not governed by confidentiality rules either, an advisor to the Secretary of State for Health explained why the government is so committed to introducing private management into the NHS. The problem that private managers can solve, but NHS managers cannot, is the problem of orthopaedic and ophthalmic cartels.

These are local agreements between surgeons in these specialties and their colleagues in anaesthetics. The agreements are based on practice in the private sector, but overspill into the NHS. The surgeons and anaesthetists make a lot of money out of private surgery, and want to keep their privileged positions. They do not want waiting lists too short, because long waits are good for private practice, and they do not wanting waiting list initiatives to work.

So obstacles are created for NHS managers who want to rearrange operating sessions and rotas, mixing and matching surgeons and anaesthetists, and introducing new staff. NHS managers are mindful of the need to keep local services going. So they try to work around the cartels, thereby colluding with the vested interests of professionals for whom the NHS is merely a base from which they can work.

Private sector managers will have none of this, according current ministerial orthodoxy, because they are concerned with ‘the bottom line’ – the numbers of operations, the length of the waiting list – not the harmony of the hospitals. They are less likely to collude and more likely to confront the cartels.

News from Nowhere moles are sceptical about this argument, for many reasons. Anyone who has worked in, or even had contact with, commercial industries will have encountered collusion, risk-avoidance and even cartels. If surgical cartels are such a significant obstacle to reform, why not say so? This will make the people waiting for hip replacements and cataract extraction even angrier than they are already, and that anger can be directed at its cause, the divided loyalties of the surgeons. This will put the profession’s political bodies and apologists on the defensive, and make it easier to engineer change at local level. The belief that the private sector has some magical power to take risks is just that: belief.

If confrontation with the cartels is desirable, why not just do it? A selected sample of cartels can be identified and targeted for managerial intervention. If necessary staff can be suspended, or even sacked, and replaced by (say) surgeons recruited from Europe. The fuss would be enormous, of course, but if the political groundwork has been done first the NHS should be able to survive the reaction. After all, sleaze and corruption are unpopular.

This makes us wonder why the minister needs outside help…could it be that the collusion that NHS management seems so guilty of is also a feature of the Department of Health, or even the Secretary of State?