Does the NHS need a 'new broom' from the private sector?

New NHS boss Simon Stevens will inherit an NHS in crisis. Will his outsider status and private sector experience be just the new broom the NHS needs - or is that part of the problem?

David Zigmond
13 November 2013

Against a mounting litany of concerns about the NHS, some seem to be pinning their hopes on Simon Stevens, David Nicholson's replacement as the new leader of the NHS.

For example in a recent letter to the Independent Ann Kemp (Outsider right choice to lead NHS, 26 October 2013) expresses confidence that because Stevens is an experienced outsider this will endow his perspective with greater clarity and realism than those blinkered by a working lifetime in the NHS.

I am one of the partially-sighted latter and I disagree with much of her argument and prophesy. Yet I hope she is right – after four decades of medical practice I shall need my successors to care for me. I hope they will do it better than we do now.

My experience of ‘outsiders’ contribution of wisdom, initiative and innovation to NHS operations and culture seems very different to Ann Kemp’s. What is the legacy of twenty-five years of industrial gurus, business consultants and monetarist economists? An increasingly industrialised and depersonalised healthcare in thrall to the 3Cs: commodification, competition and commercialisation.

What has this meant? Since the radical purchaser-provider split, and then the machinating machinery of the Internal Market, we have a service that, increasingly, can deal with the technical but not the personal. A service that manufactures treatment procedures but cannot nurture healing relationships. One which slickens protocols, but neglects care.

In our new corporatised, marketised NHS, healthcarers’ careers may be sharply successful, but are now rarely deeply and quietly vocational. Our mental healthcare seems to have lost interest in the essential complexity of human attachments and meanings, in favour of rigid, centrally determined packages of ‘treatment’. Increasingly large General Practices do not know their own staff, let alone their patients.

Hospitals vaunt Foundation Trust status, employ Spin Doctors to ply glossy brochures, induce favourable reports from Inspectors and Commissioners, and then specious statistics to assure economic and diplomatic survival.

Meanwhile – in these same hospitals – the real doctors abjectly witness and perpetuate shocking failures of care with silent, bemused acquiescence. This is the Shadow of the Internal Market’s alluring persona – a sullen fragmentation of, and disidentification from, our sense of personal vocation, responsibility and care.

Mid-Staffs may be a particularly horrible example of all this, but it is one of many – their value is to show us where the 3Cs can mislead us in healthcare.

Such are the perverse and unanticipated fruits of those who urge us to submit complex human needs Welfare to accelerated industrial expedience or commercially fuelled competition. Few working in healthcare wanted or supported such changes; it was the outside ‘experts’ who enjoined. But our struggle for survival ensures expedience, then social conformity. Healthcare workers will clamber aboard what is afloat and rapidly learn to be Commissars, Apparatchiks or mere Healthdroids. That is how we produce our industrialised healthcare atrocities.

Expert outsiders providing rapid and felicitous healthcare reorganisation? Not again, thanks.


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