Tim Almond

Gerry Robinson (ex-Granada, ex-Allied Domecq) has spent 6 months looking into the NHS. There’s a TV series on it starting this week, that I intend to follow, but there’s also a little taster from yesterday’s Telegraph.

It sounds like Gerry’s investigations show the same attitude I sense when I go into hospitals….

The theatres simply weren’t being managed in any way that I would recognise as being appropriate for an important and expensive resource.

"There was a schedule worked out, and kept to, by and large. But if somebody cancelled an operation, no one used that slot for something else. And then there were Fridays – the operating theatres were empty on a Friday afternoon."

Would a hotel do that? If a party booked a block of rooms and then cancelled, they’d be onto one of the booking agencies with a knockdown room price. So they could raise something, anything for the rooms instead of it sitting empty.

Not only was it wasteful in itself, but as the NHS system now means that money follows a patient – so the trust hospital where a patient is diagnosed as needing surgery must pay for that procedure even if it is carried out elsewhere – you are not earning the money you could be. It didn’t make any sense."

I would suggest to Gerry that he’s spent far too long working in business, where carrots and sticks exist.

"I had to overcome that myself when I arrived at Rotherham," he says. He understands why some managers might be daunted at the thought of carpeting a consultant who regularly shows up late for clinic.

Maybe I should apply for a job as an NHS manager.

It requires a "million-dollar man" (or woman) to manage the whole system: not a civil servant or a politician but one of those rare individuals of whom there are, he says, not more than 100 in the country, capable of running the third-largest employer in the world.

I don’t agree with this.

The problem with that is how do we know if that million pounds was well spent? Without comparison, we have no idea. OK, sure, we can set some targets, but the result of that is that people play the system. The targets get met, and are done by damaging the service elsewhere. With a competitive market, customers can use their experience, that of their friends, prices, press reports etc. and choose the option they like best. Managers will quickly learn to get consultants in on time, because if they don’t, and the hospital next door are, then the hospital next door will take their business away from them, and their shareholders will invest elsewhere.

In addition, getting the health service unions – traditionally resistant to reform and a problem for every government – on side would be a vital element of the job for a new NHS chief, he says. "Being efficient and businesslike is not against the spirit of healthcare that is free to the user at the point of delivery. It is a good use of resources; it is a genuine aim to deliver.

Aim - yes. Deliver - no. I believe that many people who support the NHS are well-intentioned. They believe that monopolies mean that there’s not all that inefficiency of competition, that monopolies can think more long-term. But if you start to look at the actual results of liberating the european airline market, or the opticians market, or the quality of Trabants, you realise that it doesn’t work.

He is, he says, a firm believer in the role of the NHS. "We have a responsibility to look after society from a health point of view."

There’s more than one solution to this problem. We don’t have centralised food shops where we get our free bread. We have Tesco, Sainsburys, Aldi and Waitrose that all compete. Since 1970, the percentage of a family’s income that goes on food has been cut from 17% to 10%. But there is protection in the system. People who cannot work are paid benefits to ensure that they can afford to eat. It works.

My own solution is not a million miles away from what happens with NHS Dentistry. Health isn’t like food. It’s more sporadic and so, having an "insurance" element is important. You choose your health providers, and you pay a proportion of the cost, and the government picks up the rest. For people on benefits, the state covers the costs. The reason for the "proportion" is to apply pressure on costs, without which efficiency will not happen.

Tags: Politics, Business, Health, Television //