Private healthcare managers could be sent to turn round failing NHS hospitals

Private managers could be brought in to run failing hospitals under measures to tackle poor performance in the health service. Alan Johnson, the Health Secretary, is to announce rigorous standards of quality, safety, cleanliness and financial management for all hospital trusts, making it easier for inadequate managers or chairmen to be dismissed without large payoffs, The Times has learnt. Under the controversial plan, which has strong backing from Gordon Brown, managers could be brought in from the private sector or from elsewhere in the NHS.

Ben Bradshaw, the Health Minister, told Channel 4 News last night: “What we’ve never done before is to allow the private sector to take over the running of a whole hospital in the form of a franchise, which is one of the options that would be included in this performance regime. What we know from our experience of involvement in other parts of the health service is that the private sector can bring different skills, different management skills, different techniques.”

Doctors, politicians and unions gave warning last night that the measures risked undermining the fundamental principles of the NHS. Ian Gibson, Labour MP for Norwich North and former chairman of the Commons’ Science committee, said: “The privatisation of the NHS is becoming less than subtle. This is a blatant snub to the health service.” A spokesman for the British Medical Association, the doctors’ union, said it would have “grave concerns if the private sector took over [NHS] management”. “There is already an immense amount of talent within the NHS – in leadership and management – and this should be nurtured to ensure NHS trusts do not find themselves in a position of failure in the first place.”

A key new performance measure will be levels of Clostridium difficile or MRSA infections. There are 20 trusts that are classified as “weak” in the Government’s ratings and they will come under early and tough scrutiny.

The plan has been adopted enthusiastically by the Prime Minister, who hopes to show that he will be as radical on public service reform as Tony Blair. During the Blair years Mr Brown was often accused of being an obstacle to change, and prevented Alan Milburn giving independence on borrowing to foundation hospitals.

Government sources said last night that Mr Johnson’s move would be the first of a series from Cabinet ministers aimed at improving public services. They promised stringent minimum standards “and real consequences for those who fail to meet them”. Managers and trust chairmen will have their contracts drawn to relate to their performance against the new standards. They face dismissal – without payoffs – if they are placed on a performance improvement plan and then fail to meet the deadlines set within it.

At the moment 30 trusts, out of 290, including mental health trusts, are responsible for 46 per cent of the cases of MRSA infection and 57 per cent of patients having to wait more than 18 weeks for their operation. A total of 20 trusts were rated as “weak” for both quality of services and use of resources in October, while there are also 16 trusts that are considered “financially challenged” because of long-term budget deficits.

A government source said last night: “We can proceed with the next stage of public sector reform only if we have tackled the failing hospitals and eliminated unfair variations in local services. But we can only do that if we have a stringent set of minimum standards and enforce them.”

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A flawed system of specialist credentialling in Australia

I have just failed my final examination before being deemed a medical specialist, along with half the people who sat the exam. This is despite each and every candidate being of the highest calibre, then working in the field for several years and undertaking backbreaking preparation for several months. A large proportion of the candidates had never failed anything academic before this final hurdle. A considerable number were sitting for the third or fourth time. Each had to pay several thousand dollars for the privilege.

Welcome to the college system of training doctors. It is a system grounded in traditions and old-school philosophies, much of it a throwback to the English guilds of previous centuries. Until recently, the results of these exams were handed to the candidates in the hallowed halls of college buildings. A door would then open for those who passed, who were offered a glass of sherry or soft drink, while those who failed were given directions to the nearest taxi rank.

There are few professional equivalents as archaic. The closest would possibly be the bar association for barristers, but even they have examination pass rates of up to 80 per cent. The market is then free to value their services accordingly. If a university course were run where half the students failed, the course would quickly be modified, dropped or there would be an urgent review of the selection processes. If a business undertook training of staff for a particular task and later found half to be incapable of doing so, the business would be highly dissatisfied and undertake immediate measures to ensure the vast majority were ready. They would have every incentive to do so.

The colleges have absolutely no incentive to pass anyone. Each and every person who passes represents a new competitor with access to the total pool of fees from specialist services. The same doctors deemed unqualified to practise independently are often doing the work of the specialists within the public hospital system while their bosses are running lucrative private practices.

The system is a reflection of the many inefficiencies and difficulties of our health system - rule by committees which are unable to respond to consumer needs and changing trends, little "outcomes measurement" and a disabling level of bureaucracy and duplication.

Last month, just before the 2020 Summit, Dr Bill Glasson, an ophthalmologist and former president of the Australian Medical Association, called for a greater range of health professionals to address the hopeless shortage of workers that our system suffers. This kind of statement would have been a heresy during his days as the AMA boss. But it is a reflection that our current system of training health workers simply does not meet the needs of consumers. Nowhere is this more true than with doctors, where it takes a decade and a half to produce independent practitioners who are then grossly overqualified for the relatively routine presentations they deal with each day. And when you consider that despite this and the gross shortage of doctors, that colleges do their best to keep the numbers as low as possible, it is a travesty.

The Australian Competition and Consumer Commission has already had multiple dealings with some colleges, particularly the surgeons, who have been forced to amend many of their practices as a result. And this year there has been a submission to the ACCC by a group representing training psychiatrists. If that is not enough, the Productivity Commission is investigating the low pass rates in several colleges.

As monopolies go, one feels that the number is almost up for this one. Macquarie University is attempting to set up an alternative path for training surgeons, despite huge disapproval from specialist bodies such as the AMA. In Britain, the system has been overturned, for many of the reasons stated above. While it has been implemented poorly and caused initial chaos, there is widespread agreement in Britain that doctors' training will be shorter, more streamlined and better equipped to deal with the public's needs.

Any changes here will take time. Meanwhile, I remember what a silver-haired eminent cardiologist said in my final year of university. After a casual teaching session, he gave me a stern look and said: "Son, now that you're almost finished the course, my advice to you is to get out as soon as you can. Things are going from bad to worse and it will be very difficult for you lot. Get out while you can." While I shrugged off the comments back then, now that I am demoralised and heavy with resentment, trapped within a public hospital system that utterly devalues me, I feel he was right. I regret not taking his advice.

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