Ethos vs Mechanics

 The recent NHS reforms have been accompanied by the mantra that services will continue to be free at the point of delivery. So that's alright then, well actually no. The key ethos of the NHS is that it is available to everyone when they need it. Being free at the point of delivery is only the corollary of this ethos. I pay for breakdown cover and, if my car packs up, I get towed home with no payment. The service is free at the point of delivery, but I only get the service I have paid for.

Introducing more private provision into the NHS weakens the underlying ethos of care being available when needed, because the driving force behind a company is to generate profit. There are plenty of examples where private companies have not put their customers first (insurance and pension mis-selling, Southern Cross care homes, breast implants).

The biggest issue is not necessarily that things go wrong, public organisations can provide poor service as well, but how quickly issues are put right. Private companies will fight to protect their profits (it's their reason for being after all), look at how long it took for the insurance companies and banks to admit liability over the mis-selling of various products. In the case of the breast surgery the main providers of the PIP implants have refused to carry out corrective surgery and the NHS has acted as the safety net. When things go wrong in the public sector, the politicians have more power to take corrective action.

The NHS is far from perfect and includes perverse incentives (too many targets, an obsession with structural change), but the ethos is that the patient should come first. For private companies that will only be the case whilst the patient generates a profit. The argument over how the NHS functions masks the real focus which should be on why the NHS exists – to provide healthcare to all. The only questions we should ask are:

1. What is the best thing for the patient?
2. How do we allow staff to deliver that care most effectively?

The market can generate innovation and necessary change, but it cannot ensure everyone gets the healthcare they need, when they need it.