Frank Dobson: The last thing the NHS needs is another dose of the private sector

'I suggest that ministers tackle the grotesque shortage of nurses with a big pay increase'

Internal links

Dobson fears patients will suffer in NHS reforms

"Just let us alone so we can get on with our jobs." That is the sensible response of most people in the NHS to the Government's latest proposals for another round of management reorganisation and yet more involvement by the private sector. They are fed up with such upheavals because they know that the process costs money. Even more importantly, it consumes the time and energy of the people involved. By distracting staff from the day-to-day work of treating and caring for patients, it will be bad for those patients, for the staff themselves and, consequently, for the Government. As Tony Blair said yesterday, we will be held to account by the voters if we fail.

Most people, in most parts of the country, most of the time, get a good service from the NHS, but a lot still needs to be improved. It needs higher standards of treatment and care. It needs more money, more staff, more beds and better equipment. That is what it's getting. National clinical standards are being set. New hospitals and modern equipment are coming on stream. More nurses and doctors are at work, and even more in training. The number of beds is rising. And record levels of funding are going in.

So what is needed now is a concentration of effort to make best use of the new resources to meet the new standards, not blue-sky reviews or a national debate about alternative methods of funding. It means practical work to modernise appointment systems, improve cleanliness, reduce hospital infections, prevent assaults on staff and make better arrangements with social services. It means recruiting and retaining more staff and making the best possible use of our doctors, nurses, midwives and therapists. It does not mean reforming the whole NHS yet again.

But that is exactly what the Government is proposing. It wants the management of so-called "failing" hospitals franchised out to the private sector, and for the most successful hospitals to be given "foundation" status, free from direction from the centre. It is undoubtedly true that one of the biggest problems for hospital managements has been that too high a proportion of the extra funds made available to them has been earmarked by the Government for particular tasks. I must take my share of the blame for that. But by the time I ceased to be health secretary, I was conscious that they needed more discretion. The obvious answer is less earmarking, and that could start today.

Probably the biggest early increase in the productivity of NHS nurses and doctors would be to relieve them of their burden of clerical work. Accurate, up-to-date and readily available patient records are crucial. The clerks who used to do this were got rid of in the name of efficiency so nurses and doctors had to take it on. Giving the clinicians more clerical back-up would give them more time to treat and care for patients. This sort of practical change would do no end of good.

Let us look much more critically at the practicalities of franchising NHS management. The big question is: where are the senior managers with relevant experience and a proven record to take on these franchises? Who could do a better job of running the Leeds acute NHS services – two teaching hospitals, 3,000 beds with an occupancy rate of 90 per cent plus, 12,000 staff including 1,200 doctors and dentists, thousands of emergency admissions and more intensive care beds than the total beds of the average private hospital? UK private hospital managers couldn't.

Most private hospitals are small, low-tech, 35-to 50-bed outfits with low occupancy rates, no emergency admissions, usually dependent on a nearby NHS hospital to help out when they can't cope or when they need an intensive care bed.

Or the NHS could "let" the franchise. Then the company with the franchise hires existing NHS managers on higher pay and sells their services back to the NHS; not much of a bargain for the taxpayer.

What about new management without healthcare experience? The Tories tried it, but many of the managers had to be invalided out. Few if any successful private-sector managers would take on a more difficult job for less pay. So the NHS would get the less successful, the ones who are out of work, or management consultants who've never actually run anything.

The idea of NHS hospitals with "foundation" status bothers me even more. It is claimed they would be interfered with less and would be able to raise money by selling off assets and spending the takings as they wish. That would mean the proceeds of land or property sales would no longer be shared across the NHS. So it would bring most help to the hospitals serving areas with high property values (usually the ones with the healthiest populations).

Using these extra funds, the foundation hospitals could offer better pay and so recruit better qualified staff. Where from? The non-foundation neighbouring hospitals, of course. So the hospitals most in need would lose their best staff to the ones least in need – "to them that have shall be given..."

So I am dubious about the whole concept of the Government's reforms. But even if they were a good idea, this is simply not the time. Over the next few years the interests of patients, NHS staff and the electoral fortunes of the Government would be best served if everyone in the NHS concentrated on delivering the best care possible in their clinic, on their wards, in their kitchens, in their operating theatres, in A&E units. I fear that the Government's new proposals would mean the reverse. Senior hospital managers will be scurrying round, calling meetings about applications for foundation status, spending our money, splashing out fees on the uncaring professions – management consultants, lawyers, accounts, valuers. Looking after patients will have to be done in the time left over.

The successful hospitals prove the NHS is capable of providing good management. The quickest way to improve the worst hospitals is to use the management techniques that work in the best hospitals. Unromantic, undramatic, certainly, but the only sensible way to bring about improvements that patients can see over the next two or three years.

If the Government wants to see some early visible improvements in the NHS results, I suggest that ministers: reduce the earmarking of funds; cut the clerical workload of clinical staff; and tackle the grotesque shortage of nurses and midwives with a big pay increase. Such changes would be popular with patients and staff, and would also be a healthy move for the Government.

The writer is a former Secretary of State for Health