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“Health service contracts should be won on quality, not on price”

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You turn your back for a few weeks and someone steals your health service and replaces it with an unwieldly street market full of rejects from The Apprentice, bartering with each other to see who  can win a contract to run cancer care services for £149.99 plus expenses.


Meanwhile our future workforce – the students whose compassion and generosity of spirit will form the foundation of nursing for the next 50 years – are learning they have to pay for the privilege of training. Oh, and junior doctors are at risk of being run into the ground or out of the country depending on which is cheaper.

I wonder, given that we appear to be unwilling or unable to fight this nonsense, might we want to consider joining them?

Health service contracts are sold to the lowest bidder (unless that bidder is the NHS obviously). Companies such as coffee shop chains, sofa retailers or even fast food conglomerates could bid for the right to run clinical services – if they win, you could win a free sofa bed if you enter your prostate examination into their special draw.

From the emerging healthcare companies’ viewpoint the incentive is clear: making money. They will argue that the best way to do that is to be cheap and efficient because that works in their main areas of expertise, as evidenced by the trains providing such a good service for example. After all, healthcare is no different from any other business really is it. Is it?

Meanwhile from the point of view of a government determined to grow a marketplace that drives prices down, competing providers are good too aren’t they? Competition creates value for money. Or at least it does a good impression of creating value by simply making things that should be valuable cheaper – which isn’t the same thing at all but who cares as long as it costs less?

What is clear is that old-fashioned dinosaurs like me need to get with the programme. So how about we start a business that competes with these new companies and bid for services? I know we may lack business acumen and the right contacts but if we decide to run as a not-for-profit corporation we’ll have a big advantage over our rivals. We won’t have to pay sleeping partners, shareholders or even fund tax havens so our overheads are reduced immediately. We could spend the money on nurses for example. Cheaper than a shareholder and far more useful.

Then – and this is where the cunning plan gets really cunning – we run services as they should be run. Led by clinicians, with money going into service provision rather than profit generation or corporation growth. We offer  clinical markers that take into account longer-term outcomes and we reclaim the language that measures success. Don’t measure a hospital admission by how long it lasts, measure it by how much it reduces the need for readmission, for example.

Then we grow our company, we build on our successes until we are accused of forming a monopoly. We chase other companies out of the marketplace and let them sell broadband or homeopathy. And we change our name to something with the word “national” in it. And the words “health”. And “service”.

Or – and here is my back-up plan, which I concede we may well need – we all just give up now and do something easy involving ceramics, scented candles or  growing interesting shrubs…

Oh well, regardless of the madness that invites such petulance I wish you all a loving and peaceful Christmas. When it comes.

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe

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