Sunday, 3 July 2011

The NHS: smaller isn't always better

Central to the Cameron project are two key concepts: first, that the state should no longer be the default provider of public services and, second, that the fewer large, hierarchical public sector organisations there are, the better. Better still that the invisible hand of the market determines priorities than central planning.

The NHS reforms, of course, were an attempt to do just that: GPs, clinicians and hospitals are to become ever more autonomous. Previous posts on this blog have discussed the problem this poses for accountability that this approach would bring.

Calum Paton, professor of health policy at Keele University, has penned an article that addresses this issue, amongst others. In it, he makes the very valid point that the very same government that condemns public sector hierarchies ignores the fact that in business the approach is wholly uncontroversial:

"The hardest-nosed businessmen have no problem with accountability upwards within integrated organisations. Ironically, every time the Department of Health or the media calls in a Gerry Robinson or some other troubleshooter, the absence of a clear hierarchy based on accountability is the main diagnosis – not the absence of an elegant quasi-market".

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