The NHS and private medical care do not mix. Why isn’t that obvious?

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Time and again we have been told that the presence of private health care in NHS hospitals was an issue about which we should have no concern.

Yesterday we learned that there has been a significant increase in the amount of that private healthcare in NHS hospital trusts. That, of course, is hardly surprising. NHS hospitals are now allowed to raise up to 49% of all their income from the sale of private health care services and whilst none do make sales at anything like that (at present)  it would have been extraordinary if the directors of NHS Foundation Trusts (many of whom will, by self selection, approve of the broad thrust of government policy) had not taken the hint with regard to what has been expected of them.

The fact that those directors might embrace government policy, supposedly in the interests of the hospitals and communities they serve, does not mean that there is any obligation on us to agree with them on this issue and we would be wise not to do so. The reasons for that are, I should have thought, obvious.

Firstly, there is the simple and well known fact that when any issue is made for the target of attention behaviour towards it change. This is in the case of physics an idea enshrined in the uncertainty principle. In management it is well known that the moment you measure something it is automatically assumed that the issue has a higher priority than other issues. Inevitably, and almost invariably because management really do only measure things that are important to them, real on the ground behaviour changes to improve recorded performance. So, managers will undoubtedly be increasing their efforts to promote private medicine as a result.

Second, and as obviously, directors of NHS trusts also want to appease those to whom they report - which are not really the communities they serve but are actually the NHS's senior management and, in turn, Jeremy Hunt, whose reputation for micro- management is well known. That means they too will really focus on this issue.

And it is the focus that matters most. It means that mainstream care is not given the attention it deserves as priority is given to other activity that is both outside the NHS and has an ethos contrary to it. And the fact that care outside the NHS and with an ethos contrary to it is being promoted is not chance: this is, of course the basis for the US health care model to which this government seems dedicated despite its proven and profound inefficiency.

As a result it is not whether or not private medicine is wrong per se that matters. I would not ban it. I see no reason to. Nor would I VAT exempt it and so subsidise it either. What does mater is that management and services in the NHS are being distracted from their real task by private medicine. And that does matter, a lot. And that's precisely why the NHS and its hospitals should not be in this 'market'.

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