We should expect more questions than answers from good leaders
The conventional wisdom is that greater competition is needed in the NHS to drive out the inefficiencies that some believe are inherent in sectors dominated by publicly owned providers.
It is also assumed that anybody championing increased use of the private sector in supplying NHS-funded care will have a vested interest in pushing the change – either financial or, if a commissioner, greater control over established providers.
Gareth Goodier’s views, reported in HSJ this week, provide a welcome corrective to this lazy thinking. Dr Goodier runs Cambridge University Hospitals, one of the NHS’s best known foundation trusts, and as chair of the Shelford Group he represents the country’s 10 largest teaching trusts.
Dr Goodier rejects that notion that the NHS is “inherently inefficient”, while recognising the need for it to rethink how it operates in response to growing and changing need. But rather than suggesting the existing set of providers is sufficient, Dr Goodier wants to see private providers supplying a much higher proportion of NHS care.
He suggests that only when around 30 per cent of NHS-funded hospital care is provided by non-NHS players will we see the benefits of scale, with “big brands” competing to “keep the price down and quality up”.
His view begs many questions, most notably where these “big brands” might come from. The UK private healthcare sector remains underpowered and continues to struggle for financial stability.
But Dr Goodier’s opinions also raise another question, which is what do we expect from NHS leaders?
This week brings the second report from the King’s Fund’s authoritative and welcome study of NHS leadership. It stresses – correctly – how leaders, many of them clinicians, will need to adopt a style which embraces more staff and public engagement.
But engagement does not automatically mean agreeing with what staff and the public expect or even, in some cases, want. It is also about using the privileged viewpoint that leadership brings to challenge and to stimulate debate.
Private sector providers are very unlikely to secure the market share Dr Goodier calls for – and there are good reasons for that. But in stressing how significant change is needed to meet future challenges, Dr Goodier, on his departure from the UK, is leaving a great example for the next generation of leaders.