“Wanted: Business leaders to save the NHS. £90k-110k. Public sector workers need not apply.”

That’s how Salix Consulting summed up, in a blog, the gist of an advert in The Sunday Times to recruit “experienced business leaders from outside the medical arena” to join the NHS fast track executive programme.

‘You won’t get away with putting 90 per cent of staff on zero contracts in the NHS, or refusing to recognise trade unions’

So what is it that candidates from the private sector can offer that those in the NHS lack? I assume it means the skills to do deals, generate income, be customer focused, develop partnerships and run the NHS like a business. (It’s interesting that the Department of Health thinks these skills don’t exist in the public sector.)

In which case, the proposed stint at Harvard that recruits would undergo would provide a very appropriate opportunity to study the American healthcare system at close quarters.

Confronting reality

After returning from Harvard, what can the successful candidates expect to discover about life in the public sector during a six month placement at an NHS trust? That decisions are not made solely on the strength of the business case? That the NHS is a federation of organisations that don’t always cooperate or coordinate? That ethical leadership is not just desirable – it’s expected in the public sector?

This isn’t retail; you won’t get away with putting 90 per cent of staff on zero hours contracts in the NHS, or refusing to recognise trade unions.

A familiarity with game theory could be extremely useful in understanding what’s going on around you and why people don’t always behave in their mutual interest. And the local authority adult social service department may be a small cousin, but it’s going to be increasingly relevant as integration of services and joint commissioning becomes a reality.

Beyond business decisions

Closing a hospital isn’t simply about economics. Rationing services might be a logical way of meeting increasing demand with a limited cash budget, but it’s a vote-loser. Even trying to control the drugs budget by insisting on the use of generic equivalents is rejected by GPs instating their clinical independence.

It is mutually beneficial for NHS trusts and local authorities to cooperate but duplication, demarcation and arguments over funding responsibility have characterised the relationship ever since the NHS was established. Trusts and the services they provide might be expected to be competitive, but hospitals can’t be allowed to go bust, nor can they be allowed to pick and choose their customers. 

These cultural differences will mean recruits from the private sector don’t find a long term home in the public sector. However, a stint in the NHS will be considered very advantageous by private sector companies trying to win NHS contracts.