. . . on the way to where - exactly? The pitfalls are only too clear

Published: 24/01/2002, Volume II2, No. 5789 Page 19

At the end of the long road on which the first step is to allow private sector managers to run NHS hospitals under franchise, lies the prospect of all health service provision resting in private hands. While healthcare would remain free at the point of use for all according to need and regardless of means, the state would no longer own or operate the facilities in which it was provided.

For sure, there are many twists, turns, dead ends and meandering byways before this destination looms into view, and reaching it is no foregone conclusion.

But the route is now marked on the map in a way it was not previously. Whether ministers will seek to force a way along it will depend on the success of their multifarious other reforms.

What they hope will happen is more modest. Frustrated by the slow pace of the cultural change which they identify as key to modernising the NHS - and still distrustful it will happen at all - their ideal would be for private managers, free of public sector baggage, to be drafted into a few troublesome places and for them to be seen to make a massive difference. Everyone else would then raise their game or risk being ejected by such shock troops - or so the thinking goes. It is, after all, what happened in the prison service.

The crucial difference is the intense public scrutiny and anxiety under which the NHS operates and prisons do not - plus the ability of powerful staff groups to exploit it. Ministers beware.