The health secretary's interest in a controversial Spanish model for privately run hospitals is ignoring the real problems facing health service management, according to the NHS Confederation.

This week Alan Milburn visited the 500-bed Fundacion Hospital in Alcorcon - a publicly financed hospital run by a private management team for a set fee, with government power devolved to a board representing the local community.

Its structure is similar to management models adopted in failing schools in the UK where private companies are brought in to turn round performance.

Although the visit is another indication of Mr Milburn's willingness to find private sector solutions to the NHS's problems, confederation policy director Nigel Edwards urged him to concentrate on the 'real' issues.

He said: 'The important question is why are health service organisations so difficult to run?

Simply looking at the private management models is missing the point. One question you would want to ask is who are these private managers anyway?

Like Railtrack, they are no doubt managers who were working in the public sector but now doing it for significantly more money.'

The Spanish model led to shorter waiting times for serious operations and shorter stays, but there have been accusations that it shifted more complex and costly cases back to the public sector.

King's Fund health systems programme director John Appleby said: 'It is not clear where the incentive for management comes from on a not-for-profit model.

There is the possibility of the management group running more hospitals and also the ability to renegotiate their fee.

'The question of ownership . . .

is a secondary issue. From the research it seems that it does not necessarily have that great an impact in terms of efficiency.'