The Queen Elizabeth Hospital, Birmingham, is destined to have a special place in the annals of the 2001 election campaign after Sharron Storer buttonholed prime minister Tony Blair about the treatment of her partner, a cancer patient there.
Faithfully recorded by the cameras, it was every trust chief executive's nightmare, and every prime minister's - reminiscent of the famous encounter during the 1983 election when Diana Gould of Cheltenham bearded Margaret Thatcher on prime-time TV about the sinking of the Belgrano, leaving her tongue-tied and floundering.
Ironically, Mr Blair could have mounted a reasonable defence to Ms Storer's complaints, and the hospital later went on to do so. But the encounter will remain a memorable one for him, maybe even a formative one. For it will be endlessly replayed, reinforcing in his mind the message that the government's reform programme has raised expectations about the NHS which it is still a long way from delivering. Though they have always acknowledged that change would take time, ministers may find the slow pace increasingly hard to live with.
Popular perceptions that the service is decrepit are producing a huge running sore in the body politic, rendering the government vulnerable to all sorts of infection. Mr Blair's drubbing at the QEH may remind him of those famous scars on his own back, and confirm his suspicion that the public sector is immune from change.
Hence the sudden wild talk of inflating the private sector's role in the NHS, floated by a think-tank but not denied from Number 10 with any vigour. We predicted this development last autumn when the concordat was launched: 'Whatever the current caveats, formalising the relationship in this way fosters the possibility for the private sector to expand its role in providing or managing services for the NHS in the future.
The concordat may prove to be one of the most important measures in the whole of the NHS plan. '
But it is hard to believe the Department of Health - where managers' stock seems currently high - is quite so enthusiastic about what the private sector has to offer the NHS as Downing Street and those who pay court there. The private sector can do limited things very well on a limited scale in limited circumstances. It is a myth that it contains a wealth of managerial knowledge and expertise lacking in the public sector.
The NHS, on instructions from its political masters, has flirted periodically with private sector techniques for more than 15 years. The late 1980s witnessed an influx of private sector managers who came, saw and mostly left promptly, professing admiration for the calibre of the NHS's home-grown managers. If recruiting managers from outside the service is the intention once again, Number 10 ought to look at some back issues of HSJ for the full story. We would be happy to send Mr Blair's health policy adviser, Robert Hill, a reading list.
A more constructive way forward than chasing a myth would be to capitalise on the talents of public sector managers to improve standards across the service - not ordering in private sector teams to run red-light trusts, but harnessing the skills of the best NHS teams to help the not-so-good do better. That would create opportunities for the keen, dynamic modernisers and help spread good practice. The principles are already in operation, to a degree, in clinical governance reviews, secondments and mentorships. There is everything to be said in favour of supporting existing management talent. The Leadership Centre and the newly announced University of the NHS will hopefully do much to develop it further.
But concerns remain. The thinking behind such an approach would be quintessentially New Labour - harnessing talent, developing opportunities, but with undertones of centralisation and control, suggesting only the 'on-message' would be rewarded. The huge number of factors besides the team at the top should never be forgotten - demographics, recruitment, history. All can contribute to a service succeeding or failing. And using the human resources within the NHS to make it better should never distract from the fact that financial resources are at the heart of high standards of care.
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