COMMENT: Clarification, please, on 'franchising', which continues to baffle

We at HSJ have been wondering for some months what 'franchising the NHS' might mean - is this simply a new soundbite or does it disguise a genuine policy initiative? It seems that the latter may be the case, though it does not appear to be a policy that has involved substantial consultation or discussion with those working in the service. The Times and Mirror were among those briefed on what the future might hold for NHS management, though it appears that managers themselves have not been afforded that courtesy.

HSJ first referred to 'franchising' in May when it became clear that the health secretary did not regard the private sector as a panacea for the ills of the NHS. Since the Institute for Public Policy Research commission report reiterated the idea this week (or did it come up with it in the first place? ), Alan Milburn has been telling anyone who will listen that private is not necessarily better and that the talents of NHS managers need to be developed and employed across the whole service. As HSJ said when the concept of franchises first emerged, the prospect of creating new challenges for the best NHS talent and the dissemination of good practice is one to be welcomed.

But it is still not clear how any of this might actually work in the real world of trusts and health authorities. With traffic-lighting just weeks away, the Department of Health needs to be seen to be offering solutions, not simply pointing a finger at those not doing well enough.

Harnessing the skills of both public and private sectors to help make the 'bad' bits of the NHS better may be appealing, but there are currently far more questions than answers. And management flying squads could take the best - and the key - people away from their jobs, running a very real risk of diluting a limited pool of talent and making it much harder for the successful trusts to stay that way. There is also a danger that the teams will be seen as elitist, or as 'hit squads', by the trusts they are intended to help.

Anyone who has attended management courses knows that their teaching is predicated on a single principle: for change to work, it is essential for staff to 'buy' into it. Without involving those on the front line and keeping them informed, it will fail.

No one would deny the need for change in the NHS; nor would anyone dispute that there are some very good parts of the NHS from which others can learn. But once more a plea must go to the DoH for more transparency and discussion rather than allowing Whitehall thinking to slip into the pages of a (usually) friendly newspaper in a bid to avoid negative headlines elsewhere. Let us have debate, and let the people in the NHS be part of the decision-making process about their future - and that of the service in which they have opted to work .