Published: 02/09/2004, Volume II4, No. 5921 Page 18

Allyson Pollock's new book claims the NHS has been betrayed. She may be right on PFI, says Kieran Walshe, but her attacks on NHS managers do her arguments a disservice and will alienate supporters NHS plc

The privatisation of our health care By Allyson Pollock Verso,£15.99

There is nothing like having a good rant for clearing the airways and blowing away the cobwebs. And across 271 well-written pages, Allyson Pollock and her co-authors offer just that, on the current state - and alleged terminal decline - of the NHS.

The first page starts in characteristic vein. The NHS is now run by 'senior managers... with no training or experience in public health or the principles of healthcare delivery: arts graduates of all descriptions, ex-army officers. . .

former chocolate and biscuit manufacturers'.

You might think this is grossly insulting, tendentious nonsense and stop reading right there. And I wouldn't blame you if you did. Professor Pollock, based at University College London, has a knack for alienating potential supporters.

But I would encourage you to read on.Despite the paranoid moments and ill-aimed diatribes, there is some excellent, well-researched stuff in here.

For example, she argues at some length that the private finance initiative has been a very expensive, bureaucratic and inflexible way to get new hospitals built. I think history is likely to prove her right. The government has paid a very high price for shifting NHS capital spending off the public balance sheet, which has really been the whole purpose of the enterprise.

The dubious rationale that the private sector could build and operate facilities more efficiently has long been discredited. Little if any risk seems to have been transferred to the PFI consortia, and PFI hospitals are already tied into decades-long contracts which are very expensive to vary.

But Pollock portrays NHS managers as having pushed through PFI deals (and bed number reductions to make the affordability sums add up) with enthusiasm. The reality was (and is) that, if you wanted to get a major capital project built, PFI was the only game in town.

I also largely agree with her about the risks of encouraging for-profit companies into the mainstream of NHS provision.

She maps out the way that Labour's approach to the private healthcare sector has swung from an unhealthy Dobsonite 'private sector is the last resort' view to an equally unhealthy na´ve enthusiasm for international forprofit providers who often have rather dodgy records in their own countries.

She takes some pleasure in detailing UnitedHealth Group's record of multi-million dollar fines for overcharging and other offences in nine different US states since 2000, and the jailing and fining of vice-president Michael Mooney for insider trading. But there are no nuances in her analysis, and no acknowledgement that the private sector might do some things rather well.

This is the fundamental problem with the book.

Professor Pollock is not really interested in complex shades of grey. It is a 'four legs good, two legs bad' analysis.

She ignores anything which might possibly contradict her thesis that the 1948-style NHS was a socialist nirvana of universal, free healthcare and equality for all and that the NHS in 2004 is being taken over by satanic forces of global profit.

As far as she is concerned, Labour's record since 1997 is one of betrayal and decline. All its achievements in putting the resourcing of the NHS on a sound footing for the first time, giving patients faster access to treatment, and tackling the dominant self-serving power of the professions are either not mentioned or discounted.

By making her analysis so one-sided, she undermines her own contribution to the policy debate, and makes it pretty unlikely that this book will change anyone's mind about anything.

Kieran Walshe is professor of heath policy and management at the Manchester Centre for Healthcare Management, University of Manchester.