Comment Mr Milburn's prevarication underlines doubts about franchising

Published: 07/02/2002, Volume II2, No 5791. Page 17

Time is up for the chief executives of the six no-star trusts given three months last September to rescue their organisations from performance ignominy. As HSJ went to press, health secretary Alan Milburn's decision on their fate was expected imminently. Will he, will not he open management of these trusts to a franchise? And will he or will not he make those franchises eligible to tender by the private sector?

Mr Milburn appears to have blown alternately hot and cold on the idea over a period of months. Late reports suggest he is currently cold, only days after appearing hotter than ever. At this late stage, the betting has just about closed, with the smart money backing one or two franchises - open only to NHS managers - and four of the chief executives left in situ.

No very stark 'redefinition' of the NHS there, then. So has it all been a tease to keep any lurking public sector 'wreckers' or 'small 'c' conservatives' on their toes? Has the vehement reaction of Labour colleagues - not least former health secretary Frank Dobson - forced a tactical retreat? And does private sector management remain on the longer-term agenda?

In truth, early adoption of a private sector solution for any of the ailing no-star six was only ever a remote possibility. So radical an idea needs longer to embed itself in the public consciousness if it is to escape frostbite and one day bear fruit. Concerns about private sector involvement in other policy areas are in any case now such live issues that the Cabinet would surely be extremely cautious about needlessly aggravating an already inflamed problem at this point. But it will no doubt remain, a weapon waiting to be primed, in Mr Milburn's modernisation armoury.

Press coverage of the concept continues mostly to miss the point about private sector management. Independent hospital companies do not, indeed, have experience of running large acute trusts, but it is not from them that private sector managers would come. They would more likely be former NHS managers grouped in consultancies, who by virtue of now being independent of the NHS would work to a different framework and so be better able to catalyse change. That, at least, is the theory. Much detail remains to be filled in. It appears we may have to wait a little longer to find out if it will work in practice. l