Hospital ownership

It was no surprise to read that the ownership style of NHS providers has had little impact on productivity except where owners could cherry-pick their clientele ( JRSM 2008;101:59–62). 1 Health care has many facets. There is no universal panacea. Ownership of the hospital service started with compulsory purchase, followed by rationalization in the form of asset stripping and land sales with doubtful benefit to the local population except where centralization enabled the provision of new buildings which were fit for purpose. The notion that the NHS has to pay its way ignores the fact that it was set up as a national charity (funded by compulsory donations), not a bucket factory. The fiscal fallacy was that an overall improvement in the health of the nation would ultimately lead to a reduction in demand. Free lunches typically generate appetites where previously there had been none.

Ownership should mean more than just possession of the freehold. It should embrace the desires and aspirations of the workforce and generate pride and passion for the service provided. Whilst wastage and financial exploitation should be guarded against, the ethos ‘free at the point of access’ should remain untainted. Changes aimed at making the service more effective need to focus on the patient, not the purse. Where this leads to more efficient budgetary management, that is a bonus, not a prerequisite. Foundation status is unlikely to change anything other than ownership style unless all participants – including management boards – are subjected to the same ‘place of residence’ membership criteria. It is obscene that directors should be able to make health care decisions applying to others knowing that they and their relatives would not have to endure the defects which they have imposed on the service.

Historically, changing ownership or the logo has merely allowed managers to indulge in musical chairs.

Footnotes

Competing interests None declared