Will giving hospitals private help improve the service?

The best of Britain's hospitals could be given the power to manage their own affairs, health secretary Alan Milburn will announce on Tuesday.

Managers will be given complete independence and will be able to set staff pay and conditions and bring in private teams. Although they will be subject to national standards and external inspections.

Mr Milburn described the NHS as Britain's "last great nationalised industry", with patients expected to be grateful for what they received. But he said, "that model is untenable for the 21st century. The NHS has to grow up and be part of this century rather than the last."

But will the ability to bring in private help actually help the NHS or will it lead to two tiers of hospitals? If you work in the NHS do you welcome such new powers? If you or your family use the NHS, what difference do you think this new move will make to your treatment?

This debate is now closed. Read a selection of your comments below.

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Your reaction

This latest policy is surely an attempt to devolve the blame of failure away from the government.

David Murray, UK

As an NHS employee I can see the fire through the smoke. This latest policy is surely an attempt to devolve the blame of failure away from the government. Have they realised that they cannot possibly deliver on their promises? It would have taken strong leadership to put the NHS back on track and this policy does not address the underlying fundamental problems inherent in the NHS management structure. I am disappointed on behalf of the British public; once again self service comes before public service.
David Murray, UK

Many comments here criticise the idea of private management, but not a single one proposes a workable alternative. The NHS is a shambles and despite vast increases in funding over the last 20 years (yes, the Tories did increase funding by well over inflation) the NHS has shown itself incapable of sorting out it's own problems. Carrying on as we are now is just NOT an option, so if you don't want private management, suggest a better idea!
Bernard, UK

Perhaps the NHS should have less lofty goals ... in other words, make access to "free" medical services available for emergencies, routine preventative maintenance, all children under 18, and the elderly (defined). Everybody else would need medical insurance that should be made compulsory (like car insurance). I am not saying I have all the answers here, but it's a place to start.
Mark M. Newdick, US/UK

Please, no more managers. The NHS is supposed to be a SERVICE not a business. Rather than managers, ask nurses and doctors what they need to improve the service. I believe that the bottomless pit approach should be stopped. GPs know which of their patients are swinging the lead, stop these people wasting valuable time. As a working person, I only take time off if I'm really ill yet am told I can't get an appointment for two weeks! Ridiculous. Time to slough off all those time and resources wastrels - give old people, children and genuinely ill people a chance.
Wendy, UK

The major issue within the health service is the continual re-organisation

Ian, UK

I spent twenty years working in the NHS as a Nurse. I watched as Tory governments gradually ran down the service in order to privatise it. I am now disgusted to see a Labour government finish the job. The major issue within the health service is the continual re-organisation and failure to address the issues. You can shuffle the pack as often as you like but until additional funding is available nothing will improve. The nation must choose whether it wants an NHS - with the additional tax this will cost - or whether they want a private insurance scheme. The latest bright idea from Milburn will only lead to more problems.
Ian, UK

I am sad to hear that the UK government now thinks it is OK to put hospital management out to private tender. I worked in a London NHS hospital for 10 years with my section managed by the private sector.
By definition the private sector is about profit and low cost efficiency. It is time for the NHS, and health services around the world, to return to the "care" model, whereby the hospitals and services are managed on a clinical need basis, and not just how many people we can treat for the lowest possible outlay. Medical and nursing advances have benefited all sections of our community, now is the time for doctors, nurses and the community to reclaim the health service from accountants, lawyers and CEO's
Malcolm Tulett, Australia

I have a disability which prevents me from working and thereby excludes me from having the choice of private health insurance, as it is absolutely unaffordable for anyone surviving on benefits. Also, if I regain enough good health to return to work no insurance company would cover me for the disease causing my disability, so if the NHS is privatised completely would someone like to suggest where I should go for my healthcare then? At present I receive adequate care from the NHS which was paid for by me, my father, and his father - and at what stage of the privatisation process will National Insurance contributions become "optional" or non-compulsory ? Has the government given any consideration to how much money it will lose without them?
Simon, England

People are responsible for their own health

Jane, Brit ex-pat

I am a registered nurse trained in the UK. The NHS is a shambles. As an example, women who have a Pap smear test can wait up to 6 weeks for the results. I opted to go private and at a cost of twenty pounds had the results within a week. People are responsible for their own health and if you cared for your own health you would get out of the NHS and go private.
Jane, Brit ex-pat

Look at our great railways! Need I say more?
Martyn, UK

I worked for many years as a nurse and I am disgusted at the government. Too many high paid managers justifying their existence by making life unbearable for ward staff is the last thing the NHS needs. Moral is already low and many nurses I know are leaving the profession not just because of pay but also because of working conditions. Every government's only answer to the NHS is more managers, more rules, more cash flow problems and more paper work. The last people to get anything out of the system are the patients and workers. Do not let the NHS go the way of the railways, ask the nurses, and patients. No more managers, enough is enough.
Marga-Rhett, England

It's a great system until you become ill

John Koss, USA

I get very nervous when I see the word private associated with national health insurance schemes in other countries. Come see the mess here in the USA. We spend the most on health care and are privileged to receive ongoing payment refusal notices from insurance companies. It's a great system until you become ill.
John Koss, USA

Another bright shining idea which will soon be forgotten again.
Richard L, UK

The government is continually criticising the Tory party for suggesting a public sector/private sector mix for the provision of health care. Surely this latest "initiative" is exactly that.
Paul B, Oxfordshire, UK

It makes about as much business sense as privatising the railways

Lloyd, UK

Bringing private company managers into the NHS makes about as much business sense as privatising the railways! Just think for a minute - highly paid private managers coming into a failing trust. Just think what that will do for the overworked and underpaid administration staff and that is aside from the badly neglected nursing staff. Ye Gods! What ever will this government think of next?
Lloyd, UK

Nice one, New Labour - finishing the job that Thatcher started.
Patrick, London, England

Labour abolished Grant Maintained Schools because they said they didn't work. Aren't they now suggesting we have a grant maintained NHS?
ST, UK

As a shareholder within The Private Medical Industry, I can only see this as a huge step forward. Our sector will inject some quality into the NHS along with creating a much more efficient service. Who knows, it may even assist in strengthening the UK economy with an increase in successful shareholders taking more interest.
Mark Blackburn, London, England

Those managing it need to be able to structure the organisation as they see fit

Steve Harrison, UK

In normal business situations, companies are free to structure their business as they see fit. Some functions they keep in-house, some they sub-contract or outsource depending upon the circumstances and the economics of the situation. This allows the business to be run in the most effective and efficient way possible.
For the NHS to run efficiently it needs the same freedom. Those managing it need to be able to structure the organisation as they see fit, using public and private resources as appropriate. To impose restrictions based upon dogma or tradition guarantees a less than optimum organisation, regardless of the level of ability of management.

The NHS must be doing this to some extent already. I assume that they don't manufacture their own furniture, surgical instruments or pharmaceuticals in-house for example.
Just because the goals of the NHS are different from those of a profit-making plc doesn't mean that the same skills and techniques shouldn't be used to manage it.
Steve Harrison, UK

As someone who worked for many years in the NHS as a nurse, I can say without reservation that getting private managers in to revamp the system is an appalling idea. More managers on huge wages will not cure what ails the NHS. Why do governments never think to ask those who work in the system? The sector I worked in had 4 managers and one lone porter, and the powers that be still couldn't figure out why patients were always late for appointments!
Kah, Australia/UK

I think what we really need to address is the expectations of the patient. The NHS was set up to give basic medical care to everyone. At that time, people expected to have illnesses treated, and that was that. Now, we seem to spend more and more money on things like fertility treatment which, although deeply upsetting, is not exactly a chronic disability or a life-threatening illness. My partner and I have fertility problems, but don't see why the NHS should finance our desire to have a child. However, NHS patients are seeing what private patients are getting, and are demanding the same. This just isn't feasible. I've opted out of the NHS as much as possible by paying (out of my own pocket) for health insurance. I don't earn a high salary, but I think it's worth the investment. That way, I get better service when I need it, and those who can't afford to pay for private health care are on slightly shorter waiting lists.
Denis Williams, UK

Denis Williams of the UK asks why the NHS should finance his and his partner's desire for a child. Fair point. Why should the NHS finance anyone's desire for a child (or not to have a child)? Why not go the whole hog and privatise the entire sphere of reproductive medicine including antenatal and maternity services, family planning, abortions, sterilisations etc except for those who really cannot afford it? Otherwise we are saying that having a child is just a lifestyle choice if you need fertility treatment, but not if you don't. That doesn't seem fair to me.
Jane, Wales, UK

I think the new proposals for bringing in managers from private industry is a great idea, as long as they are skilled people. It will take the business pressures away from the medical staff, who can then concentrate on patient care. The private managers can then concentrate on the business issues, and correcting mistakes made by previous incompetent NHS managers. Why not take advantage of lessons learned from industry to make hospitals more efficient? Can that really be such a bad thing?
Chris, England

Trust managers are modern Neros fiddling while the organisation burns

James, UK

As a middle-grade doctor working in one of the failing "zero-starred" NHS Trusts, I warmly welcome the introduction of a mechanism to replace a failing management team with competent managers with a proven track record. This Trust failed and one only has to spend a week here to realise the depth of bureaucratic ineptitude that caused it. The Trust managers are modern Neros fiddling while the organisation burns. Already hard-pressed nurses and doctors meanwhile are expected to support a failing management. The NHS is the last remnant of Stalinism in Europe and that's why incompetent managers are able to flourish in its dark corridors. It's high time these failures were put out to pasture, experts brought in, and doctors and nurses allowed to get back to caring for patients.
James, UK

The NHS has been shown to be the most efficient health care system in terms of providing value-for-money. The problem now is that it cannot provide the best (often the most expensive) new treatments that patients now rightly demand because we spend far too little of our GDP on health. If the British public want the best health care, then we would all have to pay more, either through taxes or through private/social insurance. There is no such thing as a free lunch in life, I'm afraid !
Dr. D. Chang, UK

The NHS is there when you need it - I know from first hand experience. However, I would suggest that the running of public and private health care side by side is doomed to failure for the simple reason of resources. There are finite numbers of doctors, nurses and all the other medical professionals, so if private care is the way to go, you simply allow those who have the ability to pay to jump the queue for the attention of the same medical professional who would have treated you from the waiting list. From the doctor's perspective, if you were in a position to receive up to four times the money for performing the same function in the same premises, what would you do?

The advances in medical science have made the NHS the victim of it's own success. There are now more people claiming on it than there are paying for it; the majority of the expenditure is on the elderly (let's not get into the debate about administrators and their brand new BMW's ), many of whom would have been dead twenty years ago due to there being no cure or treatment for their condition.

Perhaps a simple and quick ( if cynical ) solution would be to ban private practice for medical personnel for ten years after they have been trained, and to ban all politicians and their families from receiving private care or preferential treatment. The crisis in the NHS would then be solved within one parliamentary sitting!
Chris B, England

Private money is never a compensation for incompetence

Paul, UK

I believe that a hybrid solution of NHS healthcare side by side with private care is an excellent way to provide funding as well as more varied job opportunities for staff at all levels. But I think this plan of the Government is founded on the desire to abrogate responsibility for care, especially in difficult areas. There are clearly inefficient hospitals and regions and there are clearly some very incompetent managers. Private money is never a compensation for incompetence and ultimately if the core disease is not addressed it will keep spreading and taking hold.
Paul, UK

The NHS was set up to provide all UK citizens with a decent standard of healthcare. Frankly, it is presently failing in that respect. If the NHS had been run properly in the first place, we wouldn't be calling upon "private teams" to "help" the service. We should have been pooling and nurturing the best medics in the land to make the NHS the service it was established to be. Sadly, it is a modern day example of gross mismanagement!
Rob Morris, UK

Privatise the whole NHS paid for by insurance premiums and leave a safety net for the people who cannot afford the premiums.
Mark F. Rosenberg, UK

Why is privatisation the answer to all problems with nationalised public services? Are we supposed to believe that there is nobody working for the NHS who can do their job as well as people in the private sector? Privatisation was popular with the Conservative government as it allowed short-term investment opportunities for their city chums; it kept taxes low for the greedy and naive electorate; and it washed the government's hands of complex problems with public services. However, it only improved services where there were genuine opportunities for competition and consequently genuine choice for consumers. It has been a dismal failure with the railways.
Jon, UK

The government has shown no political will to deal with these fundamental flaws

Dr Anthony O'Sullivan, UK

The problem with the NHS is that it was founded on fifty-year old principles that no longer hold true. In the 1940s it was quite possible to provide free health care at the point of need but with advances in medicine that is no longer realistic. What happens is that doctors have constantly to make economic decisions. The pressure is all the more increased with the government reducing everything to the length of the waiting list - with very costly administrators running it all. The government has shown no political will to deal with these fundamental flaws: all it wants is to change things sufficiently to get itself re-elected in four years time by bringing in more costly administrators and committees.
Dr Anthony O'Sullivan, UK

Great idea - yet another layer of overpaid fat cat managers in the NHS should help get rid of a few more thousand unnecessary nurses.
Tim C, UK

As far as I'm concerned, the entire NHS should be abolished. It has been a national disgrace ever since its inception. It's a bottomless pit, bureaucratic and inefficient. Get rid of it once and for all.
Geoff, England

A recipe for an even greater disaster

Eddie, Britain

I think this is the most horrific suggestion that this Government has come up with. It will lead to even more inequality in provision of healthcare. Maybe you will be able to judge which are the better hospitals more openly but will you get a choice as to which you can use or will you, as at present, have to hope that your local hospital is one of the chosen few? This is a recipe for an even greater disaster for the Government than anything they have had so far.
Eddie, Britain

I don't see how private involvement could make things worse. But the proposals don't go far enough.
Richard Ormson, UK

My cat recently suffered a hernia jumping up a tree to avoid a dog. I immediately took him to the vet's, was very pleasantly treated, and the cat was operated on that afternoon. He has made a complete recovery although I did have to pay £100 for the operation. My friend (aged 70) has now been waiting 15 painful months for an operation on the NHS. I am now convinced the only way forward for the NHS is to privatise as much of it as possible by encouraging the use of private medical insurance. It may not be completely fair but it will overall reduce suffering.
Anthony, England