Margaret Thatcher agonised for a decade over how to improve quality and
efficiency in the NHS. Finally, she appointed hospital chairmen who had succeeded in the outside world, and gave them real freedom to compete with each other in an “internal market”. Meanwhile local GP practices excercised customer choice in purchasing hosptial care on behalf of their
patients. Just as this began to produce results, she was gone, and senior
officials lost no time convincing her (Conservative) successors to neuter her whole reform in favour of the top-down civil service controlled NHS we
Politicians will huff and puff about improving the methodology of
hospital inspection. They should do better to remember that the success of
any organisation requres first competition, desire to match or better the
performance of ones rivals combined with fear of the consequences of
failure and second, visible and inspiring leadership. The NHS struggles to
serve the public good without the benefit of either.
History provides few examples of organisations whose quality or efficiency
have been improved by bureaucratic exhortation from above.
Chairman 2020 health
83 Victoria Street London SW1H OHW