i can issue 5

Going private

Professor Karol Sikora

What does private medicine mean to you? Fat-cat consultants, broad pin stripes, fancy waiting rooms, posh receptionists, elitism and unfairness? Yet already up to 60% of the work of NHS hospitals is privatised Ì hotel and cleaning services, car parking, security and agency nurses. Can we leap over the final ideological hurdle and actually get the NHS to buy care from the private sector? We could then empower patients to be their own fundholders – choosing where they go and adding new services they wish to buy or insure against.

The NHS is a wonderful institution. But it's outdated, bureaucratic, stifling to innovation, impossible to manage and highly charged politically. At its outset it imposed a militaristic structure, arising from the last war, onto a disparate series of semi-religious institutions providing charitable care for the poor. Just think of the names of the famous London hospitals – many named after saints. Now we are in a Stalinist era: collaboratives, modernisation agencies, frameworks and commissioners.

Sure, there is more money going in – and we are paying for it through the nose in higher taxes. £503 million pounds extra is supposedly being spent on cancer care this year, although if you look at the Department of Health website the delay from referral to treatment is actually rising steadily. And aspiring to treat cancer patients within 62 days of referral (the aim for 2005) is laughable by European standards, where patients get started the next week. There's a lot of propaganda about waiting lists, clinic referral times and new targets for cancer but there is still so far to go. Dedicated front-line staff are continually frustrated by ill-conceived initiatives that are not really doing much to improve the service they actually offer.

In every other walk of life service has improved dramatically. Buying car insurance, getting a telephone or just going shopping can be fun. Staff are empowered to use their initiative if things go wrong. The NHS needs to get out of a rut and into a modern service culture, making all patients valued customers.

The only way to do this is to remove the political baggage. Just look how successful the hospice movement has been here – developed outside the NHS and now the envy of the world. Turning to the private sector to invest and run things innovatively while UK Health (my favourite to replace the NHS) regulates and pays for the service simply makes good sense. Consumerism gives power to the people – not the bureaucrats.

Karol Sikora
Professor of Cancer Medicine at Imperial College School of Medicine, London and special adviser to HCA International in creating the largest cancer care network in Britain outside the NHS