PFI and the NHS: A Case of Misplaced Accountability

The NHS is suffering. I don’t think I really to point that fact out.

I wish I had the solution to fix our woes but instead I despair both as a clinician, trainee, student and strategist.

However, the reason I despair might not be the one you expect. You see I am an advocate of public-private sector partnerships and collaborations. In fact, I believe the future survival of the NHS and delivery of free, universal healthcare will rely on these partnerships. Here’s the the thing though.

Privatisation. It’s a dirty word.

If you believe the vociferous protestations of the medical establishment and leftist establishments you would think that private firms are the grim reaper incarnate here to destroy hospitals whilst taking all our money.

The real problem is neither one of public sector bodies or privatisation rather its one of accountability. Private Finance Initiatives (PFIs) allowed health infrastructure to be developed and maintained by private organisations whilst holding public bodies, chiefly hospitals, indebted to them for vast periods of time. In many ways it’s a rather large, exorbitant mortgage.

And a mortgage by its original French meaning is an ‘engagement ’til death’. How fitting.

So when these PFIs were undertaken who was accountable? Certainly not the doctors and nurses delivering the services on the frontline, neither the departmental managers. Seemingly, not the chief executives or chief financial officers. However, on the flip side the private sector has in many cases done very little wrong. In the majority of cases they have delivered what they agreed upon and are merely collecting their debts.

Who does this leave? Only one answer. Government.

As this was a cross party project I won’t be expecting a shred of accountability to be accepted by any side any time soon. Is PFI an unmitigated disaster? A beautiful dream turned sour in its reality? Probably, yes, for now.

If I had a solution, then I’m sure others would have thought of it too but I can’t help but feel that we can still trust the private sector as long as we define the boundaries in which it has to operate. As long as we recognise that NHS services are unique in their complexity and so require a unique degree of supervision and regulation.

Sometimes, we have to accept an uglier truth. Cuts need to happen, unsustainable services need to be shutdown and workforces cut.

Wholesale, difficult reform and re-structuring has to happen.

Who am I to talk though. I’m sure the boys up at Richmond House have it covered. (I hope)

Agree or Disagree? Tweet me @Saif_Abed

Dr Saif F Abed
Founding Partner
AbedGraham Healthcare Strategies Ltd


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