Discontent and rebellion all around as the Tory led coalition government continues to force through legislation to turn the NHS into a Health Care business. The public sector is not a business it was set up to serve the whole community it was not required to make a profit, to break even or show a good return for investors. The NHS was established to ensure that people received the best medical care irrespective of their circumstances because good health care was considered a right not a privilege or something that had to be earned. As medical science has advanced and life expectancy increased the cost of the NHS has risen. Successive government have tried to control the costs of the NHS and persuade voters, tax payers and patients that the NHS does not have an open budget.

First like other sections of the public sector managerialism was to be introduced to the NHS with the aim of making it more businesslike. The new manger class were to introduce changes that would make services more efficient. Ways of doing things from the world of business were to be introduced like bench marking, performance targets, customer care, staff engagement and annual appraisals but most important of all tight budget controls. Mangers were to ensure the medical and care professionals stayed within their budgets.
The costs continued to rise. The assumption persisted, despite the lack of evidence, that the NHS was inefficient. What made business efficient? Competition. Therefore that's what needed to be introduced to the NHS. The internal market was tried basically getting different bits of the NHS to compete with each other. It didn't work because at the same time as section of the NHS were being split into providers and commissioners they were being required to cooperate and better coordinate. So if an internal market doesn't work then open up the market so that others can compete for providing health care.

And that's where we are today. As the health care professionals can't be persuaded that these changes will lead to a better service or won't lead to a worse service new organisational structures will be imposed to transform the NHS
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These reforms are no more likely to succeed than previous one as they don't have the support of the majority of health professionals; they place an emphasis on competition when the increasingly fragmented health system requires co ordination and co operation and they break a political promise not to mess with the NHS.

Blair McPherson author of Equipping managers for an uncertain future published by Russell House http://www.blairmcpherson.co.uk/