A lot of people want the NHS to be a public service. I’m one of them. We don’t want it broken down into a whole bunch of private contracts. That costs money, fragments services and diverts attention away from health and towards profits.
There is a big benefit from running the NHS as a public service. The people who work in it are keen to deliver high quality medical treatment and are more motivated by being part of a genuine service. Making profits for some faceless company doesn’t motivate them.
Much the same things apply in education. While I believe it’s best to arrange schooling through local government, a crucial development would be to remove politics from the education system so far as possible. Constant change and arbitrary targets are causing stress for teachers and questionable benefits for pupils.
In both health and education, politicians feel bound to introduce targets. But as soon as you target one thing, it is inevitable that something else is downgraded. Changing the targets just causes disruption.
Yet people do get to know whether schools or hospitals are performing well. Multi faceted reviews have value, but people should be free to pick and choose how they judge performance. They don’t need politicians forcing arbitrary measures on them.
It’s argued that organisations stagnate without competition. And it’s assumed the only kind of competition is some sort of marketplace. Neither of these is true. It is possible to have a learning organisation, one that is constantly striving to be better, constantly looking critically at itself.
For this to work, we have to recognise that people throughout the organisation have worthwhile things to say. Wisdom doesn’t all reside in the people who regard themselves as being at the top. Most people know from their own experience that there are lots of talented people with good ideas at every level.
To have the best health system and the best education system we need to run them as public services, run by people who are committed to excellence. They need to be collaborative and responsive. Hard to achieve? Yes, but immensely worthwhile.