Many objections to NHS reform centre on the threat of cherry picking by the private sector: the idea that private companies will select just the easiest cases to deal with, leaving the harder ones to the NHS.
They will ...
Private firms will cherry pick. Indeed, that is rather the point: you get improvements in efficiency (that is, improvements in quality and reductions in cost) only where you traverse the learning curve. And you traverse the learning curve fastest where there is the biggest volume. So the first you'll cherry pick are the routine procedures, where there is a large volume of relatively standard cases. And, since you are competing with firms doing the same thing, you are going to be driving down costs by innovating. And since you're going to get whopping fines if you mess up, you'll take measures to assure quality throughout the process.
But who will deal with the complex cases? Well, that is another specialism. Just as there are bookkeepers and management consultants, so you'll see lots of small/medium firms making a modest living out of routine work and a few large firms (or NHS hospitals) making a lot of money out of complex cases.
And if GPs and other care professionals hold the budget, then they should be motivated to ensure routine cases are treated before they deteriorate into complex cases. In fact, they should be motivated to prevent healthy customers from deteriorating into routine cases in the first place. (But only if they are so incentivised.)
Transition will be difficult. As Rheum points out, cherry picking removes revenue from acute trusts and will expose the true cost of the remaining cases they deal with. Transparency is a good thing, but inadequate accounting procedures will mean this exposure is not predicted and not addressed by the funding authorities. So acute trusts are at risk of running their engines without oil. Some will grind themselves into dust as a result. Their resources (and patients) can then be absorbed by the better managed trusts or emerging private operators.
But who will deal with the complex cases? Well, that is another specialism. Just as there are bookkeepers and management consultants, so you'll see lots of small/medium firms making a modest living out of routine work and a few large firms (or NHS hospitals) making a lot of money out of complex cases.
And if GPs and other care professionals hold the budget, then they should be motivated to ensure routine cases are treated before they deteriorate into complex cases. In fact, they should be motivated to prevent healthy customers from deteriorating into routine cases in the first place. (But only if they are so incentivised.)
Transition will be difficult. As Rheum points out, cherry picking removes revenue from acute trusts and will expose the true cost of the remaining cases they deal with. Transparency is a good thing, but inadequate accounting procedures will mean this exposure is not predicted and not addressed by the funding authorities. So acute trusts are at risk of running their engines without oil. Some will grind themselves into dust as a result. Their resources (and patients) can then be absorbed by the better managed trusts or emerging private operators.
Will transition prove too difficult? That, it seems to me, is the right question.
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