Skip to content

The continuing fear of two-tier healthcare

Comment on BMJ:

So we are back to the tiering argument when NHS tiering is common: waiting lists, regional variations, etc. But the tiering in provision is exacerbated by the failure to use purchasing that is agnostic to ownership.

Clearly, public capital investment is not the only game in town but it is hampered by the Treasury’s rule book. Drawing in private capital generates additional capacity from these providers — all capacity is good capacity.

Workforce implications here are important as NHS workforce planning has a failing track record. If we solve the problem beginning with workforce capacity to meet whole system healthcare needs (how much of what expertise is need for the manifest demand for care), we can then be more open about what arrangements for provision are needed (how those demands are met by what organisational arrangements for that expertise). Indeed whole new innovations in delivery of care emerge.

It is just the NHS is constrained (think Goldratt) and always trying to solve the wrong problem. FWIW.