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PT and the Greater Good

The Private Sector

Published January 25, 2011 10:50 AM by Dean Metz

The new changes coming to the NHS include requiring greater competition. What that means is the NHS must start using private companies and contractors to supply services and not rely solely on its own provider services. There is a company called "Connect" that has already established a foothold here in northeast England. They have taken over the knee service (yes, there are separate services for each body part or diagnosis) at our local primary care center.

I'm wondering how the NHS is going to adapt to the changes proposed by Prime Minister Cameron. I don't think well at all actually. The employees are used to being civil employees - nearly impossible to fire, replace or lay-off. That has, I'm sorry to say, bred a sense of laziness in many individuals, which only brings down the whole organization.

I'm going to investigate the private sector and see if the mindset there is more like what I was accustomed to in New York. Are they running real businesses or civil services? The more I interact with general practitioners, the more convinced I am that they will not be able to handle the billions of pounds they will soon be charged with. I also think this is actually part of the plan; to let them fall on their faces so they can be replaced with private enterprises.

The NHS won't disappear, but I suspect it will become more like Medicare and Medicaid. The actual provision of services will be contracted out but will continue to be paid for through the national insurance.

Let's see if my suspicions are correct.


Yes, it was clear that you were talking about some.  I hope I didn't infer all postal employees were bad.  Just like you said, there were those who took advantage of the system and those who did the right thing even when consequences for poor performance (or nonperformance) were removed.  For some, their performance is its own reward.

It does seem like there should be a happy medium - a way to combine the best of both systems while eliminating the problems of both.  Your experience and expertise certainly give you the perspective to be the one to make that breakthrough.    

Janey Goude January 26, 2011 5:19 PM

I hope I made it clear that SOME individuals have become lazy, I do work with some really fantastic people (who share Janey's and my work ethic).

We had a discussion about this at home last night and the ethical question about the US and the UK health systems. In the UK, society has made a moral choice to provide health care for all in a public service capacity. Kudos for the morals of universal health care, moral problems with clinical servants who abuse the system. The US has made a moral choice to use a market place health care system. Kudos for advancing innovation and clinical skills, moral problems because many can't afford it and must go without. I really don't think one is BETTER than the other, but I wonder if one could combine the best of both whilst eliminating the worst of both.

I guess that's why I'm back in school, to find that out.

Dean Metz January 26, 2011 12:58 PM

I guess civil employees aren't so different an ocean apart.  My grandmother worked as assistant to the Postmaster for over 40 years.  She didn't retire.  She was on sick leave when she passed.  Sick leave that she had never used.  She had over a  year and half of sick leave in her bank.  She had another year plus in her vacation time bank.  The woman had one of the strongest work ethics I've ever seen.  The only reason she was taking leave then was because she couldn't see.  A blood clot behind one eye rendered her temporarily blind, which revealed a cataract in the other eye that allowed only partial vision.  

I can still hear her complaining about the sorry employees the system bred.  The employees would reach a certain point and they knew they couldn't get fired, so they didn't work.  They showed up, took breaks, ate lunch, and cashed their checks, but did little else.  You could write them up, but you couldn't fire them.  Kind of like our education system today.  Teachers can complain about the kids' behavior, but they aren't allowed to discipline them.

When consequences are removed, there is no incentive to do the right thing.   Because often not only is there no consequence for poor behavior, but there is also no reward for good behavior.  Only those with a strong inner moral compass will rise above.  It's when you find out what people are really made of.  

It will be interesting to see how the UK fares.

Janey Goude January 26, 2011 3:03 AM

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About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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