Privatising Values

Stephen Pattison

Stephen Pattison, Professor of Religion, Ethics and Practice at the University of Birmingham, and former Visiting Fellow at the Centre for Medical Humanities, offers the following observations on the current proposed NHS reforms:

I’ve just returned from a well known, privately-owned franchised coffee bar that my institution has decided is better than employing its own staff.  The said coffee bar is slow, unresponsive to my needs to return to my desk, over-crowded, under-staffed and run by (probably under-paid) people who appear to take little pride in their work and no interest in the needs of their customers.  And it is enormously expensive!

The private sector is often lauded by politicians (paid from the public purse themselves!) as a model of efficiency, effectiveness and dynamism.  The present health care reforms in England are thus seen as an important step in making these values available to the tax-paying public.  But is there a danger of falling in love with a myth here that may in fact see the erosion of some of the real ‘big society’ values that we should rightly treasure?

My experience of going to conferences of health care professionals is that they are falling over themselves to provide ever more comprehensive and sensitive services, driven not so much by cash as by a real desire to be use to people and to improve the public health.  Even the much abused managers turn out to be old softys in this regard, as I found when I and a colleague interviewed 25 senior managers with clinical and non-clinical, private and public sector backgrounds (See S Pattison and J McKeown, ‘What are the values of NHS managers?’ in Pattison et al, Emerging Values in Health Care (2010).  Once in the health service these people just don’t seem to be able to resist becoming altruistic and centrally concerned with the public and individual good, including a need to see the value of equity as central to health care.  And lest you think that this study is an aberration, lots of others, including those conducted by Julian Le Grand himself show alarming levels of altruism in the public sector!

Sometimes, I could even wish that health care professionals were less altruistic as if anything they seem often to expect too much of themselves in the way of sensitivity to local and individual needs.  Is it really fair of me to expect every health care professional to understand and respond to my ‘spiritual needs’ whatever they may be when what I need more than anything else is a good plumbing service?  And I sometimes worry that in our quest to humanify health care with medical humanities, we might forget that if people don’t get incontinence pads, engagement with the arts should not perhaps be the priority that we would all hope it can be in the interests of providing holistic health.

Of course, not all NHS staff are ‘wonderful’.   Stafford Hospital shows that some (Perhaps particularly those who are most besotted with markets and competitition?) are positively bad for their own and others’ health.   But be that as it may, in the next couple of years thousands of formerly NHS managers and clinicians, steeped in public service values of the kind I have discussed will find themselves, willy nilly, working in the private sector or unemployed.  This may make a difference to the private sector, and judging by my experience in the coffee bar, it would be nice if it did.  But it is certainly going to affect the mood, mode and delivery of health care services and the overall moral and value climate of the nation as a whole.  As I contemplate my next 15 minute wait to get an over-priced coffee from a group of surly staff whose managers’ eyes are firmly fixed on profit not service, I wonder if we are about to lose more than just a supposedly over-staffed and under-motivated bureaucracy….

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