The Nationalised Hospital Service (NHS)

Managers in nationalised industries will likely keep their jobs and can hope for promotion if they

1. Meet their targets (so their bosses are happy)
     
2. Suppress bad news (so their ministers have a good story to tell). One of the techniques managers use is smothering complaints.

Note two points about this model. First, customers don’t necessarily matter. Satisfying customers may not intrude, unless it’s been included in the targets. Mid Staffs, part of the Nationalised Hospital Service, killed hundreds of people but met its targets. Its managers failed to suppress the bad news – but only because Julie Bailey resolutely campaigned with a small determined band of people.

Second, nationalised industries tend to be big. The bigger the organisation, the safer employees inside it are likely to be. The bigger the organisation, the more complex it is, and the harder it is to challenge, from the inside or from the outside. The Nationalised Hospital Service is like a fortress.

How to stop nationalised schools and nationalised hospitals getting away with mediocrity?

• First, give the people who will use the service a choice of where to use it. Socialists disparage this as competition. But they are putting the providers of the service above the people who use it (and pay for it). Children and patients are the reason why we have schools and hospitals. Children and patients are more important than teachers and doctors.
    
• Second, set targets which reflect the core of what the nationalised industry is there to deliver, and publish the results.
    
• Third, find a challenging, messianic insider to lead inspections of schools and hospitals. In the case of schools this is Sir Michael Wilshaw, and good for him. In the case of the Nationalised Hospital Service it must not be one of the established bureaucrats, it must be someone who has been improving and leading an excellent hospital. It’s not their background that matters, it’s their performance.

All nationalised industries need strong, relentless management. The Nationalised Hospital Service hasn’t been getting it.

So thousands die who shouldn’t.