Full steam ahead?

He was demonised as the surgeon brought in to amputate large parts of the network.

But he was not a surgeon; he was not a medical doctor. He had a PhD in chemistry and had worked for ICI.

He was not a railwayman, as many of those running the railways in those days were. He was a businessman and brought that approach to his task.

His objective was to stop the large losses which were being incurred by British Railways.

But he was attacking a public service, which was held high in affection by the public, rather as the NHS is today. Nigel Lawson called the NHS "'he closest thing the English have to a religion'. But in business terms it, like the railways of 50 years ago, is haemorrhaging money.

Sir David Nicholson, who now heads NHS England, called for ‘efficiency savings’ of £20 billion during the lifetime of this Parliament. But his hands are tied by politicians and public. He cannot adopt the ‘Beeching’ approach.

What the NHS is doing is to bring in a business approach through the private sector to deliver services. It started 18 months ago when Circle Healthcare took over Hinchingbrooke Health Care NHS Trust in Cambridgeshire.

This is not the privatisations of the 1980s and 1990s. But although it may be by the back door, it is privatisation nonetheless. There is a new word for this type of public/private partnership. Francis Maude, the Cabinet Office Minister, calls it ‘mutualisation’ and it is being rolled out across the civil service.

Will it reach NHS dentistry? Maybe. Why should the commissioning of NHS dental services be left in the hands of civil servants, with little or no business expertise, at NHS England. Would it be done more efficiently by a corporate?

Is this why rumours persist that time-limited dental contracts are on the way out? Will the future be one of large regional franchises put out to tender as happens with the railways? Anything is possible, I fear.

By news correspondent, Michael Watson

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