Monday, 18 January 2010

Buses, Taxis and the NHS

Medical School Interviews are inevitably scary; one common question is to ask about the makeup of the NHS, which sometimes lead to a discussion about the future of the NHS and the involvement of the private sector. This can be tricky for people, you need to weigh up the pros and cons of the private sector in medicine and avoid pissing off the consultant who is interviewing you - they might get a significant portion of their income via private patients.

One analogy to start with is the bus and taxi scenario. Queues of people are waiting for a bus, but there are too many people for the bus pending. A few people in the queue get together and pay for a taxi. Everybody wins! The people who get the taxi get to their destination on time and the rest of the people in the queue get to travel by bus. Except the bus driver then decided to go and work as a taxi driver

It seems that patients who need the NHS are becoming like the people waiting for a bus, where the driver has gone over and become a taxi driver. At the moment the private sector is getting the better deal over the NHS

Now it seems medical students may need to learn the pros and cons of franchises. Hinchingbrooke hospital is being lined up to be run by one of five private companies. The aim of a private company is to make a profit to give to shareholders etc. The bottom line when talking about the private sector is that any money a private company does not have to be spent on patients is seen as a good thing, whereas in the NHS any money left over can be used to improve treatment or pay for more nurses etc (or at least in theory)


  1. It's not Addenbrookes that is being offered up for private ownership but Hinchinbrooke hospital in Huntingdon. There has been talk for a long time of closing this hospital because of its large budget deficit but closure has always been considered impossible because of the impossible additional burden that this would put on hospitals in Peterborough and Cambridge. Waiting lists would increase significantly at these hospitals and the government's 18-week target would not be met.

  2. Very true - corrections made

  3. The other similarity between healthcare and buses is that if you are waiting for a bus you do not shop around. You get on the first bus that comes along. And you do not quibble over the price. It will be much cheaper than a taxi and if the ticket is a bit steep there is no way you will wait for a competitor's bus. Unfortunately our masters have a blind faith in markets even though it is clear from examples like this that they have major limitations.