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Editor's blog 12th November 2008: The CMO and the sovereign customer

Chief Medical Officer Professor Sir Liam Donaldson has been on the receiving end of a touch of criticism from certain quarters of the medical profession. Some people question why Professor Sir Bruce Keogh was appointed to the DH  as Medical Director in an apparent rivalry. Others have relentlessly criticised his involvement in the MTAS / Modernising Medical Careers fiasco.

His public profile has been low over the past 18 months, which makes his new column on the BBC News website (www.news.bbc.co.uk/1/hi/health/7698151.stm) all the more surprising. The column itself proposes that the NHS needs to be more like the John Lewis Partnership, treating the customer as king.

There are a couple of interesting thoughts in this, though not the ones Sir Liam seems to be selling. The first is about mutual ownership - the arrangement of JLP. Its local staff have a direct and personal interest in the organisation's success. They share in bonuses. They are partners in the organisation. I do not imagine that Sir Liam thinks this model is likely to be allowed to break out in the running of NHS services. The glacier-like progress of social enterprise in the sector also gives this the lie.

Secondly, a key feature of the JLP is 'Never Knowingly Undersold' - they compete with the rest of the market on price as well as quality. As the NHS moved towards more professional financial management, there were legitimate reasons to avoid competition based on price - previous research has shown the problem of this approach.

Reforms to the tariff are meant to be moving towards normative pricing, and the BMA has accepted the principle of the ending of the Minimum Practice Income Guarantee (MPIG). At the end of the current comprehensive spending review, the NHS will be facing financial pressures whose like it has not experienced for years.

Healthcare is not shopping
Customers of a shop have different motivations to customers of healthcare. The information assymetries between the sellers and buyers are grossly weighted in favour of the providers. Data on services provided is retrospective and often of little use.

So healthcare is not shopping. But if we want the NHS to be more responsive and personal, it is going to be necessary to consider the radical changes this will involve.