It takes a considerable amount of coordination for a business to be productive in industry, and even more coordination for an entire industry to be considered mature and efficient. So what happens if producers fall—or are pushed—out of practice? Supply chains need to be reestablished, business relationships reforged, neglected production capacity must be brought back online, and so on. It takes time. Not surprisingly, the English government takes this all for granted.

In a speech to the National Health Service¹ Confederation Conference, NHS Chief Executive Sir Nigel Crisp boasted of the impact his agency has had on the "external world":

"The first external confirmation that we were changing came from the private healthcare sector. For years their business plans had been based on growth as patients left the NHS. This growth stopped as the NHS improved. We have had the interesting spectacle of the private sector closing down and selling some hospitals as they revised their plans to match the reality."

In other words, according to Crisp, the dismantling of healthcare provider resources in the private sector is a "win" for public health.

How quickly things can change. This speech was given on June 19th, 2005. This week—just nine months later—the 54-year old announced he will be taking early retirement after it emerged that the NHS is facing a budget deficit on the order of £800 million ($1.38 billion). It has also been sussed out that things are getting worse, not better. Adjusted for population, if the United States instituted a similarly-performing health service, the deficit would be nearly $10 billion.

Incidentally, The Economist² notes of Crisp that "only a few months ago, his stock was so high that he had been in the running for the top job in the civil service." Of course it would be; that was before the numbers came out, before anyone could tell how poorly the NHS was doing. Private companies can tell how they are stacking up against their competitors week by week and day by day.

The NHS monolith, with its worsening performance, should be dismantled, not preserved. But this is not happening. Crisp, though sacked from his office, has been given life peerage and will no doubt re-emerge with his hands in something else. If the NHS were to be halted, and private producers are called back into action, the transition would be costly and disruptive in the immediate term. But within just a few months, England's healthcare system would be on track to becoming the envy of the world.

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¹ According to the official history of the National Health Service (NHS), the system was "set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay."

² The Economist, "Grappling with deficits," March 9 2006

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