Doctor No

One of the lessons that should have been learned from attempts to inject private sector capital and expertise into state industries in the UK over the past decade and more is that outsiders brought in to shake up a business rarely know more than the people who already work there. The railways cost more to run than they ever did when they were in public hands; PFI-based IT schemes in all parts of the public sector go wildly over budget, or don't work properly, or both; a wackjob plan to privatise military training went so far over budget that it was finally killed off by the new Government; and so on and on.

By and large, professionals know best how to do their jobs, and at first glance that seems to be the principle behind the Government's announcements today on public sector reform. There's a problem, though: in the biggest public sector entity of all, the National Health Service (the larget civilian employer in Europe), the professionals are warning that the Government's proposals could spell chaos.

The essence of the Government's plan is to abolish the so-called "Primary Care Trusts" that operate hospitals and provide other health services in each area. Instead, consortia of general practitioners will be given control over local budgets and allowed to commission hospital and other services, ostensibly in response to patient demands. There may well be some entrepreneurial types among them, but surely if all of these GPs had really wanted to be small businessmen all along, they wouldn't have bothered with all of that expensive, exhausting and icky medical training.

The NHS unions are predictably opposed to all this, but what's more striking is that the professional bodies, including the BMA and the Royal College of Nursing, are also sounding alarms. Given that doctors and nurses usually can't find a way to agree on what day it is, this should give the government pause. Empowering people against their own better judgment is unlikely to prove a successful recipe for NHS reform.