# A Royal Charter for the NHS? **URL:** \ **Category:** Great Debates\ **Created:** [August 21, 2012, 7:18pm UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197 "2012-08-21T19:18:39Z")\ **Posts on this page:** 8\ **Page:** 2
**Author:** ![Ximenean](https://avatars.discourse-cdn.com/v4/letter/x/aca169/32.png) [@Ximenean](https://boards.straightdope.com/u/Ximenean)\ **Post date:** [August 23, 2012, 8:54pm UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/21 "2012-08-23T20:54:50Z")
> [@Mangetout](#): > > True, but that’s a fairly trivial factor. I also don’t have any choice in the question of where Edinburgh is sited, but multiple operators can run trains on the same tracks. But the monopoly nature of the track means that there are high barriers to entry for train operators, so that in practice there is little competition between them. It’s not like road, sea, or air traffic, where there is plenty of room and free access for competing companies. Well, relatively free access. ---
**Author:** ![Mangetout](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mangetout/32/19_2.png) [@Mangetout](https://boards.straightdope.com/u/Mangetout)\ **Post date:** [August 24, 2012, 12:30am UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/22 "2012-08-24T00:30:10Z")
> [@Ximenean](#): > > But the monopoly nature of the track means that there are high barriers to entry for train operators, so that in practice there is little competition between them. It’s not like road, sea, or air traffic, where there is plenty of room and free access for competing companies. Well, relatively free access. I’m fairly sure constraints of similar difficulty impinge on the notion of privatising the NHS - at least, if the plan would be to try to carve it up into businesses, rather than just trash it and start over from scratch - it’s a single interconnected, interdependent web of services. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [August 24, 2012, 12:55am UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/23 "2012-08-24T00:55:19Z")
> [@Mangetout](#): > > Well, sure, the destinations are fixed (and so’s the track), but any number of different carriage companies could offer competing services on the same or similar routes, or part thereof (in fact, that’s pretty much how it was supposed to work when it went ‘private’). > > Hospital services aren’t so very different - a city is probably not going to have an unlimited number of hospitals and when you accidentally sever your own foot in a freak golfing accident, you’re probably not in the mood for shopping around. Maybe that’s not so true for non-emergency cases, but at the moment, we already have choices if you don’t like the standard service (in the same way that, if you don’t like the train options, you can fly, drive, bus, cycle, etc instead). No, hospital services have some fixed amount of monopolistic characteristics too - but health insurers don’t. If rail had some sort of mechanism where you could buy your tickets to Edinburgh from whoever, but they all got you onto the same train, that would be a similar scenario… but that business model doesn’t yet exist. ---
**Author:** ![Mangetout](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mangetout/32/19_2.png) [@Mangetout](https://boards.straightdope.com/u/Mangetout)\ **Post date:** [August 24, 2012, 6:06am UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/24 "2012-08-24T06:06:40Z")
> [@Really\_Not\_All\_That\_Bright](#): > > No, hospital services have some fixed amount of monopolistic characteristics too - but health insurers don’t. If rail had some sort of mechanism where you could buy your tickets to Edinburgh from whoever, but they all got you onto the same train, that would be a similar scenario… but that business model doesn’t yet exist. Actually, it does. Some trains work that way in the UK. Not many, but there’s no particular reason for that. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 24, 2012, 11:51am UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/25 "2012-08-24T11:51:30Z")
Among other fallacies, your friend characterises the NHS as, “the second-biggest spending department – with a bloated £100bn budget and employing a quarter of all public sector workers,” as if that’s all they are, just a cost center of the “public sector” and thus as something ripe to be cut. It’s also bizarre to see someone complain about poor-quality care the breath after characterizing NHS as “bloated.” NHS appears statistically to be the most efficient system in the world; perhaps it’s not too expensive at all, but a little too cheap in treating, say, mental illness? Also, I find his use of “dead hand” strangely erroneous. Surely he’s complaining about the very live hand of ministerial intervention? It scares me that so many Britons in a position to do something about it think they need more competition in the provision of health care, like they think they’re missing out on some great quality of care that France or Germany has. ---
**Author:** ![Ximenean](https://avatars.discourse-cdn.com/v4/letter/x/aca169/32.png) [@Ximenean](https://boards.straightdope.com/u/Ximenean)\ **Post date:** [August 24, 2012, 6:18pm UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/26 "2012-08-24T18:18:16Z")
Anyway, I don’t see how the BBC is an appropriate model for the NHS. The reason the BBC has its independent status, and its funding mechanism that goes direct from viewer to the BBC, is that any broadcaster worth having should be free to comment on issues of the day, whether it’s through news programmes, or things like drama and satire. A healthcare service such as the NHS has no use for this kind of editorial protection. And since we taxpayers pay for the NHS, I think it’s right and proper that our elected representatives can “interfere” in its operations. Some of us may disagree with the way a particular government runs the NHS, but then we can exercise our rights and vote for some other party at the next election. ---
**Author:** ![Mangetout](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mangetout/32/19_2.png) [@Mangetout](https://boards.straightdope.com/u/Mangetout)\ **Post date:** [August 24, 2012, 6:53pm UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/27 "2012-08-24T18:53:54Z")
Well, one way in which the NHS could be like the BBC is _divorce from profit motive_ - you still have budgetary limits on what you can do, but you’d be doing things because they are measured to be _a good and appropriate part of the service you deliver_, rather than _capable of generating fat shareholders_. Except… the NHS is actually already similar to the BBC in this way. ---
**Author:** ![Ximenean](https://avatars.discourse-cdn.com/v4/letter/x/aca169/32.png) [@Ximenean](https://boards.straightdope.com/u/Ximenean)\ **Post date:** [August 25, 2012, 10:09am UTC](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197/28 "2012-08-25T10:09:53Z")
I’m afraid I don’t see what you’re getting at. This debate is not about whether the NHS should be run for profit. There are various that publicly-funded organisations can be funded and run. I’m saying that I don’t see why the NHS would be better if it were run in the same way as the BBC is, since the two organisations serve completely different purposes and are subject to different economic and political pressures. I mean, why does the OP’s friend pick the BBC? Just because it is an admirable organisation? Why not NASA, or the Salvation Army? It seems arbitrary. [Previous page](https://boards.straightdope.com/t/a-royal-charter-for-the-nhs/632197.md?page=1)