The Black Hole
Peter Morris
November 1, 2024
I do wonder why successive Governments are consistently under the illusion that throwing more and more and yet more money at the NHS will solve the problem of waiting lists and an abysmally poor service – and no, that’s not directed at hard working doctors or nurses. Or Ambulance crews either for that matter.
Chancellor Rachel Reeves has just announced a huge increase in NHS funding but doesn't it require someone to step back and have a close look at exactly where what is a stunningly huge amount of money is going to go? What it's being spent on, and why?
It’s not hard to find out what the billions the NHS gets (regardless of which party is running the country) is spent on; Diversity and inclusion managers, numerous executives and a whole shed load of underlings. What do these people actually contribute to patient outcomes - actually not very much, if anything, and it's indefensible.
Procurement for example - why does the NHS pay exorbitant money for basic drugs like Paracetamol? Stuff we can all buy locally for 16p. Maintenance people come in large numbers for every job including the most mundane tasks like changing a light bulb. Or other simple jobs that pretty much everyone could do themselves. The same applies to looking after buildings; the NHS pays vastly inflated costs to do pretty basic stuff – as any competent builder will point out.
The NHS commissions artworks to display in hospital foyers and pays a big salary for a Director of Art to oversee this.
Yet financial excess seems never to be questioned, least of all by governments who are quite content to keep throwing billions at the NHS, an appallingly badly-managed organisation. It really has become the proverbial black hole.
The 1997 government of Tony Blair swept to power with a substantial majority on the back of Tory in-fighting (who says history doesn’t repeat itself?) and it was that government which enabled big changes to the way the NHS is run. It included new contracts for GPs, paying front-line Doctors more but allowing them also to work fewer hours. Blair’s reforms closed many smaller hospitals and concentrated services in big mega-hospitals on one site, sites that were often not centrally located and thus harder to reach for patients.
And significantly, recruiting large numbers of senior managers to run those massive new hospitals - most of them by the way were not new but were additions to existing hospitals. But more than that, to pay for it, Blair’s government introduced PFI, which enabled local NHS trusts to keep the debts off their balance sheets but still left them with huge amounts to pay on those new structures.
In 2017 my colleague here at KJM Today, Kevan James, published a book, ‘Comments of a Common Man.’ His book was updated in 2018 and again with Edition 3 in September 2019. In the book, Kevan devoted an entire chapter to the NHS along with healthcare, and it’s worth reading for that alone.
With his permission, here are some extracts:
‘There are large swathes of the UK where cataract operations continue to be rationed to save money; the blind stay blind. There are parts of the UK where the acronym NHS stands for ‘No Hope Service’. People can wait for hours, lying in the street in agony after an accident, waiting interminably for an over-stretched and under-staffed ambulance service to respond and show up.
Get sick or have an accident in the wrong part of the country and you have one foot in the grave.
The NHS, overall, is undergoing something of a crisis. Yet the problem is not new. In the late 1990s, I was at a sports centre which had as one of its activities, a five-a-side football league and a player was severely injured, suffering a broken leg. The centre staff, although being qualified and able to offer first aid, were limited by Law in what they could do as this was clearly a case for an ambulance and fully qualified medics. So the call was made – attendance was estimated at something over an hour as the nearest available ambulance was some fifty miles away on another call…
Yet next door to the sports centre was the local ambulance station, complete with one fully kitted out and serviceable ambulance inside. Just no crew to use it - neither Labour nor the Conservatives have been able to do what is really needed with the NHS and there is more to it than simply throwing money at it. As illustrated with our injured footballer (and a huge number of others in everyday situations) the NHS is struggling to cope.
Under Labour, some hospitals became places where infections became rife as they were dirty and not cleaned properly. Why were they not cleaned properly? There were no cases of hospital infections (and deaths) under the Conservative government that Tony Blair’s Labour replaced in 1997.
Labour can brag about how much it cares for you and the NHS as much as it wishes to, and as much as I may be sorry to disavow you of your much cherished aversion to the Tories, the fact remains that both political parties are guilty of mucking things up. It isn’t and never has been only a Conservative thing.
Under Tony Blair, the massive spending spree on the NHS between 2001 and 2007 was a perfect example of how it should not be done - most of it went on salaries for the suits and higher prices charged by suppliers, not treating the sick.
As well as ensuring value for money and correct spending, also properly accounting for that spending, there are three further things the Government must do.
The first is to educate the young properly, free of ideological distortion and bias, and include the concept that a career in medicine is an honourable one, one that will be amply rewarded both in terms of salaries and otherwise, even though it means a lot of hard work studying and learning first, then working hours of the day not found in other, less demanding professions.
The second is to stop trying to score political points off each other and blaming the other side for the ills that have befallen the NHS. Hold your hands up, admit you got it wrong and both Labour and Tory have made a mess of it. Take the NHS out of Government control and have it run by an independent commission, which puts health above and beyond any political consideration. The commission’s primary members must be those who know what it takes to run a medical service – Doctors, Surgeons, Nurses; people at the sharp end and ordinary people, those who either have or might need to actually use it. Not politicians or political appointees.
The third is this – bin the bureaucrats. Dump the extravagantly over-paid ‘Chief Executives’, along with the levels and levels of ‘Management’ below them. Chief Executives run businesses, not hospitals and healthcare. Medical people run hospitals and healthcare. The bureaucrats see their job as cutting costs, not delivering treatment.’
I couldn’t have put that last bit better myself.
© Peter Morris, 2024
Book extracts © Kevan James 2017-2019
Image - James Veysey
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Comments of a Common Man Edition 3
Published in September 2019
Still available via Amazon £9.99
Unlike Peter I do direct criticism at Doctors and Nurses. When I see them proposing strike action to get rid of wasteful management I may be more supportive.
Kevan James