Monday, July 15, 2024
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Who’ll stop shovelling billions into the NHS money pit?


IN a rare example of a politician telling the truth, Wes Streeting, the shadow Health Secretary, has stated what everyone outside the Westminster bubble knows, namely that the NHS is broken and that fixing it requires it to be treated ‘as a service not a shrine’. Predictably the Labour Party doesn’t like this and (of course) neither does the British Medical Association or the Royal College of Nursing.

The organisations which should be most concerned are the Conservative Party and, to a lesser extent, Reform.

I was at a Spectator health summit a couple of weeks ago, where we were addressed by Steve Barclay, the Secretary of State. With strikes looming and Amanda Pritchard, the lavishly paid NHS Chief Executive, more interested in the clothing of menopausal nurses than delivering health care, I had hoped to hear him set out what this latest Conservative government proposed to do to fix the mess. Not a bit of it. In a speech which could have been written by the NHS Confederation (a NHS mouthpiece whose paying members ‘cover the full range of organisations that plan, commission and provide NHS services in England, Wales and Northern Ireland’ – that is, they are funded by the public who fund NHS services) he wittered on about the wonderful advances that new drugs, technologies and, inevitably, Artificial Intelligence will deliver. There was no vision of structural reform, just more shovelling money into the bottomless pit.

I fear that the reality is that no one in the NHS machine is interested in reform and no one in Westminster has a clue how to deliver it – although Wes Streeting has taken the first step by accepting that there is a problem. As a TCW writer pointed out in October, NHS management are largely a self-serving coterie who seldom appoint from outside, although they are compelled to advertise, not least to justify their substantial pay. Let’s face it, a hospital is essentially a hotel (beds, food) with some top-notch room service (operating theatres, A&E, ICU). A general practice is directly analogous to a vet’s. An ambulance service is a cross between the AA and a taxi firm. So why is it that the NHS hires so few outsiders? Presumably because its Stalinist management structure is so opaque and its administrative language and budgetary provisions are massively complex. (This is an organisation which has to employ diversity officers on more pay than nurses or midwives to meet its ‘performance’ targets.)

Gillian Tett is the Financial Times journalist who broke the story of the (then) imminent collapse of the CDO (collateralised debt obligation) market which broke the banking system. In her excellent book Anthro-Vision she explains how, as an anthropologist not a financial rocket scientist, all the briefings on CDOs and their incomprehensible jargon put her in mind of a tribe building a religious belief system rather than a group of risk management professionals dealing with reality. I fear it’s the same with NHS management – in all the departments and acronyms they’ve lost sight of their purpose.

Of course, NHS reviews are hardly new. Unfortunately they generally follow the same process: announce the review, appoint a committee and hire some consultants. Then reorganise – no easy task in an organisation with 1.4million employees. Then wonder why it didn’t work. It’s noteworthy that when Lord Weinstock took over the bureaucratic nightmare that was the General Electric Company his first acts included abolishing all committees, firing all consultants and closing all meeting rooms. The company’s turnover rose from £100million in 1960 to £11billion in 1996. (That’s a 100-fold increase, the sort of growth that the denizens of Westminster can only dream of). It might be time to get radical with the NHS.

This is where the Reform Party come in. They have a costed, viable health policy (unsurprising since their deputy leader is a doctor). To achieve power they can’t rely on disaffected Tories (although they have already increased their polling to be number three, ahead of the Lib Dems). Wes Streeting has put solving the manifest shortcomings of the NHS into political play (as opposed to the usual, incorrect, parroting of ‘Tory cuts are to blame’ – which ignores the fact that health spending has risen every year). For sure much of the Labour Party will hate Streeting’s line. The party is in hock to its union paymasters which include Unison and Unite – the non-medical healthcare unions – and throwing money at the NHS has become their core belief. Indeed it’s already started, Labour MP Sam Tarry among the first to lob brickbats.

But here’s the thing. The public know something is badly wrong and that neither main party has a credible solution. The disaffected ‘Red Wall’ Tory voters may well think it’s time to try something different, not least because they are also Brexit seats.

Buckle up – it’s going to be a roller coaster ride up to the next election.

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Patrick Benham-Crosswell
Patrick Benham-Crosswell
Patrick Benham-Crosswell is a former Army officer who has spent the last 30 years in commerce. He is the author of Net Zero: The Challenges, Costs and Consequences of the UK's Zero Emission Ambition. He has a substack here. He is the Reform Parliamentary Candidate for Swansea West.

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