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'From fanaticism to barbarism is only one step' - Diderot

Thursday 3 September 2009

What was the point of getting consultants to report on the NHS?

Before we get on to discussing the consultants' report on the NHS, a preamble. I find it pretty bizarre that any employer, in this case the British government, pays out good money (our money of course) for an external consultancy firm to provide recommendations for the NHS. Particularly a Labour government. How likely was it, do you think, that a Labour government was ever going to accept a report from a firm such as McKinsey? Did the government think McKinsey might recommend staff increases?

The NHS is apparently the largest employer in the world. Many people (and politicians wanting to get elected) are happy to trot out the mantra, as Health minister Mike O'Brien does:

"... In core frontline services like maternity, nursing and primary care we need more staff rather than fewer."

- without then going on to look at the obvious corollary: what's to happen with levels of non-frontline activities. Quite the contrary! In the sentence immediately preceding the one I quote above, Mike O'Brien opines:

"The government does not believe the right answer to improving the NHS now or in the future is to cut the NHS workforce.

So what, according to you Mr O'Brien, is the right answer? Bearing in mind that the government brief to the consultants was to "come up with proposals for how savings could be made". There is silence from Mike O'Brien on this vital matter, except to put the kybosh on the whole report thus:

"Ministers have rejected the suggested proposals in the McKinsey report and there are no plans to adopt these proposals in the future."

OK, so another tens/hundreds(?) of thousands of Pounds of our money down the drain! No surprise there then, that's what this government specialises in - squandering money it does not have.

The context of this ridiculous exercise in self-delusion is electoral politics - no politician has the courage (whether in the governing Labour Party, or the likely future government of the Conservative Party) to state the obvious - that much of the waste that is said to exemplify the NHS is a function of its chronic over-manning, not its under-manning! Of course it needs to become 'more efficient' rather than simply indulge in yet more job-creation for the sake of it and think that this will solve the underlying problem, which is people working less-efficiently than they should be. For Gawd's sake, what planet do these people live on? No, the real reason for this determined myopia is that with a country mired deeply in recession and with an election inevitable within 9 months at the maximum, and with official unemployment figures already already rising rapidly (the 'dsguised' unemployment is already much greater and has been so for many years) the last thing an unpopular government needs is to accept a report which plans for an increase of 137,000 in unemployment numbers - for who else, even if there were not already a recession, would be likely to employ many of these people?

The whole mind-set which has blighted healthcare politics in the UK for decades is summed-up in these ridiculous statements from two of the 'unions' who effectively dictate to the Labour government (and in various ways to other political parties, too, in rather blunt terms) how this country's healthcare has to be run to avoid them 'cutting-up rough'. First from the self- acknowledged union, Unison, whose head of health, Karen Jennings, says:

"The McKinsey report comes up with the same old formulaic answers and their much-repeated mantra of job cuts as the answer to NHS savings.

"There is no room for complacency in the NHS. We must constantly look for new ways to be efficient and to deliver better patient care."

- fair enough, in her first sentence she trots out her ideological objections to reducing employment levels, that much I understand, although I disagree fundamentally of course. But what does the obfuscatory second sentence mean? It seems to me to be trying to say a lot when it actually says almost nothing, other than that Ms Jennings is skilled in the art of meaningless verbiage masquerading as intelligent commentary.

Now on to that other 'union', the British Medical Association (BMA) which, despite its name which [deliberately?] suggests it is some kind-of quasi-official body is in fact a professional 'trade' body designed to protect the interests of medical practitioners of one kind or another as well as enforcing professional standards as the price of admittance to the 'club'. On the one had it does a lot of good, but ignore at your peril its naked self-interest on behalf of its members in other ways. At least Dr Mark Porter of the BMA is being intellectually honest when he stated clearly its official position:

"If implemented, these short-sighted proposals would have been disastrous.

"We welcome the commitment given by the government that it has rejected them and does not see workforce cuts as the solution to the challenges facing the NHS."

This brings me to a question that I have for many years asked about the NHS. Does the National Health Service exist to provide medical care to the British people, or is its principal function to provide employment to the 1.3 or so million people employed by it? Of course even I would agree that the answer to this question has to be a combination of both to a certain extent, but I give definite priority to its basic function being to provide health services, whereas the 'unions' (and politicians, whether ideologically supportive or coerced by the electoral realities of a benefits-addicted electorate) seem to think it is basically a glorified 'make work' scheme.

John Appleby, chief economist at The King's Fund, basically talks about 'tractor production figures':

"I don't really see the necessity for actually cutting jobs, but I certainly do see the necessity for employees and the NHS overall to find new ways of working, being more productive, being more efficient."

However, Sir Gerry Robinson, a successful and apparently wealthy businessman, sums the whole issue up:

"You wonder at the mindset behind getting a report like that and then saying because it is not politically acceptable, we are not actually going to do anything with it," he told Radio 4's Today.

"It's infuriating, the way the government handles the NHS and the way the opposition handles the game that gets played."

As he says, he saw an "enormous amount of waste" and [felt that] jobs should go (when he presented a BBC series about the NHS), saying that he was "infuriated" by yet another report, which cost a lot of money and "tells you the obvious". Quite!

Welcome to Britain and its crazy healthcare politics.


  1. Excellent piece, Bill, which asks the right questions. It's so difficult to see how the bureaucracy can realistically be reduced.

  2. Thanks, James .... maybe the original Guy Fawkes had the right idea? ;)

  3. Having worked for the NHS, used its services as a patient and carer and been a Highland Health Councillor I have seen the Service from many different perspectives.

    My opinion, and it is just that, formed from the sum of my personal experiences and upbringing is; when I was ill I was glad of the care; when I was a carer I was grateful for the support; when I was a Health Councillor I saw the system at its best and worst.

    What we must ensure is that decisions on the future of the service are never be taken by people who can never imagine tnemselves suffering pain, loneliness or distress.

  4. Hello APTSec

    I think most would agree, me included, that the NHS performs many things well, but it is nowhere near perfect, and the solution is not simply to go on pumping more money into it and to further increase its already bloated personnel levels.

    As for your final remark - most people, me included (and I've no doubt Sir Gerry Robinson, too) have either suffered "pain, loneliness or distress" themselves or have close members of their families who have at some time. To be honest I do not see the purpose of making statements like this (unless it is to try and close down discussion of reform of the NHS). 'Faceless bureaucrats' (i.e. the folks who actually run the NHS as currently organised) are just as likely, in my experience, to be unfeeling about the needs of individual clients/patients as any health insurance company or other entity which might become involved in helping to manage healthcare services in this country.

    I have lived in other countries which, frankly, have better public healthcare services than the UK and are much more responsive to the individual needs of those they are there to serve, ill people. Labour and the vested interests of the unions and BMA need to realise they do not have a monopoly on good ideas for the NHS - indeed they seem unwilling to contemplate anything but more personnel and more 'investment' (i.e. putting more money into a system which is crying out for root-and-branch reorganisation).

    I am just very grateful that I can afford private health insurance, including the spiteful health insurance tax imposed by Labour to show its disapproval of free-thought and free-choice amongst citizens in healthcare. It was only very recently that the prohibition on patients funding their own medication not approved by NICE was relaxed to allow them to continue to enjoy complementary NHS-provided service, for which they already pay through their taxes, after substantial public protest. This symbolises much of what is wrong with the closed thinking which blights rational discussion of healthcare issues in this country.


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